Can Supplements Cause Testosterone Levels >52 nmol/L?
No, over-the-counter testosterone-boosting supplements cannot cause hyperandrogenism with testosterone levels exceeding 52 nmol/L (approximately 1,500 ng/dL). The evidence consistently demonstrates that these supplements do not meaningfully increase testosterone levels in men, and certainly cannot produce supraphysiological elevations of this magnitude.
Evidence Against Supplement-Induced Hyperandrogenism
Lack of Testosterone-Boosting Efficacy
Research demonstrates that 90% of "testosterone booster" supplements claim to boost testosterone, but only 24.8% had any published data supporting these claims, while 10.1% actually showed data suggesting a decrease in testosterone levels 1
The majority (61.5%) of supplement ingredients had no published data whatsoever regarding their effect on testosterone 1
Controlled trials of prohormone supplements (androstenedione, androstenediol, DHEA) show they do not produce anabolic or ergogenic effects in men and do not meaningfully increase testosterone levels 2
Specific Supplement Data
Androstenedione at 300 mg/day for 8 weeks did not increase serum free or total testosterone concentrations in young men, despite being marketed as a testosterone precursor 3
Interestingly, androstenedione supplementation actually increased estradiol (from 220 to 310 pmol/L) and estrone levels while failing to raise testosterone 3
Only select supplements (zinc, vitamin D in deficiency states, L-arginine, mucuna, ashwagandha) showed modest effects on testosterone in well-controlled trials, and these effects were in men with low baseline testosterone or specific deficiencies 4
What Can Actually Cause Testosterone >52 nmol/L
Exogenous Testosterone Therapy
Prescription testosterone replacement therapy (TRT) is designed to achieve mid-normal physiologic levels of 450-600 ng/dL (approximately 15.6-20.8 nmol/L), not supraphysiological levels 5
Supraphysiological testosterone levels (>1,000 ng/dL or >34.7 nmol/L) occur with excessive TRT dosing and significantly increase adverse effects, particularly erythrocytosis 6
Injectable testosterone formulations can produce peak levels exceeding normal ranges 2-5 days post-injection, though guidelines recommend targeting mid-normal values 6
Anabolic Steroid Abuse
- Levels exceeding 52 nmol/L (1,500 ng/dL) are typically only seen with:
- Anabolic steroid abuse (controlled substances requiring prescription as of 2005) 2
- Excessive prescription testosterone dosing well above therapeutic ranges
- Endogenous pathology (extremely rare, such as testosterone-secreting tumors)
Clinical Implications
Safety Concerns with Supplements
Many supplements contain supra-therapeutic doses of vitamins and minerals, with some exceeding FDA upper tolerable limits for zinc, vitamin B3, and magnesium 1
Prohormone supplements may raise the risk for negative health consequences without providing testosterone-boosting benefits 2
Common Pitfall to Avoid
Do not assume that over-the-counter "testosterone boosters" can cause clinically significant testosterone elevation or hyperandrogenism - the evidence shows they are ineffective for this purpose 2, 1, 3
If a patient presents with testosterone >52 nmol/L, investigate prescription testosterone use, anabolic steroid abuse, or endogenous pathology rather than attributing it to supplements 5, 6