Low LH and FSH with low-normal Testosterone

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drew_k

New Member
I'm a 34 year old man and here's my recent bloodwork, with lab's normal values in parentheses:

Total-T LC/MS/MS: 496 ng/dL (250-1100) [LOW NORMAL]
Estradiol: 16 pg/mL (< 39)
LH: 2.1 mIU/mL (1.5 - 9.3) [BARELY NORMAL]
FSH: 1.6 mIU/mL (1.6 - 8.0) [BARELY NORMAL]
Prolactin: 7.5 ng/mL (2.0 - 18.0)
TSH: 2.47 mIU/L (0.40 - 4.50)

As you can see my LH and FSH are at the low end of the normal range, and total T isn't that high considering I'm 34. I've been experiencing classic low-T symptoms for almost 3 years now. I have very poor erections, low libido, very rare morning erections, depression, lack of focus etc. I can't sleep properly, I wake up in the night with hot flushes and I've been lacking the usual zest for life so to speak. I've been prescribed Wellbutrin and Adderall recently to help with my symptoms but at a fundamental level I think I'm going down the wrong path. Up until around 31, I never had any issues focussing or sleeping...

Around 2 years ago I had visited a Urologist complaining of Erectile Dysfunction, so he got my hormones tested. The results then were:

Testosterone, total: 617 ng/dL (250 - 1100)
Testosterone, free: 113.5 pg/mL (35.0 - 155.0)
Estradiol: 20 pg/mL (< 39)
FSH: 1.8 mIU/mL (1.6 - 8.0) [BARELY NORMAL]
LH: 1.5 mIU/mL (1.5 - 9.3) [BARELY NORMAL]

Again my LH and FSH level were only borderline normal. Although the urologist gave me some samples of Cialis to try out which certainly helped, it didn't really fix the root of the issue. I still had low libido, fogginess, etc. I'm now at a point where I want to evaluate if TRT can be an option.

Questions:

1. What conditions can cause low LH and FSH levels with a "normal" testosterone level? I read that this can be due to tumors in Pituitary...
2. Are low LH and FSH levels enough to diagnose secondary hypogonadism, even when Testosterone level is normal or low normal?
3. Does one need to have fairly low level of Testosterone to be considered for TRT? Any advice is much appreciated.

Drew
 
Defy Medical TRT clinic doctor

Re-Ride

Member
With relatively high free T, low SHBG is suspect. Get it tested. Knowing that one is low SHBG is helpful particularly if you later go on TRT. You are unlikely to be prescribed TRT at this time. If insur coverage allows I would engage a competent MD who might be able to determine if the cause is low GrH or an unresponsive pituitary or something else. He might offer an alternative to boost natural T. And/or search for the multi-pronged "boost T naturally". Keep getting tested. Ideally you will avoid TRT as long as possible but get it when appropriate.
 
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