From the FDA Drug Label
2.5 Treatment of Primary Hyperaldosteronism Administer spironolactone tablets in doses of 100 mg to 400 mg daily in preparation for surgery. The treatment for high serum testosterone is not directly addressed in the provided drug label, but spironolactone can be used to treat conditions related to high aldosterone levels, such as primary hyperaldosteronism.
- Spironolactone is an antiandrogen and can be used off-label for conditions associated with high testosterone levels, but its use for this purpose is not explicitly stated in the label. 1
From the Research
Treatment for high serum testosterone typically involves addressing the underlying cause, and for men with congenital adrenal hyperplasia (CAH), intensification of glucocorticoid therapy, such as dexamethasone, may be necessary to reduce testosterone levels and improve fertility outcomes, as seen in a recent case report 2. The goal of treatment is to reduce testosterone to a normal range while minimizing side effects and addressing the specific underlying condition causing the elevation.
- For men with CAH, the use of supraphysiologic doses of glucocorticoids, such as dexamethasone, has been shown to be effective in reducing testosterone levels and improving fertility outcomes 2.
- In cases where testicular adrenal rest tumors (TARTs) are present, treatment with glucocorticoids may help to reduce tumor size and improve fertility outcomes, as seen in a study published in the Journal of Urology 3.
- Regular monitoring of testosterone levels and symptom improvement guides therapy adjustments, and the treatment duration varies based on the cause - lifelong for congenital conditions but shorter for reversible causes.
- Lifestyle modifications, including weight loss, regular exercise, and dietary changes, can also help normalize testosterone levels in conditions like polycystic ovary syndrome.
- GnRH agonists like leuprolide may be used in specific cases to suppress testosterone production, but this is typically reserved for cases where other treatments have failed or are not effective. Key points to consider when treating high serum testosterone include:
- Identifying and addressing the underlying cause of the elevated testosterone levels
- Using glucocorticoids, such as dexamethasone, to reduce testosterone levels and improve fertility outcomes in men with CAH
- Monitoring testosterone levels and symptom improvement to guide therapy adjustments
- Considering lifestyle modifications and other treatments, such as GnRH agonists, as needed to achieve optimal outcomes.