Understanding High Testosterone Levels in Men - Causes, Symptoms, Risks

Understanding Testosterone in Men

Testosterone is an important hormone that plays a key role in male health and development. Produced primarily in the testes, testosterone is responsible for the development of male reproductive tissues and contributes to typical male characteristics such as increased muscle mass, bone strength, and growth of body hair. While testosterone is a key part of normal male physiology, there are some instances where a man may have abnormally high levels of this hormone.

What Causes High Testosterone in Men?

There are several potential causes of elevated testosterone in men:

• Testicular tumors - Cancerous growths in the testes may secrete excess testosterone.
• Adrenal gland disorders - The adrenal glands sit above the kidneys and also produce small amounts of testosterone. Tumors or hyperplasia (overgrowth) of the adrenal gland can result in testosterone overproduction.
• Congenital adrenal hyperplasia - An inherited disorder that causes increased adrenal gland activity and testosterone production beginning in utero.
• Use of testosterone therapies - Testosterone injections, gels, patches and other treatments for low testosterone can raise levels too high, especially if doses are too high.
• Anabolic steroid abuse - Illicit use of synthetic testosterone derivatives elevates testosterone to supraphysiologic levels.

In some cases, no specific cause of high testosterone can be identified. This is referred to as idiopathic hirsutism in women or idiopathic hyperandrogenism in men. Nonetheless, underlying medical conditions still may be responsible.

Signs and Symptoms of High Testosterone

The symptoms associated with elevated testosterone in men can include:

• Increased facial and body hair growth - Since testosterone impacts hair follicles, excess levels can lead to increased growth of facial and body hair.
• Scalp hair thinning - Although testosterone impacts hair growth, excessive levels can actually cause scalp hair to thin and become patchy. The mechanism is not fully understood.
• Oily skin and acne - Testosterone increases activity of oil glands in the skin, leading to increased oiliness, clogged pores and acne outbreaks.
• Breast reduction - High testosterone can cause breast tissue to atrophy, leading to shrinkage of male breast tissue.
• Testicular atrophy - The testes may shrink in size due to suppression of natural testosterone production by excess hormone levels.
• Reduced sperm production - Very high testosterone levels can impair sperm production and lead to reduced fertility.
• Prostate enlargement - Increased prostate size and urinary symptoms may occur with excess testosterone.
• Emotional changes - Mood swings, irritability, depression or aggressive behavior tendencies may be seen.
• Sleep apnea - High testosterone contributes to increased muscle mass and soft tissue growth, which can exacerbate sleep apnea.
• Gynecomastia - Although rare, testosterone in excess can be converted to estrogen causing breast development in men.

However, symptoms vary based on the underlying cause, the age of onset, and individual sensitivity to androgens. Diagnostic testing is important to pinpoint the specific reason for elevated testosterone.

Health Risks of High Testosterone

If left untreated, persistently high testosterone levels in men can lead to several health complications:

• Infertility due to impaired sperm production
• Osteoporosis and increased fracture risk as excess testosterone suppresses estrogen production needed for bone health
• Cardiovascular disease correlating with a higher hematocrit (red blood cell concentration) induced by testosterone
• Progression to testicular cancer in the case of a testicular tumor
• Metabolic effects such as insulin resistance and abdominal obesity
• Obstructive sleep apnea exacerbation
• Enlarged prostate and urinary tract complications

Additionally, the emotional and psychological effects of chronic high testosterone like mood instability and aggression can negatively impact relationships, work performance, and overall well-being.

Diagnosing High Testosterone

If signs and symptoms of excess testosterone are present, a physician will perform a thorough evaluation consisting of:

• Physical exam to look for signs of virilization like increased facial/body hair, reduced breast tissue, testicular atrophy, etc.
• Lab testing to directly measure testosterone levels in the blood - This will reveal if testosterone is truly elevated and by how much. Multiple measurements may be needed as testosterone has natural fluctuations throughout the day.
• Other hormone tests to evaluate the pituitary-gonadal axis
• Imaging tests such as CT scans or MRI to look for potential tumors of the testes, adrenal glands or pituitary
• Genetic testing may be done to look for congenital adrenal hyperplasia

Once the underlying cause is determined through proper clinical evaluation, appropriate treatment can be pursued.

Treating High Testosterone in Men

Treatment will depend on what is spurring the testosterone excess but may include:

• Surgery - Removal of a testicular or adrenal tumor causing excess hormone production
• Medication - Drugs that decrease testosterone production directly or block testosterone action in the body
• Testosterone reduction - Lowering the dose or discontinuing testosterone therapies being used
• Steroid discontinuation - Stopping anabolic steroid use that is leading to supraphysiologic levels
• Blocking conversion to dihydrotestosterone (DHT) - DHT is a potent derivative of testosterone and blocking its production can alleviate symptoms
• Estrogen therapy - Administering estrogen treatment can oppose high testosterone action

Precise treatment aims to normalize total and free testosterone levels in the blood and alleviate troubling signs and symptoms.

Coping with High Testosterone

For men with bothersome symptoms of high testosterone, the following lifestyle measures may help provide relief until treatment takes effect:

• Shaving or removing excess facial and body hair through electrolysis, waxing or laser treatments
• Using prescription topical creams to slow facial hair growth
• Taking saw palmetto supplements to block testosterones action on the prostate
• Using over-the-counter acne washes and creams to prevent oily skin and breakouts
• Practicing stress management and relaxation techniques to stabilize mood
• Joining a support group to discuss challenges with other men
• Communicating openly with loved ones about symptoms and treatment

With proper diagnosis and management, most men with elevated testosterone can experience an improved quality of life and reduction in troubling symptoms.

Key Takeaways

In summary, key points to know about elevated testosterone in men include:

• Excess testosterone can be due to tumors, gland disorders, medications or illegal steroid use.
• Common symptoms are increased body hair, oily skin, mood changes and reduced fertility.
• High testosterone left untreated poses long term health risks.
• A thorough workup is needed to identify the exact cause.
• Treatment aims to normalize hormone levels using surgery, medications or lifestyle modifications.
• Coping measures can help improve quality of life while undergoing treatment.

Understanding the implications of high testosterone empowers men to seek evaluation and find the right management plan for their hormonal health.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.