Testosterone is a steroid hormone produced primarily in the testes of males and in smaller amounts in the ovaries and adrenal glands of females. It plays a role in developing male reproductive tissues and secondary sexual characteristics, and also maintains bone density, muscle mass, energy levels, and libido in both sexes. Levels that rise far above the typical physiological range are considered supraphysiological and can produce distinct physical and psychological changes. This article will detail how high testosterone levels manifest, the causes behind this elevation, the long-term health risks, and the medical steps for confirmation and management.
How Elevated Testosterone Manifests
The subjective experience of high testosterone levels differs significantly between males and females due to the contrast in baseline hormone concentrations. In males, where testosterone is naturally dominant, excess signs often involve an intensification of typical male traits and adverse reactions. Increased energy and a heightened libido are commonly reported. Psychological changes may include increased irritability, mood swings, and a tendency toward aggressive or risk-taking behaviors.
Physically, males may notice increased body hair growth (hirsutism) and accelerated male-pattern balding. The skin often becomes oilier, leading to severe or persistent acne. The prostate gland may also enlarge, potentially causing urinary symptoms such as a poor stream or difficulty starting urination.
In females, the effects of elevated testosterone (hyperandrogenism) are generally more pronounced because their natural levels are much lower than in males. The most frequent physical sign is hirsutism, which is the growth of coarse, dark hair in a male-like pattern on the face, chest, or back. Voice changes, specifically a deepening, may occur due to the effect of androgens on the vocal cords.
Other significant manifestations in females include menstrual irregularities, ranging from infrequent periods (oligomenorrhea) to a complete cessation (amenorrhea). Increased muscle mass may be observed, and the clitoris can enlarge (clitoromegaly). These physical alterations, known as virilization, are often accompanied by significant acne and sometimes a reduction in breast size.
Underlying Causes of High Testosterone
Elevated testosterone levels can arise from sources within the body (endogenous) or from external substances (exogenous). The most common endogenous cause of hyperandrogenism in pre-menopausal women is Polycystic Ovary Syndrome (PCOS), which accounts for the majority of cases. In PCOS, the ovaries produce excessive androgens, often due to high levels of insulin and luteinizing hormone.
Other endogenous conditions include congenital adrenal hyperplasia, a group of genetic disorders causing the adrenal glands to overproduce testosterone and related hormones. Rarely, a tumor on the adrenal glands or the testes/ovaries can secrete androgens, leading to a sudden and very severe rise in testosterone levels. These tumors, though uncommon, produce a rapid onset of symptoms.
The primary exogenous cause of high testosterone in both sexes is the use of synthetic anabolic-androgenic steroids or performance-enhancing drugs (PEDs). These substances are chemically similar to natural testosterone and are often taken to increase muscle mass. Improperly dosed Testosterone Replacement Therapy can also inadvertently lead to supraphysiological levels. Certain supplements marketed for muscle building may contain unlisted or unregulated prohormone ingredients that elevate testosterone levels.
Systemic Health Implications
Sustained, untreated elevation of testosterone can lead to serious systemic health complications. Cardiovascular risks are a major concern, as high levels can negatively affect blood pressure and lipid profiles. The hormone excess can contribute to hypertension (high blood pressure) and a decrease in high-density lipoprotein (HDL) cholesterol, often called the “good” cholesterol.
High testosterone stimulates the bone marrow to produce more red blood cells, a condition called polycythemia or erythrocytosis. This thickening of the blood increases the risk of dangerous blood clots, potentially leading to stroke or heart attack. The liver can also be strained, particularly when the elevation is caused by the use of oral anabolic steroids, which are often hepatotoxic.
Reproductive issues are common with excess testosterone. In males, the body’s natural feedback loop shuts down, leading to testicular atrophy (shrinking of the testicles) and reduced sperm production, resulting in infertility. In females, the chronic hormonal imbalance often causes severe menstrual disruption, making conception difficult. Psychological effects, such as severe mood instability and increased aggression, can negatively impact personal and professional relationships.
Medical Confirmation and Management
Confirming high testosterone levels requires specific blood tests, usually drawn in the morning between 8 a.m. and 10 a.m. due to the body’s natural diurnal hormone cycle. Healthcare providers typically measure total testosterone, free testosterone (the active, unbound form), and sex hormone-binding globulin (SHBG). Other hormones, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH), may also be tested to determine the source of the excess.
If tumor involvement is suspected, imaging studies like an ovarian ultrasound or a CT scan of the adrenal glands may be necessary. Management is dependent on the identified underlying cause. If the cause is exogenous, such as the use of anabolic steroids, the primary management step is complete cessation of the substance.
For women with PCOS, treatment often involves lifestyle changes, such as diet and exercise, and medication. Oral contraceptives are frequently prescribed as a first-line treatment because they help regulate the menstrual cycle and contain anti-androgenic components that lower free testosterone. Anti-androgen medications like spironolactone may also be used to block the effects of testosterone, particularly to manage symptoms like hirsutism and acne.