From the Research
Treatment for hyperandrogenism in men should focus on addressing the underlying cause rather than directly lowering testosterone levels, with the goal of improving morbidity, mortality, and quality of life. The approach to treating high testosterone levels in men depends on the underlying cause, which could be tumors, adrenal disorders, or medication use.
- For tumors of the testes or adrenal glands, surgical removal is typically recommended 1.
- If caused by congenital adrenal hyperplasia, glucocorticoid therapy such as hydrocortisone (15-20 mg daily in divided doses) or prednisone (5-7.5 mg daily) may be prescribed.
- For anabolic steroid users, discontinuation of the steroids is essential, sometimes requiring supportive care during withdrawal.
- In cases of functional causes, lifestyle modifications including weight loss, regular exercise, and dietary improvements can help normalize hormone levels. Medications like ketoconazole or finasteride are rarely used in men specifically to lower testosterone unless treating prostate cancer or severe androgenic symptoms, as supported by a study on the practical management of testosterone deficiency in men 2. Treatment should always be supervised by an endocrinologist who can monitor hormone levels and adjust therapy accordingly, taking into consideration the potential effects of aromatase inhibition on serum testosterone levels in elderly men with low or borderline-low serum testosterone levels 3. Unlike in women, where anti-androgen medications are commonly used, men typically require treatment of the source rather than direct testosterone suppression, as highlighted in a study on testosterone therapy in men with androgen deficiency syndromes 4.