High Testosterone / Hypergonadism and Male Infertility

The Relationship between elevated testosterone levels and male infertility problems

Baseline elevated testosterone levels are defined as being over 1,000 ng/dL. Management of elevated testosterone levels depends on the results of LH testing.

Possible scenarios include:

Elevated testosterone plus normal LH (1.0–8.0 IU/L)

Some men just naturally make high levels of testosterone, and in these men the LH is typically within the normal range. In this situation, I recommend checking the FSH to make sure that it is not suppressed (under 1.0 IU/L). If the LH and FSH are both normal and the patient is not taking any hormonally active medications or supplements, then I would not recommend any hormonal treatment. I would, however, recommend monitoring hematocrit level, since a total testosterone of over 1,000 ng/dL can increase the risk of erythrocytosis (see “Erythrocytosis/Polycythemia” section of this website for more information).

Elevated testosterone plus low LH (under 1.0 IU/L)

Elevated blood testosterone levels can suppress pituitary production of LH. The most common cause is the use of exogenous androgens in the form of prescription hormone replacement, anabolic steroids, or prohormone/T booster supplements (see “Exogenous Androgens” section for more information)

If no exogenous androgens are being used and the LH is still found to be suppressed upon repeat testing, then I would be concerned about another source of excess androgen production, such as an androgen-secreting tumor of the adrenal glands or testicles. Overactivity of the adrenal glands such as congenital adrenal hyperplasia can also cause elevated testosterone and suppressed LH levels. These men should have an evaluation by an endocrinologist as well as imaging studies of the adrenal glands (MRI or CT scan with contrast) and the testicles (scrotal ultrasound).  See "Medical Conditions and Male Fertility" section for more information on congenital adrenal hyperplasia.

Elevated testosterone plus high LH (over 8.0 IU/L)

Partial androgen insensitivity syndrome (AIS) is rare, but it can be a cause of elevated testosterone levels and LH. See the "Medical Conditions and Male Fertility" section (link above) for more information on AIS.