31yo. Pre-TRT bloods. Low free test, low LH, high prolactin, albumin, SHBG

[akenbake24]

Hello everyone. I have been experiencing low libido, high refractory period, brain fog, low motivation, and just generally not as energetic as I used to in my early-mid 20s. I booked an initial consult with a TRT clinic that ordered a bunch of labwork. Before I have the consult, I'm wondering what the community thinks about my numbers.

I have high albumin. I don't eat a super high protein diet and I drink a lot of water so I shouldn't be dehydrated, so I don't know what could be causing this.

I had my testosterone tested 3 years back and it was 400 ng/dL, so I am very happy to see it is now at 460. Although, I know this is still considered low end of normal for my age. My free testosterone is LOW. Could my high end SHBG and Albumin levels be causing this? My Estradiol level is the low end of normal, but perhaps this is simply because my Free Test level is too low?

Also, my LH levels seems pretty low. My Prolactin level is HIGH and I didn't ejaculate 24-48 hrs before the test, so I'm wondering what could cause this as well.

I added my Thyroid bloodwork as well since it is often asked for in other posts I see.

I would rather not start TRT, but am willing to if it is the appropriate answer to my problems and labwork. Please let me know what you think. Thanks!


31 year old male
5' 9"
165 lbs


Albumin - HIGH
5.2 (4.0 - 5.0) g/dL

A/G Ratio
2.1 (1.2 - 2.2)



Testosterone
460 (264-916) ng/dL

Free Testosterone (Direct) - LOW
7.8 (8.7 - 25.1) pg/mL

Estradiol, Sensitive
11.8 (8.0 - 35) pg/mL

Luteinizing Hormone (LH)
1.9 (1.7 - 8.6) mIU/mL

DHT
45 (30 - 85) ng/dL

DHT, Percent Free
1.10 (0.54 - 2.58)

DHT, Free
4.95 (2.30 - 11.60) pg/mL

Prolactin - HIGH
18.4 (4.0 - 15.2) ng/mL

SHBG, Serum
40.6 (16.5 - 55.9) nmol/L

DHEA-Sulfate
403 (138.8-475.2) ug/dL




TSH
2.81 (0.45 - 4.50) uIU/mL

T4 Free, Direct
1.44 (0.82 - 1.77) ng/dL

T3 Free
3.6 (2.0 - 4.4) pg/mL

Reverse T3, Serum
19.7 (9.2 - 24.1) ng/dL

Thyroid Peroxidase (TPO) Ab
<8 (0 - 34) IU/mL

Thyroglobulin Antibody
<1.0 (0.0 - 0.9) IU/mL

 

[Cataceous]

You're wise to want to avoid TRT, but your testosterone is low enough to potentially be causing your symptoms. Elevated prolactin can suppress testosterone on its own, and independently reduce libido. But yours is only modestly elevated. Your provider may be able to tell you how likely it is that this is a significant contributor to your problems. You might retest, and if it's still elevated it could be worth a trial with low doses of cabergoline.

Sometimes estrogen is a driver of higher prolactin, but that's not the case with you. Your E2/T ratio of 0.26% is on the low side, and is something to monitor if you begin some kind of treatment.

Otherwise, or in addition, I suggest looking at a nasal testosterone gel product. These include Natesto, and Empower also makes one. The nice thing about these is that they don't interfere too much with your natural testosterone production. You get the possible benefits of higher testosterone without the drawback of suppressed HPTA function that's common with conventional TRT. At the least it can help determine if low testosterone is the main problem.

 

[akenbake24]

My total testosterone seems ok, although it is on the low side of normal. On the other hand, my free testosterone is clinically LOW. My understanding is that LOW free T in the presence of normal Total T is caused by high SHBG+Albumin levels. Do mine look too high? Should I first explore trying to lower my SHBG/Albumin? Thanks!

 

[madman]

Hello everyone. I have been experiencing low libido, high refractory period, brain fog, low motivation, and just generally not as energetic as I used to in my early-mid 20s. I booked an initial consult with a TRT clinic that ordered a bunch of labwork. Before I have the consult, I'm wondering what the community thinks about my numbers.

I have high albumin. I don't eat a super high protein diet and I drink a lot of water so I shouldn't be dehydrated, so I don't know what could be causing this.

I had my testosterone tested 3 years back and it was 400 ng/dL, so I am very happy to see it is now at 460. Although, I know this is still considered low end of normal for my age. My free testosterone is LOW. Could my high end SHBG and Albumin levels be causing this? My Estradiol level is the low end of normal, but perhaps this is simply because my Free Test level is too low?

Also, my LH levels seems pretty low. My Prolactin level is HIGH and I didn't ejaculate 24-48 hrs before the test, so I'm wondering what could cause this as well.

I added my Thyroid bloodwork as well since it is often asked for in other posts I see.

I would rather not start TRT, but am willing to if it is the appropriate answer to my problems and labwork. Please let me know what you think. Thanks!


31 year old male
5' 9"
165 lbs


Albumin - HIGH
5.2 (4.0 - 5.0) g/dL

A/G Ratio
2.1 (1.2 - 2.2)



Testosterone
460 (264-916) ng/dL

Free Testosterone (Direct) - LOW
7.8 (8.7 - 25.1) pg/mL

Estradiol, Sensitive
11.8 (8.0 - 35) pg/mL

Luteinizing Hormone (LH)
1.9 (1.7 - 8.6) mIU/mL

DHT
45 (30 - 85) ng/dL

DHT, Percent Free
1.10 (0.54 - 2.58)

DHT, Free
4.95 (2.30 - 11.60) pg/mL

Prolactin - HIGH
18.4 (4.0 - 15.2) ng/mL

SHBG, Serum
40.6 (16.5 - 55.9) nmol/L

DHEA-Sulfate
403 (138.8-475.2) ug/dL




TSH
2.81 (0.45 - 4.50) uIU/mL

T4 Free, Direct
1.44 (0.82 - 1.77) ng/dL

T3 Free
3.6 (2.0 - 4.4) pg/mL

Reverse T3, Serum
19.7 (9.2 - 24.1) ng/dL

Thyroid Peroxidase (TPO) Ab
<8 (0 - 34) IU/mL

Thyroglobulin Antibody
<1.0 (0.0 - 0.9) IU/mL

Unfortunately, you had your FT tested using the piss poor direct immunoassay which is known to be inaccurate.

The only way to know where your FT truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

Sure you can also use the older outdated calculated methods but I would not rely upon such especially in cases of altered SHBG.

Although your TT 460 ng/dL would seem far from low your SHBG is highish 40.6 nmol/L and Albumin slightly elevated 5.2 g/dL so your FT would most likely be low and definitely suboptimal!

Too many doctors let alone men looking into starting trt get caught up on TT and although it is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Even then many of the doctors let alone men on trt are using/relying upon inaccurate assays when testing FT.

Critical to use accurate assays when testing.

Excess (very high) levels of prolactin can have a negative impact on libido.

Prolactin <425 µg/L (20 ng/mL) in most cases would not be a cause for concern.

Comes down to the individual and although yours is slightly elevated it is far from being considered absurdly high.

 

[akenbake24]

Thanks for the info. Since my prolactin is elevated but not very high, I think my symptoms likely are due to either Low Free T or Low E2.

Is the low LH of any concern? Are the thyroid levels ok?

I'm wondering if HCG monotherapy would be more appropriate than TRT for me since my Total T isn't too bad and my LH is very low. I'm thinking I am secondary hypogonadal.

 

[Systemlord]

Could my high end SHBG and Albumin levels be causing this?

Should I first explore trying to lower my SHBG/Albumin?

A lot of guys that end up with an elevation in SHBG fail to lower it to a meaningful degree if at all, you might not think it's very high, but you also have high albumin which also binds T.

Also an elevation in SHBG can be the direct result of low-T.

I'm wondering if HCG monotherapy would be more appropriate than TRT for me since my Total T isn't too bad and my LH is very low.

HCG isn't a very good alternative to TRT, most report feeling better when switching over to TRT.