The Negative Effects of High Testosterone Levels on the Body

Testosterone is typically considered a desirable hormone associated with muscle growth and a healthy sex drive. Mostly produced in the testicles in males, testosterone surges during puberty and leads to facial and body hair, an enlarged penis and testicles, more muscle and bone mass, and a deeper voice.

But there can be too much of a good thing when it comes to hormone levels.

The human body usually does an excellent job of monitoring and balancing testosterone. The brain sends signals to the pituitary gland at the base of the brain, and these signals regulate testosterone production in men. The pituitary gland then transmits messages to the testes to produce testosterone, creating a feedback loop that closely regulates how much of the sex hormone is released into the blood.

If levels get too high, your brain reacts by telling the pituitary gland to slow production.

Naturally high testosterone levels that lean into the abnormal range are rare but do occur. Testosterone can also be unusually high due to medications or supplements, either self-administered or under the supervision of a doctor. When these high levels happen, some undesirable side effects can occur in the short and long term.

Increased risk of heart attacks and strokes

"Super-physiologic levels of testosterone can cause numerous effects on the body. Specifically, high testosterone causes increased red blood cell proliferation from bone marrow, causing a condition called polycythemia [an abnormal thickening of the blood]," said Russel Williams, M.D., a board-certified urologist and urological surgeon with the Y Factor, a men's urological wellness and fertility practice with locations in Texas.

"Thickened blood or high red blood cell count could result in clotting of the blood vessels, resulting in a heart attack or stroke," said Tira Chaicha-Brom, M.D., a board-certified endocrinologist with Texas Diabetes & Endocrinology in Austin.

This side effect is the most common condition that arises from testosterone replacement therapy (TRT). If it occurs, it can be treated with regular blood donations or therapeutic phlebotomy—drawing a large quantity of blood—every three months, according to Chaicha-Brom.

Possible increase in mood changes

Mood changes are one of elevated testosterone's more commonly known side effects. The hormone is often associated with anger, rage and violence. There's more to the picture, however.

Some research suggests the excessive use of a synthetically derived anabolic steroid like testosterone in men with previously normal testosterone levels can lead to brain changes, negative moods and impulsive behaviors such as:

• Aggressive reactions
• Impulse-control issues
• Sleeplessness
• Irritability
• Depression
• Anxiety
• Extreme mood swings
• Mania

These behaviors can be concerning for people in the user's life. There are also dire consequences for the individual, according to Susie Gronski, D.P.T., a pelvic pain specialist for men and sexual health educator based in Asheville, North Carolina.

"A June 2022 large sample size retrospective study showed that testosterone use was independently associated with both major depressive disorder and suicide attempts or intentional self-harm for both testosterone-deficient and nondeficient groups who were on testosterone replacement therapy," said Gronski, who is also a medical advisor for Aeroflow Urology.

Suicide attempts are already high among men. Depression, anxiety, anger, irritability and relationship conflicts can be more likely to occur while using testosterone. Each contributes to suicidal behavior.

Liver inflammation

Your liver helps metabolize hormones. With higher-than-normal levels of testosterone, liver metabolism demands increase.

"Increased demands of testosterone metabolism cause liver inflammation and can lead to liver cirrhosis," Williams said.

Liver inflammation and cirrhosis can result in a drop in testosterone levels or low testosterone (hypogonadism), which in turn can lead to muscle loss, osteoporosis, gynecomastia (male breast enlargement) or low libido.

Skin and hair issues

Some common skin issues can occur when testosterone levels are elevated. Chaicha-Brom listed several:

• Oilier skin or acne
• Red face
• Increased facial and body hair
• Occasional scalp hair loss

Gronski explained that baldness can occur from an increase in dihydrotestosterone when testosterone levels rise. Dihydrotestosterone is an androgen that is responsible for male characteristics. About 10 percent of the testosterone adults produce is converted to dihydrotestosterone, so increasing testosterone levels above normal gives a boost to this hair-loss-causing androgen.

Infertility and hormone issues

If synthetic (lab-produced) testosterone remains too high for too long, it can lead to the decreased production of your natural testosterone, which has several consequences.

"Testosterone therapy can decrease a man's own production of sperm and make it more challenging to be able to father a child," Chaicha-Brom said.

Decreasing testosterone also leads to testicular shrinkage.

High testosterone is also associated with the increased production of estradiol, a female hormone, according to Williams. High levels of estradiol in men can lead to breast enlargement and tenderness.

Prostate enlargement and cancer

Abnormally high levels of testosterone also cause increased proliferation of prostate tissue.

"The increased proliferation of prostate tissue can result in the growth of prostate cancer and enlargement of the prostate, causing urination difficulties," Williams explained.

What can you do if your testosterone is too high?

"If someone's testosterone level is too high, the natural recommendation would be to reduce the dose or frequency of the dose," Chaicha-Brom said. "If the testosterone levels are normal, but the patient is experiencing any of the above signs or symptoms, then the remedy would be, again, to reduce the testosterone dose or frequency."

It's important to understand that many of the adverse effects of increased testosterone, including red blood cell and sperm production, depression and low self-esteem, and hair loss, are also medical concerns that can be treated by testosterone replacement therapy.

The key is to find a balance between appropriate treatment and overuse or abuse of the hormone. You should speak to your doctor if you're concerned about your testosterone levels or any side effects.