Blood work help (Low T, Low E2, High Prolactin) - What's going on?

[jjjj1909]

29 yr old male. Athletic/muscular 5 foot 9, 185 lbs

Labs below. Any ideas whats going on with me? Have been having low T type symptoms like loss of libido, weight gain, emotional, anxiety, lack of motivation and not finding things fun that I used to find fun. Any help is much appreciated.

Thanks

Total T: 363 ng/dL (range 264 - 916)
Free T: 13.7 pg/mL (range 8.7 - 25.1)
Prolactin: 44.1 (range 4.0 - 15.2)
TSH: 4.31 uIU/mL (range 0.450 - 4.50)
FSH: 5.6 mIU/mL (range 1.5 - 12.4)
IGF-1: 160 ng/mL (range 98 - 292)
Estradiol, Sensitive: 14.5 pg/mL (range 8.0 - 35.0)
SHBG: 23.7 nmol/L (range 16.5 - 55.9)
LH: 8.7 miU/mL (range 1.7 - 8.6)
Glucose: 87 mg/dL (range 65-99)
Reverse T3, Serum: 16.2 ng/dL (range 9.2 - 24.1)
T4, Free: 1.38 ng/dL (range 0.82 - 1.77)
T3, Free: 3.3 pg/mL (range 2.0 - 4.4)
DHEA-Sulfate: 480.9 ug/dL (range 138.5 - 475.2)

 

[MarkM]

Looks like you may have primary hypogonadism. The HPTA is generating LH an FSH but the testes are not producing testosterone like they should be.

It also looks like you have a thyroid issue going on. Your TSH is very high and your Reverse T3 is on the high side even though both the TSH and Reverse T3 are within range. T3 should be a little higher. You should have both of your thyroid antibodies tested. An under performing thyroid can give someone low T symptoms. Hypothyroidism is becoming very common, I actually think I am having some thyroid issues myself.

 

[jjjj1909]

Looks like you may have primary hypogonadism. The HPTA is generating LH an FSH but the testes are not producing testosterone like they should be.

It also looks like you have a thyroid issue going on. Your TSH is very high and your Reverse T3 is on the high side even though both the TSH and Reverse T3 are within range. T3 should be a little higher. You should have both of your thyroid antibodies tested. An under performing thyroid can give someone low T symptoms. Hypothyroidism is becoming very common, I actually think I am having some thyroid issues myself.

Thanks for the response. How does the sky high prolactin levels fit into this?

 

[MarkM]

Thanks for the response. How does the sky high prolactin levels fit into this?

Do you have breast and/or nipple tenderness? Prolactin level that high should be looked into and you should discuss with your doctor. It is not normal and it could be a signal of a tumor on the pituitary gland. It could very well be something else too and I would not rule out a lab error. But, you should check it out.

A prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactinomas are the most common type of pituitary tumor. Symptoms of prolactinoma are caused by hyperprolactinemia—too much prolactin in the blood—or by pressure of the tumor on surrounding tissues.

 

[jjjj1909]

Do you have breast and/or nipple tenderness? Prolactin level that high should be looked into and you should discuss with your doctor. It is not normal and it could be a signal of a tumor on the pituitary gland. It could very well be something else too and I would not rule out a lab error. But, you should check it out.

A prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactinomas are the most common type of pituitary tumor. Symptoms of prolactinoma are caused by hyperprolactinemia—too much prolactin in the blood—or by pressure of the tumor on surrounding tissues.

Got it thanks. Could a potential tumor or high prolactin be what is holding my T levels down?

 

[MarkM]

Got it thanks. Could a potential tumor or high prolactin be what is holding my T levels down?

Based on your LH and FSH it appears that the pituitary is working, at least to some degree but I don't believe that would impact your t levels being low. I believe you can have both high prolactin and high testosterone. For me though, when my prolactin goes up a little bit I notice my t comes down. Might just be a coincidence and I have never had prolactin that high. Highest mine has been is around 12.

Maybe someone more knowledgeable will weigh in with their insight.

 

[Systemlord]

You need to run a thyroid antibody test, current labs don't explain why TSH is elevated. Your pituitary is working beautifully and testicles aren't responding to LH stimulation, testicles are failing. Prolactin is a concern and may be the smoking gun.

Any TRT protocol needs to focus on frequent injections since SHBG is lower, smaller injections EOD is guaranteed to show great results.

 

[Vince]

One common cause of hyperprolactinemia is a growth or tumor on the pituitary gland called a prolactinoma. The tumor produces highlevels of prolactin. These tumors can be large or small and are usually benign, meaning they are not cancerous. Large tumors can alsocause headaches, vision problems, or both.
Hyperprolactinemia | Hormone Health Network
Hormone Health Network › pituitary › h...

 

[jjjj1909]

You need to run a thyroid antibody test, current labs don't explain why TSH is elevated. Your pituitary is working beautifully and testicles aren't responding to LH stimulation, testicles are failing. Prolactin is a concern and may be the smoking gun.

Any TRT protocol needs to focus on frequent injections since SHBG is lower, smaller injections EOD is guaranteed to show great results.

Is this Thyroglobulin Antibody? If so I did run that. Result was <1.0 IU/ml on range 0.0 - 0.9

Also TPO: 14 IU/mL on range 0 - 34

 

[MarkM]

Is this Thyroglobulin Antibody? If so I did run that. Result was <1.0 IU/ml on range 0.0 - 0.9

Also TPO: 14 IU/mL on range 0 - 34

Yes, those are the two antibodies we are talking about. The thyroglobulin antibody is normal and the TPO antibody is just below where you ant it. You really don't want it higher than 15.