Highest Testosterone Concentration Ever: Pathology or Laboratory Error?

madman

Super Moderator
CASE DESCRIPTION The laboratory obtained a testosterone result of 30 117 ng/dL for a 51-year-old man and called the medical director to assess whether this value was feasible because it would represent the highest testosterone concentration ever reported by the laboratory. The patient was an avid runner with a history of a right testicular mass and orchiectomy 10 years previously. The patient was supplemented with testosterone cypionate (200 mg/2 weeks). The results for follicle stimulating hormone and luteinizing hormone were unremarkable.


QUESTIONS

1. What conditions are associated with the extremely high testosterone concentrations?

2. Could exogenous testosterone account for this concentration?

3. If pathological, what is the prognosis for patients with this condition?




ANSWER
Increased testosterone concentrations are seen in individuals with exogenous testosterone supplements and sex hormone–producing adrenal tumors. At supraphysiological doses, exogenous supplements could raise serum testosterone concentrations by approximately 2- to 6-fold (1–3).This patient had a metastatic Leydig cell tumor diagnosed 5 years post orchiectomy. Testosterone concentrations began to increase dramatically around this time (Fig. 1). Malignant Leydig cell tumor is refractory to chemotherapy and radiotherapy (4). The median survival time of patients with malignant Leydig cell tumor is 2 years (5).
 

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My TT came back at 7579 ng/dl on a 50mg Testogel daily application. Naturally I was quite concerned (The online doctor just advised me to cut my steroid intake lol).

My follow up TT came back at 720 ng/dl which is more in keeping with the protocol I was on at the time.

I found it quite disconcerting that the endo wasn't worried about such a high T level and gave no advice but to 'cut my steroid use' even though he knew I was on a TRT regime of Testogel only.
 

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