Normal Variation: A testosterone level of 1187 ng/dL is within the normal range for many laboratories, suggesting that this value may not be pathological but rather a normal variation. This is particularly true if the patient is asymptomatic and has no other abnormal laboratory findings.

Exogenous Testosterone Use: The use of anabolic steroids, which include testosterone, can lead to elevated levels of testosterone in the blood. This is a common issue in individuals who use these substances for bodybuilding or athletic performance enhancement.
Testicular Tumors: Certain tumors of the testes, such as Leydig cell tumors, can produce excess testosterone, leading to elevated levels.
Congenital Adrenal Hyperplasia (CAH): Although more commonly diagnosed in infancy or childhood, some forms of CAH can present later in life and may cause elevated testosterone levels due to adrenal gland dysfunction.

Adrenal Tumors: Tumors of the adrenal gland, such as adrenal adenomas or carcinomas, can produce androgens, including testosterone, leading to elevated levels. These conditions can be life-threatening if not diagnosed and treated promptly.
Pituitary Tumors: Certain pituitary tumors can lead to an overproduction of hormones that stimulate the testes to produce more testosterone, such as gonadotropin-secreting tumors.

Familial Glucocorticoid Resistance: A rare genetic disorder characterized by resistance to glucocorticoids, which can lead to an overproduction of androgens, including testosterone, due to adrenal gland hyperactivity.
Gonadotropin-Independent Familial Sexual Precocity: A rare condition where there is premature sexual development due to mutations affecting the sex hormone production pathway, potentially leading to elevated testosterone levels in males.