From the Research
Elevated testosterone levels, such as 1800 ng/dL, in males over 50 can have negative health effects, including increased risk of cardiovascular problems, polycythemia, sleep apnea, and potentially worsening benign prostatic hyperplasia or stimulating prostate cancer growth, despite other lab values appearing normal. These high levels can also cause mood swings, aggression, and fluid retention. The most recent and highest quality study, 1, found that elevated endogenous testosterone levels are not associated with significant clinical morbidity, but this study also noted that men with higher testosterone had increased hematocrit, which could be a concern.
Key Considerations
- High testosterone levels can disrupt the body's feedback mechanisms for controlling hormone levels, potentially leading to testicular atrophy and fertility issues.
- Regular monitoring of hematocrit, PSA, liver function, and cardiovascular markers is essential, regardless of whether other labs currently appear normal, as complications may develop over time with sustained exposure to supraphysiologic testosterone levels.
- Men with naturally occurring testosterone levels this high should undergo evaluation for potential testosterone-producing tumors.
- For men on testosterone replacement therapy who develop levels this high, dose reduction is typically recommended to bring levels back to the mid-normal range (around 500-700 ng/dL).
Clinical Implications
- The study by 1 suggests that the association between elevated endogenous testosterone levels and deleterious effects associated with testosterone therapy may not be as clear-cut as previously thought, but it is still crucial to monitor patients closely.
- The findings of 2 and 3 highlight the potential risks of testosterone therapy, including increased risk of prostate cancer and cardiovascular disease, which should be taken into consideration when managing patients with elevated testosterone levels.
- Overall, a comprehensive approach to managing elevated testosterone levels in males over 50 is necessary, taking into account the potential risks and benefits of treatment, as well as the need for regular monitoring and evaluation.