An Unusual Case of Elevated Testosterone: When Testosterone by Dialysis Saves the Day

TL;DR

A man with high testosterone levels and hair loss had normal results after a dialysis test, showing the importance of accurate testing methods.

Contribution

Demonstrates the value of equilibrium dialysis in resolving discrepancies in testosterone testing.

Findings

The patient's total testosterone was elevated, but dialysis showed normal levels.

Equilibrium dialysis clarified the discrepancy in testosterone measurements.

Varied testosterone-protein binding affinity can lead to misleading lab results.

Abstract

This case reviews an uncommon clinical scenario in which a markedly elevated total testosterone was detected in the setting of a complaint of hair loss in a male. Clinically, the patient had no other manifestations of elevated testosterone and did not have any notable supplement use that would explain such aberrant values. Due to concerns for potential malignancy, imaging was pursued that failed to show a source. Given the discordance in his lab values and his workup, a testosterone by dialysis was pursued that returned with reassuringly normal range testosterone levels, highlighting the impact of varied testosterone-protein binding affinity among humans and the ongoing value of equilibrium dialysis as a laboratory technique.

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