From the Guidelines
Elevated testosterone levels in males can be caused by several factors, including testicular tumors, adrenal disorders, anabolic steroid use, and certain genetic conditions, and management should prioritize treating the underlying cause while minimizing harm and optimizing quality of life, as supported by recent evidence 1.
Causes of Elevated Testosterone
The causes of elevated testosterone levels in males are varied and can include:
- Testicular tumors
- Adrenal disorders
- Anabolic steroid use
- Certain genetic conditions like congenital adrenal hyperplasia
Management of Elevated Testosterone
Management of elevated testosterone levels depends on the underlying cause but typically involves:
- Treating the primary condition, such as surgical removal of testicular tumors or discontinuation of anabolic steroid use under medical supervision
- Symptomatic treatment with anti-androgens like spironolactone (50-200mg daily) or finasteride (5mg daily) to block testosterone's effects
- Lifelong hormone replacement therapy in cases of genetic conditions to maintain proper balance
- Regular monitoring of testosterone levels through blood tests, with normal male testosterone ranges being 300-1000 ng/dL
- Lifestyle modifications, including maintaining a healthy weight, regular exercise, and avoiding excessive alcohol, to support hormonal balance during treatment
Importance of Supervised Management
Management should always be supervised by an endocrinologist who can adjust treatment based on symptoms and hormone levels, ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life 1.
From the Research
Causes of Elevated Testosterone in Males
- Elevated testosterone levels in males can be caused by various physiopathological mechanisms, including hyperandrogenism and relative hypoandrogenism 2
- Congenital adrenal hyperplasia (CAH) is a genetic disease that can lead to elevated secretion of androgens, resulting in virilizing syndromes and elevated testosterone levels 3
- Testicular adrenal rest tumors (TARTs) are frequently found in male patients with CAH and can produce adrenal-specific steroids, contributing to elevated testosterone levels 4, 5
- Undertreatment or overtreatment of CAH can lead to the development of TARTs, which can interfere with gonadal function and contribute to elevated testosterone levels 4, 6
Management of Elevated Testosterone Levels
- Aetiological investigations are necessary to determine the underlying cause of elevated testosterone levels in males 2
- In patients with CAH, careful management of glucocorticoid medication and monitoring of androgen levels can help prevent the development of TARTs and elevated testosterone levels 4, 6
- Testis-sparing surgery may be necessary to remove TARTs and prevent further interference with gonadal function 5
- Monitoring of serum adrenocorticotropic hormone (ACTH) levels can help predict the presence of TARTs and insufficient hormonal treatment in patients with CAH 6