Testosterone is the primary male sex hormone, playing a crucial role in regulating numerous physical, sexual, cognitive, and emotional changes throughout life. Before puberty, this hormone has a minimal role to play in male processes. However, starting from the early teens, testosterone levels begin to rise, typically peaking in the late 20s.
While often linked with a strong libido and masculinity, unusually high testosterone levels can indicate underlying health concerns. Symptoms of elevated testosterone may include increased irritability, and fluctuations in energy levels. Monitoring and maintaining balanced testosterone levels is crucial, as an excess may lead to unexpected health impacts.
High Testosterone vs. Normal Testosterone
Historically, it was thought that testosterone levels typically drop by 1% per year starting from the age of 30, although there is now increasing suggestions that this might just be free testosterone rather than a total drop. There is also evidence to suggest that men with chronically low testosterone levels tend to experience poorer outcomes across almost all aspects of health.
But should this gradual decline be taken as normal? And what is the reference range that defines ‘normal’ testosterone?
The NHS considers 6 to 27 nmol/L as the normal testosterone range in adult men. However, studies and organisations are conflicted on the ideal reference range. To further complicate things, this range does not account for free testosterone, which is the biologically active portion of testosterone in the body.
The British Society of Sexual Medicine suggests that normal testosterone levels are between 12 and 30 nmol/L and 15 to 30 nmol/L for men with certain metabolic or pre-existing conditions. Also, if patients are symptomatic, age should not be a factor if we want to keep testosterone levels in a healthy reference range, whether a person is 20 or 80.
It is generally accepted that keeping testosterone in this healthy range will have good long-term benefits for health and longevity
The best way to think about testosterone levels is through a Gaussian curve, this is a typical bell-shaped graph. In this graph, too little or too much testosterone tends to have adverse health effects. We know that high testosterone in men, once above normal reference ranges, increases the risk of various chronic medical issues.
Signs of High Testosterone in Men
Most men with naturally high testosterone levels are often unaware of it. For many, elevated concentrations have a subtle impact on the body, as most men don’t notice significant high testosterone symptoms when their levels range from 20 to 30 nmol/L.
This is contrasted with teenagers going through puberty, who may develop acne due to a sudden spike in testosterone. In adulthood, persistently high testosterone levels can trigger acne again for the same reason. When testosterone levels remain persistently above normal range, however, adult patients may develop acne for the same reason.
Emotional Impact: Aggression and Testosterone
Because emotions are closely linked to testosterone levels, once raised past normal ranges, men may become irritable and angry again. This effect is connected to the common association with steroid rage. The studies around aggression and testosterone are often self-reported and have been based on research from such studies as male prisoners incarcerated for violent crimes. These men had high-normal levels of testosterone and were considered to be more aggressive. But, the quality of these studies has not been great.
In contrast, there is good evidence (summarising 562 men from 12 trials), that taking excess testosterone, in the form anabolic steroid abuse, is associated with increased aggression and irritability.
Similarly, men with low testosterone tend to become more anxious, irritable, and unhappy. So to keep our emotions stable and keep yourself content, you need just the right amount of testosterone; not too little, and not too much.
Effects of Testosterone on Muscle Mass and Physical Health
In terms of muscle mass, low levels of testosterone can interfere with increasing muscle mass and shedding excess fat despite training hard or eating well. Once levels return to a normal range, ideally 15 to 30 nmol/L, these aspects of physiology and metabolism can improve.
When testosterone levels exceed the normal range, patients may experience enhanced muscle development due to the stimulation of androgen receptors in skeletal muscle, which is why testosterone is commonly abused in sports.
Risks of Excess Testosterone on Cardiovascular Health
However, excessive androgens and increased muscle mass come with risks. Raised testosterone in males negatively affects other areas of the body, including cholesterol levels, blood pressure, heart function, and red blood cell count. It's well-documented that athletes who abuse anabolic steroids face a higher risk of cardiovascular diseases, including heart attack and stroke. Maintaining a healthy testosterone balance is critical to avoid these complications.
Other signs of High Testosterone
Elevated testosterone levels can manifest in various other ways, some of which may be easy to overlook. However, certain physical changes, like hair loss are often attributed to testosterone concentration. But does high testosterone cause hair loss? We explore below.
Hair loss
Interestingly, hair loss isn't directly linked to high testosterone, though it is often assumed that bald men are more virile and testosterone-driven than those with a full head of hair. This misconception holds despite the lack of a direct connection between testosterone levels and baldness.
In reality, the connection between hair loss and testosterone lies more in sensitivity to a byproduct of the hormone called dihydrotestosterone (DHT). While DHT can contribute to hair loss in men genetically predisposed to it, high testosterone alone won't cause baldness unless there's an underlying genetic tendency for hair loss.
Causes of high testosterone
High testosterone levels in men can result from several factors, including medical conditions, external influences, or lifestyle factors. Here are some common causes:
Genetic factors
A small percentage of the population naturally produces more testosterone than the average man. As with many aspects of medicine, there's a range for a reason, and some individuals will naturally fall outside of it. This does not indicate a disease or pose any health risks; it's simply how these bodies function, with many unaware of their high testosterone levels. For others, the effects may be more apparent, perhaps manifesting in enhanced athletic ability or greater physical performance.
Medical problems
Medical conditions that cause abnormally high testosterone levels are extremely rare. However, they can occur if there is a disorder in the pituitary gland, often due to a tumor that indirectly stimulates excess testosterone production. Elevated testosterone can also result from adrenal gland dysfunction.
In rare cases, certain medications like fluoxymesterone may increase testosterone levels. However, anabolic steroid use and similar substances can actually reduce natural testosterone production over time, as they cause damage to the testicles.
Anabolic steroids
The most common cause of high testosterone is the use and abuse of anabolic steroids. Over the past 30 years, steroid abuse—particularly among young men—has become increasingly common across the globe. While regulations on personal steroid use vary by country, the negative impact on male health is undeniable and continues to worsen.
Different countries have specific regulations around the personal use of anabolic steroids. But while not everyone that takes anabolic steroids might be put in jail, the negative impact on young male health is no doubt significant and worsening.
One of the major concerns with anabolic steroid abuse is the suppression of the body’s natural testosterone production. In some cases, this suppression can become permanent, leading to lifelong dependence on testosterone replacement therapy and permanent infertility.
Other signs of excess testosterone include increased body hair, headaches, high blood pressure, excess libido, infertility, insomnia, mood swings, urine problems, ankle swelling, or unexplained weight gain.
Testosterone supplementation
Testosterone supplements are often a cause for concern, but only testosterone replacement therapy (TRT) prescribed by a doctor is effective in significantly increasing testosterone levels—over-the-counter supplements have only minimal influence on T levels.
While there are a few products on the market that may have a slight effect on testosterone, in general, anything potent enough to truly impact hormone levels should only be prescribed by a healthcare professional.
How Do You Know If You Have High Testosterone?
If you are a fit and healthy man with a good lifestyle, free of any unknown supplements or anabolic steroids—it is extremely unlikely to have high levels of testosterone.
However, if you are concerned about an underlying medical problem that could result in high testosterone concentrations—the best thing is to get a blood examination. The Manual blood test can be a convenient first step to measure testosterone concentration and can even be administered from home.
How to Reduce Testosterone
High testosterone is only a cause for concern when it is caused by an underlying condition. In such cases, focus should be on treating the root cause, whether by removing or blocking the effects of a tumour or managing the medical issue.
When high testosterone is caused by anabolic steroids, the solution may be one of two things: reduce or stop usage to limit health risks. These are effective methods when considering how to reduce testosterone in men.
Conclusion
While it's important to recognize the signs of high testosterone, if you're fit, healthy, and do not use unregulated supplements, the chances of having abnormally high T-levels is quite low. However, if you're concerned about your testosterone concentration, consider taking a blood test and consulting a doctor for directions on managing your health going forward.
¹The 'male menopause'. NHS website for England.
²Testosterone and Aggressive Behavior in Man. Menelaos L. Batrinos (2012).
³Anabolic-androgenic steroid administration increases self-reported aggression in healthy males: a systematic review and meta-analysis of experimental studies. Razieh Chegeni, Ståle Pallesen, Jim McVeigh, Dominic Sagoe (2021).
⁴DHT (Dihydrotestosterone). Cleveland Clinic.
