From the Guidelines
Elevated testosterone in men is clinically relevant as it can significantly impact physical, mental, and sexual health, and treatment may be warranted when levels fall below normal ranges, usually with testosterone replacement therapy (TRT). When considering the relevance of elevated testosterone in men, it's essential to understand the role of testosterone in male physiology. Testosterone is a crucial hormone that affects muscle mass, bone density, energy levels, mood stability, and sexual function. Men with optimal testosterone levels typically experience better overall health and well-being. However, when testosterone levels fall below normal ranges (generally under 300 ng/dL), treatment may be necessary to restore normal physiological functions. The most common treatment option is testosterone replacement therapy (TRT), which can be administered through various methods, including:
- Injections (testosterone cypionate 50-200mg every 1-2 weeks) 1
- Transdermal gels (AndroGel or Testim 50-100mg daily) 1
- Patches (Androderm 2-6mg daily) 1
- Pellets implanted subcutaneously every 3-6 months 1 Before starting TRT, comprehensive blood testing should be done to establish baseline levels and rule out contraindications like prostate cancer. During treatment, regular monitoring of testosterone levels, hematocrit, PSA, and liver function is essential 1. It's also important to note that TRT is not appropriate for all men with low testosterone, particularly those still interested in fertility, as it can suppress natural production and sperm counts. Side effects may include acne, fluid retention, breast enlargement, and potentially increased cardiovascular risks in some populations. In conclusion, elevated testosterone in men is a critical aspect of male health, and treatment with TRT may be necessary to restore normal physiological functions and improve overall well-being.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Endogenous androgens are responsible for normal growth and development of the male sex organs and for maintenance of secondary sex characteristics
Androgens have been reported to increase protein anabolism and decrease protein catabolism.
Androgens are responsible for the growth spurt of adolescence and for eventual termination of linear growth, brought about by fusion of the epiphyseal growth centers.
The relevance of elevated testosterone in men is related to its effects on normal growth and development of male sex organs and maintenance of secondary sex characteristics. Elevated testosterone can also lead to increased protein anabolism and decreased protein catabolism. However, exogenous administration of androgens can inhibit endogenous testosterone release and may suppress spermatogenesis at large doses. Key points include:
- Growth and development: Elevated testosterone is crucial for normal growth and development of male sex organs.
- Protein metabolism: Elevated testosterone can increase protein anabolism and decrease protein catabolism.
- Secondary sex characteristics: Elevated testosterone is necessary for maintenance of secondary sex characteristics. 2
From the Research
Relevance of Elevated Testosterone in Men
- Elevated testosterone levels in men have been associated with various effects, including increased muscle strength and bone density, as well as potential risks such as prostate enlargement and cardiovascular events 3, 4.
- A study published in 2022 found that men with naturally elevated endogenous testosterone levels (>800 ng/dL) had similar rates of sleep disorders, urinary symptoms, and depression compared to men with normal testosterone levels, but had higher hematocrit and liver enzyme levels 5.
- Testosterone replacement therapy has been shown to be effective in relieving symptoms in hypogonadal men, with the selection of treatment method depending on patient preference and physician advice 6.
- The use of finasteride, a 5α-reductase inhibitor, has been found to prevent prostate enlargement associated with testosterone therapy, while not altering the musculoskeletal benefits of testosterone 3.
- Recent landmark trials have provided insights into the benefits and risks of testosterone therapy in older men, including modest improvements in energy, mood, and sexual function, as well as increased bone density and muscle strength, but also potential risks such as fractures and cardiovascular events 4.
- Anabolic steroid-induced hypogonadism is a potential consequence of anabolic-androgenic steroid use, and management strategies include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators 7.