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Endogenous Testosterone and B12 Therapy have increased levels to the Alarm High in the FHR. What is the effect of this on other biomarkers?

Elevated testosterone and elevated vitamin B12 should be assessed further.

We are assuming the high testosterone is in a male… in a female, it may be a sign of PCOS.

The first question would be whether it’s truly endogenous testosterone causing the alarm high range or is the patient taking exogenous testosterone?

If taking exogenous testosterone then results need to be referred back to the monitoring physician. Elevated endogenous testosterone can be due to tumor production so a full workup may be indicated.

Nassar, George N. and Stephen W. Leslie. “Physiology, Testosterone.” StatPearls, StatPearls Publishing, 9 January 2021. [R]

Higher serum testosterone is associated with higher hemoglobin, hematocrit, red blood cell volume, and HDL-cholesterol, and associated with lower uric acid, triglycerides, triglyceride to HDL index, and total to HDL cholesterol ratio.

Interestingly, low testosterone and poor testicular function were associated with an unhealthy Western-style dietary pattern. This pattern was characterized by an abundance of deep-fried foods, organ meats, processed meat or fish, rice or flour products cooked in oil as well as a deficit of dairy products, legumes, and dark or leafy vegetables.

Kurniawan, Adi-Lukas et al. “Association of Testosterone-Related Dietary Pattern with Testicular Function among Adult Men: A Cross-Sectional Health Screening Study in Taiwan.” Nutrients vol. 13,1 259. 18 Jan. 2021, doi:10.3390/nu13010259 [R]

Serum B12 may be elevated if the patient is taking too much supplemental B12, or if the circulating B12 is not getting into the cells or being processed normally, causing a functional deficiency. Other reasons can include:

  • Increased transport proteins, or a hematological or autoimmune process.
  • Chronic disorders such as renal failure, cancer, or hepatic disease
  • Critical illness and, when combined with an elevated CRP, may be associated with poorer outcomes and mortality.
  • Disease state including leukemia, polycythemia vera, and hypereosinophilic syndrome.
  • Assess for other markers of B12 if a functional deficiency is suspected.
    • Increased MCV, homocysteine, and methylmalonic acid
    • Low holotranscobalamin
    • Assess folate status as well, as B12 and folate are interdependent.

Vollbracht, Claudia et al. “Supraphysiological vitamin B12 serum concentrations without supplementation - the pitfalls of interpretation.” QJM : monthly journal of the Association of Physicians, hcz164. 28 Jun. 2019, doi:10.1093/qjmed/hcz164 [R]

Andrès, E et al. “The pathophysiology of elevated vitamin B12 in clinical practice.” QJM : monthly journal of the Association of Physicians vol. 106,6 (2013): 505-15. doi:10.1093/qjmed/hct051 [R]

Ermens, A A M et al. “Significance of elevated cobalamin (vitamin B12) levels in blood.” Clinical biochemistry vol. 36,8 (2003): 585-90. doi:10.1016/j.clinbiochem.2003.08.004 [R]