High Testosterone in Men: Symptoms, Causes & Treatment Options

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Reviewed by
Anneliese Cadena
AGNP-C

Board-certified Nurse Practitioner helping midlife adults optimize performance with personalized care: hormones, nutrition, sleep, fitness, sex.

Optimal testosterone levels are necessary for normal brain function and physical health. High testosterone levels are relatively uncommon in men who do not supplement with testosterone therapy or take artificial steroids.

However, other causes can lead to high testosterone in men. Abnormally high testosterone levels can induce physical, behavioral, reproductive, and other symptoms affecting many systems of the body. 

Key Takeaways

  • Hypertestosteronemia, or high testosterone, is comparatively uncommon in men who do not use steroids or supplements to build muscle mass. However, levels may exceed the normal range due to specific lifestyle, medical, and genetic factors.
  • When blood test results exceed 1300 ng/dL, high testosterone is usually diagnosed clinically. However, this number can vary slightly depending on the lab used. Early morning testing is the most accurate because testosterone levels change throughout the day.
  • The levels of this important sex hormone can be affected by: genetic predisposition, obesity, certain medical conditions, artificial steroid abuse, and testosterone replacement therapy (if not properly monitored).
  • Cardiovascular problems, liver damage, infertility, prostate cancer, and psychological side effects like aggression or insomnia are among the complications associated with abnormally high testosterone levels.
  • Visible signs can include changes in facial and body hair growth, increased muscle mass and reduced body fat, and skin issues.
  • Less obvious symptoms could involve mood swings, poor sleep, trouble conceiving, and changes in normal libido.
  • Treatment depends on the underlying cause and may include lifestyle changes or medication.

An older man who's looking down and being sad.

The testes produce about 95% of testosterone in adult males, making them the main source of the hormone. Only about 5% comes from the adrenal glands. This contribution is more important in:

  1. Boys in their prepubescent years (before their testes fully mature)
  2. Older men, since testicular function deteriorates with age.

What Is High Testosterone?

Doctors diagnose high testosterone when levels exceed 1300 ng/dL. It's important to note that testosterone levels naturally rise and fall throughout the day.

Testosterone levels rise early in the morning and decrease as the day goes by. Generally, they are lowest in the evening.

When a blood test indicates a level higher than 1300 ng/dL, a doctor would run further tests to determine the cause.

What Are the Causes of High Testosterone Levels In Men?

Hormonal Imbalances

Testosterone Replacement Therapy (TRT)

Medical professionals should always supervise men undergoing TRT for testosterone deficiency. They should regularly check bloodwork to ensure testosterone levels remain within the normal range.

The objective of testosterone replacement is not to increase the levels too much. Rather, its purpose is to maintain normal testosterone levels that support overall health and well-being.

Only men with low testosterone should participate in TRT. Doctors prescribe it for men with testosterone deficiency.

Artificial Anabolic Steroids

By contrast, men who abuse artificial steroids to build lean muscle mass do not always follow medical advice. This can mean that their testosterone levels become dangerously high, leading to uncomfortable and sometimes dangerous side effects. For clarity on where testosterone itself fits in, read our blog on is testosterone a steroid.

Genetics

Some men’s genetics make them susceptible to unusually high levels of testosterone.

Medical conditions

Certain medical conditions, like pituitary gland dysfunction and tumors, can cause an increase in testosterone levels in the body.

Body mass index can also contribute to high testosterone levels, and weight gain can exacerbate this issue. Obesity increases estrogen, which leads to high testosterone.

What Are the Risk Factors of High Testosterone?

Testosterone plays such an important part in so many bodily functions in men that when the levels are too high, a broad range of symptoms can present. 

When testosterone is too high, men may experience:

high testosterone levels in men

Cardiovascular Disease

When too much testosterone is in circulation, the cardiovascular system can become stressed, which can damage the heart muscle. Blood pressure can also be affected; hyper- and hypotension (high and low blood pressure) have been observed in men whose testosterone levels are too high. 

It can also cause problems with cholesterol, particularly lowering the good cholesterol in the blood. These cardiovascular issues can put men at increased risk of a heart attack.

Liver Problems

Anabolic steroids (ASAs) are toxic to the liver. Men whose testosterone levels spike from taking synthetic steroids can experience liver damage and disease as a consequence.

Prostate Cancer

For many years, testosterone and its potent derivative, dihydrotestosterone (DHT), were believed to stimulate the growth of both normal and malignant prostate tissue. Earlier studies suggested that increased androgen activity could accelerate the progression of existing prostate cancer. 

Large-scale epidemiological research hasn't been able to establish a direct correlation between the risk of prostate cancer and circulating testosterone levels, though. For instance, the Endogenous Hormones and Prostate Cancer Collaborative Group (Roddam et al., 2008) conducted a thorough pooled analysis of 18 prospective studies and found no correlation between the incidence of prostate cancer and serum levels of DHT or testosterone. According to other analyses (e.g., Chodak et al., 1991; Calof et al., 2005), men receiving testosterone therapy are more likely to be screened and biopsied. This raises the rate of diagnosis rather than an increase in risk.

The saturation model, which suggests that the growth of prostate cancer is sensitive to androgens only up to a certain threshold, is supported by recent research. More testosterone does not seem to promote tumor growth once androgen receptors are saturated. 

There is no solid proof that testosterone replacement therapy raises the risk of prostate cancer or exacerbates pre-existing disease, according to studies published in Urologic Clinics of North America (Morgentaler et al., 2016) and Nature Reviews Urology (Morgentaler & Traish, 2014). Likewise, recent studies have not found a direct correlation between elevated prostate cancer progression and physiologic testosterone levels attained during treatment (European Urology, 2016).

Many clinicians continue to have concerns regarding testosterone therapy and prostate cancer despite these findings. This is partly because the early research had limitations in how it was designed and conducted. 

Together, patients and healthcare professionals should examine the most recent research and carefully consider the possible advantages and disadvantages of testosterone treatment for men with a history of prostate disease.

excess body hair

What Are the Warning Signs of High Testosterone?

High blood pressure and cholesterol issues are silent problems, and they may not be obvious at first. However, side effects like headaches, dizziness or fainting, nausea, and fatigue can indicate a problem with the cardiovascular system early on.

For some men, changes to their hair may be one of the first signs of a testosterone imbalance. Excessive testosterone levels could cause an increase in hair growth or the opposite: male pattern baldness.

The other area that may present an issue is the skin. Imbalanced testosterone levels can also cause unexpected skin breakouts and acne. Excessive testosterone promotes sebum production, which can cause skin problems.

Mood Swings

An excess of testosterone can cause changes in mood and aggression. Studies have also linked it to mental health disorders like anxiety and depression. Keeping testosterone levels in proper balance can promote a normal mood and support cognitive function.

According to a randomized, placebo-controlled, double-blind crossover study published in JAMA Psychiatry, when healthy men were given supraphysiologic doses of testosterone cypionate (up to 600 mg/week), some of them experienced increased hypomanic symptoms and aggressive behaviors. The study offered evidence that mood and behavioral changes can be correlated with elevated testosterone levels.

Increased Muscle Mass

Using anabolic steroids or testosterone therapy at supraphysiological levels can lead to significant muscle gains, but they also pose serious health risks, including cardiovascular problems, liver damage, and hormone imbalances.

Problems Sleeping

Some men report insomnia when their testosterone levels are too high. High testosterone can also exacerbate sleep apnea, a condition where the person stops breathing during sleep. This interrupts the sleep cycle, putting the cardiovascular system under stress.

Sleep apnea can also contribute to the chronic health conditions listed above: damage to the heart, high blood pressure, and an increased risk of a heart attack. Sleep deprivation can contribute to temporarily heightened testosterone.

Infertility

High testosterone can reduce sperm production and harm fertility.

Getting a High Testosterone Diagnosis: What To Expect

A healthcare practitioner will take your full medical history and conduct an examination to investigate any physical symptoms. A blood test is the most accurate way to associate symptoms with high testosterone. Blood tests should be done early in the morning, as this is when testosterone levels peak.

Conclusion

Too much testosterone can disrupt the body’s balance and lead to serious health issues. Don’t ignore abnormally high testosterone levels. If you or someone you know is experiencing unusual symptoms or undergoing testosterone therapy, it’s essential to seek medical advice and regular monitoring. Proper diagnosis and tailored treatment can help restore balance and protect long-term well-being.

References

  1. Bhasin, S., Woodhouse, L., Casaburi, R., Singh, A. B., Bhasin, D., Berman, N., ... & Storer, T. W. (2001). Testosterone dose-response relationships in healthy young men. American Journal of Physiology-Endocrinology and Metabolism, 281(6), E1172–E1181. 
  1. Boyle, P., Koechlin, A., Bota, M., d’Onofrio, A., Zaridze, D., Perrin, P., & Boniol, M. (2016). Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA): a meta-analysis. European Urology, 70(1), 82–94. 
  1. Chodak, G. W., Vogelzang, N. J., Caplan, R. J., Soloway, M. S., Smith, J. A., Kennealey, G. T., & Seay, T. (1991). Independent prognostic factors in patients with metastatic (stage D2) prostate cancer: The Zoladex Multicenter Study Group. Journal of the American Medical Association, 265(5), 618–621. 
  1. Calof, O. M., Singh, A. B., Lee, M. L., Kenny, A. M., Urban, R. J., Tenover, J. L., & Bhasin, S. (2005). Adverse events associated with testosterone replacement in middle-aged and older men: A meta-analysis of randomized, placebo-controlled trials. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(11), 1451–1457. 
  1. Jaspers, L., Dhana, K., Muka, T., Meun, C., Kiefte-de Jong, J. C., Hofman, A., ... & Tiemeier, H. (2016). Sex steroids, sex hormone-binding globulin and mood in middle-aged and elderly men and women: The Rotterdam Study. Psychoneuroendocrinology, 72, 153–164. 
  1. Morgentaler, A., & Traish, A. M. (2014). Shifting the paradigm of testosterone and prostate cancer: The saturation model and the limits of androgen-dependent growth. Nature Reviews Urology, 11(5), 261–270. 
  2. Morgentaler, A., Miner, M. M., Caliber, M., Guay, A. T., Khera, M., & Traish, A. M. (2016). Testosterone therapy and cardiovascular risk: Advances and controversies. Urologic Clinics of North America, 43(2), 195–202. 
  1. National Institutes of Health. (2022). Testosterone: What it does and doesn't do. Mayo Clinic. 
  1. Pope, H. G., Jr., Kouri, E. M., & Hudson, J. I. (2000). Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: A randomized controlled trial. Archives of General Psychiatry, 57(2), 133–140. 
  1. Roddam, A. W., Allen, N. E., Appleby, P., Key, T. J., & the Endogenous Hormones and Prostate Cancer Collaborative Group. (2008). Endogenous sex hormones and prostate cancer: A collaborative analysis of 18 prospective studies. Journal of the National Cancer Institute, 100(3), 170–183. 
  1. Ruth, K. S., Day, F. R., Tyrrell, J., Thompson, D. J., Wood, A. R., Mahajan, A., ... & Murray, A. (2020). Using human genetics to understand the disease impacts of testosterone in men and women. Nature Medicine, 26(2), 252–258. 
  1. Travis, R. C., Appleby, P. N., Albanes, D., Black, A., Chan, J. M., Chen, C., ... & Key, T. J. (2016). Prediagnostic circulating sex hormone concentrations and prostate cancer risk in men: A collaborative analysis of 20 prospective studies. Journal of the National Cancer Institute, 108(2), djv346
  1. University of Oxford. (2020). Largest study to date confirms role of two hormones in aggressive prostate cancer risk. Cancer Epidemiology Unit. 
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