Testosterone is a sex hormone that must be present at an optimal level because both high and low levels can cause significant health concerns. Our last article reviewed the signs and symptoms associated with low testosterone levels in men and women, and this article will explore the concerning effects of high testosterone levels.
While many men believe the higher the testosterone level, the better, high testosterone levels in men can be very harmful. Too much of a good thing is not always good! And it is well-known that high testosterone levels in women are associated with significant health concerns.
What is Testosterone?
Testosterone is known as “the elixir of life,” and many have referred to testosterone as the “fountain of youth.”1,2 Testosterone is a steroid hormone and a sex hormone. Sex hormones include androgens, estrogens, and progestogens. Testosterone is an androgen.3
Small amounts of T are also produced in the brain; therefore, testosterone is also known as a neurosteroid.4
How is Testosterone Produced?
Testosterone is derived from cholesterol, like all other steroid hormones in the body. Cholesterol might have a bad reputation, but it is the precursor for testosterone, progesterone, cortisol, and all steroid hormones that support healthy energy levels, fertility, hair growth, bone health, optimal libido, balanced mood, well-being, and more.
To initiate the process of testosterone production, cholesterol is shuttled into mitochondria and converted into the hormone pregnenolone. Enzymes then convert pregnenolone to either progesterone or DHEA, which are further transformed into androstenedione, the direct precursor of testosterone. Once testosterone is produced from androstenedione, testosterone becomes a precursor for the production of estrogens and the more potent androgen hormone known as dihydrotestosterone (DHT). Roughly 7% of testosterone in healthy men is converted to DHT, and 0.5% of testosterone is converted to estrogen.5
Here is a picture of the Androgen Pathway that shows the production of testosterone and the conversion of testosterone to DHT and Estradiol:
Where is Testosterone Produced?
Testosterone is predominantly produced in the adrenal glands and reproductive organs in both sexes. The ovaries produce testosterone in women and the testes produce testosterone in men. Small amounts of testosterone are also produced in the brain and other tissues. Men have approximately ten times as much testosterone as women, and optimal testosterone production is crucial for the health of men and women.4
What does Testosterone Do?
We primarily think of testosterone as a reproductive hormone, but testosterone has an effect on all tissues that have testosterone receptors, and testosterone receptors are present in most tissues in men and women, including the brain. The number and sensitivity of testosterone receptors in reproductive and non-reproductive tissues, however, vary from person to person based on sex, genetics, and other factors.6 When assessing the impact of a hormone systemically, the free hormone level and receptor function must be considered.
Testosterone plays many functional roles in the body; including the orchestration of metabolism; energy production, and use; the maintenance of skeletal and body protein; the integrity and development of cognitive abilities and behaviors; control of the reproductive system; and more.7
What is Free Testosterone?
Free testosterone is the bioavailable testosterone that is actively affecting cells, tissues, and organs throughout the body.
The testosterone circulating in the blood is primarily bound to blood proteins that inactivate it. Most circulating testosterone binds to sex hormone-binding globulin (SHBG) and albumin, but small amounts also bind to corticosteroid-binding globulin (CBG) and alpha-1-acid glycoprotein (orosomucoid).8
Overall, only 2%–4% of circulating testosterone is free, and the amount can differ significantly depending on many variables, including the levels of SHBG, albumin, CBG, and alpha-1-acid glycoprotein present in the blood.8
The Importance of Testing Free Testosterone with a Saliva Hormone Test
The overall health of the liver, thyroid, kidneys, gastrointestinal tract, and other organs has a direct impact on blood protein levels. Since most inactive testosterone is bound to sex hormone-binding globulin (SHBG), changes in the SHBG level in the blood will significantly affect the free testosterone level in your patients.8
Obesity, acromegaly, diabetes mellitus, hypothyroidism, nephrotic syndrome, and metabolic syndrome are some of the conditions that could lower SHBG levels, leading to elevated free testosterone levels and signs and symptoms of hyperandrogenism. Polymorphisms in the SHBG gene can also be an underlying cause of decreased SHBG levels.8
Measuring free hormone levels becomes even more important with aging and certain conditions due to many factors. Some postmenopausal women naturally experience a significant reduction in sex hormone-binding globulin (SHBG) production, leading to elevated free testosterone levels and symptoms of hyperandrogenism even when the total testosterone level appears normal.9
Research also shows approximately 20–40% of women with PCOS have a total blood testosterone level that is normal even though they suffer with the clinical features of high testosterone. In women with PCOS, the free testosterone level correlates better with their clinical presentation and is highly recommended for diagnosis and monitoring the response to treatment.10
Assessing the bioactive, free hormone level is one benefit of saliva hormone testing since the binding proteins in the blood are large molecules that are not present in saliva. Read about many other benefits in the blog post The Benefits of Saliva Hormone Testing.
Since saliva hormone testing offers an opportunity to directly test the free testosterone level, ordering a salivary testosterone level will provide insight into the level of testosterone that is actively affecting cells, tissues, and organs in your patients.
The signs and symptoms of high testosterone in women include:
- Deepening of the voice
- Facial hair growth
- Acne
- Polycystic ovaries (PCOS)
- Androgenetic alopecia (scalp hair loss)
- Infertility
- Absent menstrual cycles (amenorrhea)
- Irregular menstrual cycles
- Heavy and prolonged menstrual periods
- Insulin resistance
- Metabolic syndrome
- Enlargement of the clitoris
- Aggressiveness
- Weight gain11,12
The signs and symptoms of high testosterone in men include:
- Erythrocytosis or an elevated red blood cell count (polycythemia)
- Blood clots
- Heart attack
- Stroke
- Androgenic alopecia (scalp hair loss)
- Acne
- Enlarged prostate
- Increased levels of prostate specific antigen (PSA)13-15
If your patients have the signs or symptoms of a high testosterone level, consider having a conversation with them about saliva hormone testing and what treatment protocol might be best for them based on their test results, family history, symptoms, and other factors.
Salivary (free) testosterone can be ordered as part of a:
- Bone Health Panel
- Customized Flexi-Matrix panel
- Male Hormone Panel and Expanded Male Hormone Panel
- Cycling Female Hormone Panel and Expanded Cycling Female Hormone Panel
- Peri Menopause Hormone Panel and Expanded Peri Menopause Hormone Panel
- Post Menopause Hormone Panel and Expanded Post Menopause Hormone Panel
Salivary (free) testosterone can also be ordered as a single test.
To place a test order, click here. As a reminder, DiagnosTechs will drop ship test kits directly to your patients. You may select this option at the top of the order form.
Please visit our Provider Tools page for more information about choosing the right test and supporting the androgen pathway.
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TESTING (FREE) TESTOSTERONE AND HOW TO BOOST TESTOSTERONE NATURALLY
Testosterone is an important steroid hormone that plays many functional roles; including the orchestration of metabolism; energy production, and use; the maintenance of skeletal and body protein; the integrity and development of cognitive abilities and behaviors; control of the reproductive system; and more. Research shows boosting low testosterone levels into the normal range improves overall sexual function, mood, and libido; increases bone mineral density, energy, and lean body muscle mass; and decreases body fat mass.
THE BENEFITS OF OPTIMAL TESTOSTERONE LEVELS IN WOMEN AND MEN
Testosterone (T) is considered the “elixir of life” and has been sought after for its rejuvenating properties for millennia. Testicular extracts from animals were used by the ancient Chinese and the Romans for men’s health. The idea and practice of optimizing hormone levels for health benefits became more widespread when the acclaimed scientist and endocrinologist Dr. Charles Brown-Séquard regularly injected himself with testicular extracts in the late 1800s to restore vitality.
THE BENEFITS OF SALIVA HORMONE TESTING
If you could choose, would you rather spit into a tube or have a needle jabbed into your arm to measure your hormone levels? We suspect you would rather not get stuck with a needle, and you do have a choice! Saliva hormone testing offers many benefits, including painless collection in the comfort of your home at any time. Saliva hormone tests can help determine the underlying cause(s) of PMS, insomnia, anxiety, fatigue, infertility, migraines, weight gain, hot flashes, hair loss, and many other health concerns.
HIDDEN HORMONES IN PERSONAL CARE PRODUCTS
Have you noticed salivary hormone levels trending higher lately? We have certainly noticed this alarming trend in our lab! And we want to let you know we believe it is due to the presence of hidden hormones in personal care products (PCPs). Yes, bioidentical hormones are added to products without being listed as an ingredient. Manufacturers and raw material suppliers are not supposed to add ingredients to products without disclosing them, but; it does occur and seems to be occurring more frequently in recent months, according to our internal data and trends.
References:
- Gagliano-Jucá T, Alvarez M, Basaria S. The medicalization of testosterone: reinventing the elixir of life. Rev Endocr Metab Disord. 2022;23(6):1275-1284. doi:10.1007/s11154-022-09751-8
- Giagulli VA, Lisco G, Mariano F, et al. Is Testosterone the “Fountain of Youth” for Aging Men?. Endocr Metab Immune Disord Drug Targets. 2023;23(2):169-178. doi:10.2174/1871530322666220516160435
- Pompili A, Iorio C, Gasbarri A. Effects of sex steroid hormones on memory. Acta Neurobiol Exp (Wars). 2020;80(2):117-128.
- McHenry J, Carrier N, Hull E, Kabbaj M. Sex differences in anxiety and depression: role of testosterone. Front Neuroendocrinol. 2014;35(1):42-57. doi:10.1016/j.yfrne.2013.09.001
- Lucas-Herald AK, Touyz RM. Androgens and Androgen Receptors as Determinants of Vascular Sex Differences Across the Lifespan. Can J Cardiol. 2022;38(12):1854-1864. doi:10.1016/j.cjca.2022.09.018
- Handelsman DJ. Androgen Physiology, Pharmacology, Use and Misuse. [Updated 2020 Oct 5]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279000/
- Alemany M. The Roles of Androgens in Humans: Biology, Metabolic Regulation and Health. Int J Mol Sci. 2022;23(19):11952. doi:10.3390/ijms231911952
- Guzelce EC, Galbiati F, Goldman AL, et al. Accurate measurement of total and free testosterone levels for the diagnosis of androgen disorders. Best Pract Res Clin Endocrinol Metab. 2022;36(4):101683. doi:10.1016/j.beem.2022.101683
- Tyagi V, Scordo M, Yoon RS, et al. Revisiting the role of testosterone: Are we missing something?. Rev Urol. 2017;19(1):16-24. doi:10.3909/riu0716
- Shea JL, Wong PY, Chen Y. Free testosterone: clinical utility and important analytical aspects of measurement. Adv Clin Chem. 2014;63:59-84. doi:10.1016/b978-0-12-800094-6.00002-9
- Franks S, Hardy K. Androgen Action in the Ovary. Front Endocrinol (Lausanne). 2018;9:452. doi:10.3389/fendo.2018.00452
- Bianchi VE, Bresciani E, Meanti R, et al. The role of androgens in women’s health and wellbeing. Pharmacol Res. 2021;171:105758. doi:10.1016/j.phrs.2021.105758
- Filatova VA, Rozhivanov RV. [ Features of hyperandrogenism in men]. Probl Endokrinol (Mosk). 2021;67(2):111-115. doi:10.14341/probl12732
- Grech A, Breck J, Heidelbaugh J. Adverse effects of testosterone replacement therapy: an update on the evidence and controversy. Ther Adv Drug Saf. 2014;5(5):190-200. doi:10.1177/2042098614548680
- Center for Drug Evaluation and Research. FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. U.S. Food and Drug Administration. February 26, 2018. Accessed May 8, 2023. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due.