Understanding High Testosterone Levels

January 5, 2024
high testosterone levels can occur in both men and women

Both men and women have testosterone and estrogen. Males have much higher testosterone levels than females, and females have much higher estrogen levels than males. Hormone levels are tightly regulated because they affect tissues and organs throughout the body. A small increase in one hormone can affect the levels of other hormones, ultimately leading to abnormal organ function and disease.

Read More: Can Thyroid Problems Cause Low Testosterone?

The pituitary gland controls testosterone production in the body by releasing a hormone called luteinizing hormone. In the male, this hormone prods the testes to produce more testosterone. Likewise, the ovaries produce testosterone in females, and the adrenal glands produce it in both sexes. Therefore, any disorder affecting the testes, ovaries, or adrenal glands can cause overproduction or underproduction of testosterone.

Read More: What is Testosterone and How Does It Affect Your Health?

Both men and women can have abnormally high testosterone levels, but the definition of high will be significantly different between the two sexes. Many people have a vision of a male with excess testosterone. They might imagine bulky muscles, a short temper, and a healthy libido. What they might not think about are infertility, acne, blood clots, insomnia, and high blood pressure. Women with high testosterone levels can experience infertility, weight gain, severe acne, mood disorders, and insomnia.

Read More: What Can Harm Your Chances of Getting Pregnant

Signs And Symptoms Of High Testosterone

Low testosterone levels are much more common in males than are high levels. Abnormally high levels of testosterone is known as hypergonadism. The most common cause of high testosterone levels is using anabolic-androgenic steroids and testosterone replacement therapy.

In Men

When testosterone levels are too high, potential side-effects include:

  • Low sperm counts
  • Infertility
  • Acne
  • Headaches
  • Insomnia
  • Liver disease
  • Enlarged prostate
  • Increased risk of blood clots
  • Increased risk of sleep apnea
  • High blood pressure
  • Mood changes
Understanding High Testosterone Levels

Excess testosterone can cause infertility by suppressing the production of three other hormones:

  • GnRH in the hypothalamus of the brain
  • FSH and LH in the pituitary gland

When the production of these hormones declines, testosterone levels in the testes decline as well. The effect of high testosterone levels on sperm is so significant. It can almost be considered a contraceptive.

Low testosterone levels can also cause infertility and, sometimes, may be associated with erectile dysfunction. There are many causes of erectile dysfunction. Most commonly, they are associated with blood flow or, more precisely, the lack of blood flow into the penis.

High Testosterone Levels

Read More: Let’s Talk About Erectile Dysfunction

In Women

Abnormally high testosterone levels can cause the following signs and symptoms in women:

  • Balding and increased body hair (hirsutism)
  • Irregular periods
  • Enlarged clitoris
  • Acne
  • Deepening voice
  • Infertility
  • Weight gain
  • Mood changes
  • Insomnia and sleep apnea

Causes Of High Testosterone

Synthetic derivatives or human-made versions of testosterone are called anabolic-androgenic steroids. This term encompasses the growth-promoting effects of anabolic steroids and the androgenic effect of a male sex hormone.

Adrenal tumors are a rare cause of excess testosterone in both men and women. Tumors of the testes are another rare cause of high testosterone production in males. The most common cause of high testosterone levels in males is anabolic-androgenic steroid use.  

In women, high testosterone levels can be due to anabolic androgenic steroid use or a tumor in the adrenal gland or ovary. However, the most common cause of high testosterone levels in women is polycystic ovary syndrome.

High levels of androgens due to polycystic ovary syndrome are fairly common, affecting up to 20% of women of reproductive age.

How To Tell If You Have High Testosterone

In Women

Testosterone levels begin to increase in girls between the ages of 6 and 8. During puberty and throughout a woman’s reproductive years, testosterone levels fluctuate according to the menstrual cycle. Testosterone levels peak in women in their 30s and 40s and then begin a steady decline with aging.

Women with polycystic ovary syndrome may notice excessive body hair, acne, missed periods, and weight gain as symptoms that point to an abnormal testosterone level.

This constellation of symptoms may prompt a gynecology exam, followed by blood work, to check hormone levels.

If polycystic ovary syndrome is suspected, an ultrasound of the uterus and ovaries may show enlargement and cysts covering the ovary.

Read More: Do Women Have Testosterone?

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In Men

In men, suspicion of abnormal testosterone levels is usually focused on low testosterone levels, not high. However, concerns about excess body hair, acne, and increased muscle mass may prompt a full medical history and physical exam to explore potential causes of high testosterone levels, especially using anabolic-androgenic steroids.

Labs that may be requested when evaluating testosterone levels include:

  • Testosterone levels: At least two blood samples should be taken in the morning (between 8 am and 10 am) after fasting. The timing is important is because testosterone levels naturally fluctuate throughout the day.
  • Sex hormone-binding globulin (SHBG): Testosterone circulates in the blood bound to sex hormone-binding globulin, bound to the protein albumin, or unbound. Only the free testosterone plus the testosterone bound to albumin is available to act on target tissues. Therefore, free testosterone and SHBG should be checked to determine the level of biologically active testosterone.
  • Luteinizing hormone (LH) and follicle-stimulating hormone (FSH): LH and FSH are hormones secreted by the pituitary gland. LH stimulates the testes to produce testosterone, and FSH is involved in sperm production.
  • Prolactin: Prolactin is a pituitary hormone that stimulates milk production in the female. Abnormal levels of prolactin can indicate a problem in the pituitary gland.

Additional lab tests

  • Hemoglobin level to check for red blood cell count. 
  • Lipid panel to check for cardiovascular risk. 
  • PSA to screen for prostate cancer.
  • A baseline level of free estrogen is also recommended. When testosterone is supplemented, some will be converted to estrogen. A baseline level of highly sensitive estrogen will help determine how high the conversion rate is.

Men’s Standard Hormone Panel 

Men’s Advanced Hormone Panel

Lab values for normal testosterone levels vary. However, these are the values used by Kaiser Permanente.

 Total TestosteroneFree Testosterone
Men270–1070 ng/dL  (9–38 nmol/L)50–210 pg/mL (174–729 pmol/L)
Women15–70 ng/dL (0.52–2.4 nmol/L)1.0–8.5 pg/mL (3.5–29.5 pmol/L)

How To Treat High Testosterone

The most common cause of high testosterone in men is anabolic-androgenic steroid use or testosterone supplementation. Stopping the use of these substances will typically allow testosterone levels to fall within a normal range.

It is extremely rare for ovarian, testicular, or adrenal tumors to cause elevated testosterone levels as a single symptom. However, if either benign or malignant tumors are suspected, a series of labs and X-ray studies will probably be requested, followed by a biopsy.

How To Treat High Testosterone

For women with polycystic ovary syndrome, treatment options depend on the symptoms. Spironolactone is a water pill that has the side effect of blocking the action of male sex hormones. Spironolactone cannot be used in women who are trying to conceive, neither can another potential treatment, low dose birth control pills. Metformin is a medication used to treat diabetes. Treating insulin resistance can help normal ovulation resume.

Recent research shows that high testosterone levels have been linked to an increased risk of type 2 diabetes in women and polycystic ovary syndrome. Yet, ironically, it seems to decrease the risk of type 2 diabetes in men. High testosterone levels may also increase the risk of breast and endometrial cancers in women and prostate cancer in men. However, more research is needed in this area.

If you suspect that you might have an endocrine disorder of any type, whether high or low levels of a hormone, consult with your doctor. The impact of abnormal hormone levels can be far-reaching, causing many symptoms that may be difficult to explain.

Author: Leann Poston, M.D.
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