What are the risks of having high testosterone levels?

Risks of High Testosterone Levels

High testosterone levels can lead to several significant health risks, with erythrocytosis (elevated hematocrit) being the most common and potentially dangerous complication, particularly in elderly individuals where increased blood viscosity could aggravate vascular disease in coronary, cerebrovascular, or peripheral circulation. 1

Cardiovascular and Hematologic Risks

• Erythrocytosis (elevated hematocrit) is a common and potentially serious complication of high testosterone levels, with incidence varying by administration route: 43.8% with intramuscular injections versus 15.4% with transdermal patches 1
• The risk of erythrocytosis increases with testosterone dosage - occurring in 2.8% of men receiving 5 mg/day via nonscrotal patches, 11.3% with 50 mg/day gel preparations, and 17.9% with 100 mg/day gel preparations 1
• Elevated hematocrit can increase blood viscosity, potentially aggravating vascular disease in coronary, cerebrovascular, or peripheral vascular circulation, particularly in elderly individuals 1
• The risk of hemoconcentration is greater in individuals with conditions already associated with increased hematocrit, such as chronic obstructive pulmonary disease 1

Prostate-Related Risks

• While there is no compelling evidence that high testosterone directly causes prostate cancer, it may potentially stimulate growth of occult prostate cancer 1
• Benign prostatic hyperplasia (BPH) is a rare but potential risk associated with high testosterone levels 1
• Monitoring of PSA levels and digital rectal examination is recommended for men with high testosterone levels to detect any prostate abnormalities early 1

Other Physical Risks

• Sleep apnea may be exacerbated by high testosterone levels 1
• Skin conditions such as acne can develop or worsen 1
• Gynecomastia (breast enlargement in men) can occur due to conversion of excess testosterone to estradiol 1, 2
• Testicular atrophy and infertility are common with sustained high testosterone levels 1
• Fluid retention may occur 1

Metabolic and Lipid Effects

• Supraphysiologic doses of androgens, particularly oral nonaromatizable androgenic steroids, can lower high-density lipoprotein (HDL) levels 1
• However, physiologic testosterone levels generally show neutral effects on lipid profiles, with most studies showing no change or minimal reduction in HDL, often accompanied by reduction in total cholesterol 1
• Only very high doses of testosterone (600 mg/week, well into the supraphysiologic range) are associated with significant HDL reduction 1

Behavioral and Psychological Risks

• High testosterone levels may increase the odds of engaging in health risk behaviors 3
• Both very high and very low testosterone levels can be associated with depression, suggesting an optimal range exists 4
• Aggressive behavior has been associated with high androgen levels in both men and women 4

Monitoring Recommendations

• Regular monitoring of hematocrit or hemoglobin levels is essential to detect erythrocytosis early 1
• If erythrocytosis develops, appropriate measures include dosage reduction, withholding testosterone, therapeutic phlebotomy, or blood donation 1
• Regular prostate monitoring with PSA testing and digital rectal examination is recommended 1
• Assessment for sleep apnea symptoms should be performed regularly 1

Special Considerations

• The elderly are at particularly high risk for complications from erythrocytosis due to increased likelihood of underlying vascular disease 1
• Individuals with pre-existing conditions that increase hematocrit (like COPD) require extra vigilance 1
• The relationship between testosterone and health appears to follow a parabolic curve, with both very low and very high levels associated with health problems 3, 4