Significance of High Testosterone

The 3 most common reasons for high testosterone are:

  • Polycystic Ovarian Syndrome (PCOS)–this is if you are PRE-menopause
  • Over-zealous testosterone therapy (either pre or post menopause)
  • Poor testosterone metabolism (either pre or post menopause)


PCOS is a condition with irregular periods, infertility, insulin resistance and high androgens (like testosterone). The more I learn about PCOS the more I think it’s mostly affected by insulin resistance. The high androgens are a byproduct.

Overzealous Testosterone Therapy

Regarding too much testosterone in hormone therapy, I see this sometimes in new patients that were working with another provider prior to seeing me. I’ve seen them come on with VERY high doses of testosterone. When asked why, the women often say that they weren’t feeling better with the dose they were on so their provider kept raising the dose, without checking levels and looking at the whole picture. Unfortunately this way of thinking didn’t do the women any favors.

Poor Testosterone Metabolism

The metabolite of testosterone, Dihydrotestosterone (DHT), is responsible for the unwanted androgenic effects like acne and whiskers. The enzyme that triggers this pathway is more active in insulin resistance and obesity.

Are you getting the sense that the body is intimately connected? YES!!! All the hormones interact like a symphony! High insulin leads to high testosterone, and the negative side of testosterone (like acne and whiskers) not the fun stuff (like libido and decision making). And then high testosterone leads to higher insulin… Yikes, what a vicious cycle it can be!

In order to further evaluate what’s going on, here are the tests I suggest:

  • Serum total and free testosterone
  • Sex hormone binding globulin
  • Fasting insulin and blood sugar
  • Insulin and blood sugar levels both 1 and 2 hours after a sugar-load
  • Hemoglobin A1C
  • Urine hormones for testosterone metabolism
  • Cortisol curve testing (several points throughout the day, because timing matters; urine or saliva is best)
  • DHEA

Of course, it’s important to know what to do with the results… Here is where I believe it’s important to work with someone that understands the difference between “normal range” and optimum. They are NOT the same! Normal range is 9 out of 10 people–seriously! Here are some disturbing facts about normal range:

  • Normal range is determined by lab companies, not doctors
  • Normal range is a statistical equation
  • Normal range is set to include 90% of the population
  • Normal range differs between labs and among the same labs across geographic locations

Consider this closely–do you honestly think that 90% of the population is thriving? I don’t! Maybe 10%. So do you want to be like 90% of the population? I don’t, and I don’t want that for you! I want you to THRIVE! When your doctor tells you that your labs are normal does that mean you are truly healthy? Truth is… not necessarily! Maybe, but maybe not! You have to compare your labs with OPTIMUM in order to know if you are healthy. And I hope we can agree that OPTIMUM is a much narrower range than “normal”…

So if you plan to get tested, make sure you are working with a provider that can guide you towards OPTIMUM and not just say “Your labs are normal.”

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