From the Guidelines
A testosterone level of 1800 ng/dL in a 20-30 year old male is significantly above the normal range and can have negative health effects, including increased risk of cardiovascular problems, liver damage, and fertility issues, despite normal laboratory results. According to the American College of Physicians guideline 1, high testosterone levels can lead to adverse cardiovascular events, with low-certainty evidence from 14 trials showing a small increase to no difference in adverse cardiovascular events (Peto odds ratio, 1.22 [CI, 0.66 to 2.23]). Additionally, high testosterone can cause physical and emotional changes, such as acne, mood swings, and aggression.
Some potential effects of hyperandrogenism in this age group include:
- Increased risk of cardiovascular problems, including heart attack and stroke, due to elevated red blood cell production (polycythemia)
- Liver damage
- Accelerated male pattern baldness
- Acne
- Mood swings and aggression
- Testicular atrophy with reduced sperm production, leading to fertility issues
- Potential development of gynecomastia (breast tissue development) due to aromatization of excess testosterone to estrogen
It is essential to note that the body's response to high testosterone levels can vary, and some individuals may experience more severe effects than others. Regular monitoring of complete blood count, liver function, lipid profile, and PSA (in older men) is crucial, even when other labs initially appear normal, as complications may develop over time with sustained high testosterone levels. The guideline from the American College of Physicians 1 emphasizes the importance of careful consideration and monitoring when dealing with high testosterone levels, particularly in younger men.
From the Research
Effects of Hyperandrogenism in 20-30 Year Old Males
- Hyperandrogenism, or elevated testosterone levels, can have various effects on the body, but the provided studies do not directly address the effects of testosterone levels of 1800 in 20-30 year old males with normal laboratory results.
- However, a study 2 found that elevated endogenous testosterone levels are not associated with significant clinical morbidity, suggesting that high testosterone levels may not have severe adverse effects in healthy individuals.
- The same study 2 compared men with elevated testosterone (>800 ng/dL) to men with normal testosterone (300-800 ng/dL) and found that men with high testosterone had similar rates of sleep disorders, urinary symptoms, and depression.
- Another study 3 found that an elevated circulating total testosterone level has a low positive predictive value for androgen-secreting neoplasms, suggesting that high testosterone levels are not always indicative of underlying pathology.
Potential Causes of Elevated Testosterone Levels
- Falsely elevated testosterone levels can occur due to contamination of the phlebotomy site by testosterone topical gel 4.
- Other factors, such as comorbidities (diabetes and chronic renal failure) and failure of the testosterone assay, can also lead to falsely elevated testosterone levels 5.
- Certain medical conditions, such as intracranial germ cell tumors, can cause elevated testosterone levels 6.
Laboratory Results and Clinical Evaluation
- Elevated testosterone levels should be interpreted with caution, considering the potential for false positives and the need for clinical evaluation to rule out underlying pathology 4, 5.
- Laboratory results should be correlated with clinical signs and symptoms to determine the significance of elevated testosterone levels 3, 6.
- Further testing, such as adrenal and ovary morphological assessment, may be necessary to determine the cause of elevated testosterone levels 5.