From the Guidelines
Fluctuations in testosterone levels from very high to very low over a three-month period are most likely caused by steroid or testosterone supplement use followed by discontinuation, which can lead to a temporary spike in levels followed by a significant drop as the body's natural production becomes suppressed. The most common causes of such fluctuations include:
- Steroid or testosterone supplement use followed by discontinuation, leading to a temporary spike in levels followed by a significant drop as the body's natural production becomes suppressed 1
- Medical conditions like pituitary tumors, which may cause initial testosterone overproduction followed by gland burnout
- Certain medications such as opioids, glucocorticoids, or some psychiatric drugs, which can dramatically alter testosterone production
- Liver or kidney disease, which can affect hormone metabolism, initially causing elevated levels that later drop as the condition progresses
- Stress, significant weight changes, or sleep disturbances, which can also cause substantial hormonal fluctuations
- Laboratory errors or inconsistent testing conditions (time of day, fasting status), which might create apparent changes without actual biological shifts
Anyone experiencing such dramatic testosterone changes should seek medical evaluation promptly, as this pattern often indicates an underlying condition requiring treatment. Blood tests, imaging studies, and a thorough medical history will help determine the specific cause 1. It is essential to note that the use of testosterone treatment in men without established conditions that cause permanent testicular or hypothalamic–pituitary dysfunction is a topic of ongoing debate, and the benefits and harms of such treatment are not yet fully understood 1.
From the Research
Testosterone Level Fluctuations
- Testosterone levels can fluctuate due to various factors, including age, comorbidities, and exogenous testosterone therapy 2.
- A study found that men with symptoms of testosterone deficiency had no significant difference in testosterone levels between morning and afternoon measurements, but younger men showed more significant variations in testosterone levels 3.
- Exogenous testosterone therapy can suppress luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion, leading to variable LH suppression profiles in men treated with testosterone therapy 4, 5.
Possible Causes of High Testosterone Levels
- Male hypertestosteronemia, defined by a plasma testosterone level above 13 ng/ml, can be caused by various physiopathological mechanisms, including hyperandrogenism, relative hypoandrogenism, and excess of oestrogens 6.
- High testosterone levels can be a biochemical sign of underlying pathology, and aetiological investigations are necessary to determine the cause 6.
Impact of Testosterone Therapy on Testosterone Levels
- Testosterone replacement therapy can cause suppression of LH and FSH, leading to decreased semen parameters and possible infertility 4.
- Different testosterone formulations can have varying effects on LH and FSH suppression, with shorter-acting preparations potentially having less suppression than longer-acting preparations 4.
- LH suppression profiles may be relevant for dose titration during testosterone therapy and minimizing testicular atrophy 5.