HELP! What is wrong with me? (labs included)

[csnation1]

Hey guys I’m new here,

I’m a 29 year old Asian male, 140 lbs, and had a complete drop in sex drive when I was 25. My dick works perfectly fine in terms of erections but I just have zero sex drive.

Endo got me an MRI which shows I have a pituitary tumor. However, Total t and free T is solid, and even beyond the upper limit. My tumor is barely producing any prolactin in the first place at 21. He tested it 3 times and each time it’s about the same(around 20). So while I have a tumor it doesn’t seem to be suppressing my HTPA based on the labs.

I’m not sure what’s going on. My other theory is that given my history of Accutane use, my testosterone is not converting enough DHT due to inhibition if the 5-ar enzyme. Do you think that’s a possibility? I took the drug 13 years ago. Unfortunately I don't have DHt tested.

Or do I have some kind of neurotransmitter problem? Low dopamine?

Would I be a good candidate for TRT even though my levels are great?

Any input would help. Thank you!
—

Latest labs :
Pitutiary tumor confirmed 3.4 mm

Testosterone: 526 ng/DL (264 -916 ng/ dl)
Free T(direct): 32.5 pg / mL (9.3 26.5) H
Prolactin: 21.5 ng / ml (4.0 -15.2) H
SHBG: 42.5 nmol/L (16.5-55.9)
FSH: 3.1 mIU/ml (1.5 - 12.4)
LH: 5.8 mIU / mL (1.7 - 8.6)
Estradiol: 34.8 pg/mL (7.6 -42.6 pg/mL)

TSH, Ultrasensitive: 1.380 uIU/mL (0.270 -4.200)
Free T4: 1.47 ng/dL (0.93 - 1.70)
T3 Uptake 36.6 % (24.3 - 39)
Free T3: 3.29 pg/mL (2.00 - 4.40)
Thyroperoxidase AB TPO: 20 Iu/ML (<35)
Thyroxine Binding Globulin: 14 ug/mL (13.0 - 30.0)
Cortisol: 13.7

 

[pmgamer18]

Hi csnation and welcome.



I am Hypopituitary but due to a head injury so you are lucky I don't make any hormones.



You said your Prolactin is low but looking at your labs your high. I don't think you need to go on TRT.



Just treat your Prolactin and this should fix things. Also keep an eye on this try to get labs I do mine every 90 days. Things can change only treat things that need it.

Phil aka pmgamer

 

[Systemlord]

I doubt it's possible to have midrange Total T and very high Free T with SHBG high normal. It may be in error, I would do labs again to confirm.

According to your numbers, Free T percentage is 1.81 %, well below the 2-3% considered normal. You would have to have very low SHBG to have your Free T numbers.

Accutane has ruined countless people sex drives.

 

[Vince Carter]

Your Prolactin is high not sure if you typo'd that it's low or what but your test is high. High Prolactin is treated with Cabergoline.

 

[csnation1]

Thanks for the response guys.


Yes prolactin is high but just barely above upper range. Usually pituitary tumors cause prolactin levels to jump to values over 200 and cause much lower T levels. I got a second opinion from a urologist and he told me a prolactin value is 21.5 is hardly an issue and would not cause problems. That’s why I’m confused.

But I guess I have nothing to lose! I’ll try Cabergoline on a low dose and see if it helps.

 

[csnation1]

I doubt it's possible to have midrange Total T and very high Free T with SHBG high normal. It may be in error, I would do labs to confirm.

According to your numbers, Free T percentage is 1.81 %, well below the 2-3% considered normal. You would have to have very low SHBG to have your Free T numbers.

Accutane has ruined countless people sex drives.

Thanks for the reply. If it is a lab error, do you think the error is in the Free T value or in SHBG?

 

[Cataceous]

Elevated prolactin does suppress libido independently of its possible effects on testosterone.

If your free testosterone test was not equilibrium dialysis or LC/MS then I would disregard it and use the calculated value of 9-10 ng/dL, which is right at the threshold where guys can start to have problems. Your estradiol level should be confirmed via mass spectrometry. If it is correct then it is a little high relative to your testosterone.

 

[pmgamer18]

I forgot to say if you had an orgasm a few days before you didi your labs they can

show higher.



Phil

 

[Systemlord]

Thanks for the reply. If it is a lab error, do you think the error is in the Free T value or in SHBG?

The only way to rule out lab error is to run the exact same labs, that way you can compare them side by side. Total T, Free T and SHBG are intertwined because SHBG influences Total T, Free T, estrogen, thyroid hormones and even insulin.

I believe Free T is in error and would be shock if Free T wasn't in error.

The Roche ECLIA methodology is the incorrect estrogen testing for men, this test in men picks up on other steroids (C-reactive protein) as estrogen and falsely elevates estrogen, you need the Liquid Chromatography–Mass Spectrometry or LC/MS/MS sensitive method.

The range is a dead giveaway.

 

[CoastWatcher]

A prolactin reading of 22.0 essentially wiped out my father’s libido. A small dose of cabergoline restored it. Recognizing that each of us is different, I’d not dismiss your prolactin value quite as quickly as your doctors seem to.

 

[csnation1]

A prolactin reading of 22.0 essentially wiped out my father’s libido. A small dose of cabergoline restored it. Recognizing that each of us is different, I’d not dismiss your prolactin value quite as quickly as your doctors seem to.

Wow that gives me hope thanks for sharing. Do you know what his T was? And what dose of caber did he take?

 

[CoastWatcher]

Wow that gives me hope thanks for sharing. Do you know what his T was? And what dose of caber did he take?

This happened many years ago, in the Dark Ages of androgen replacement. He was, without a doubt, hypogonadal and still was dealing with the loss of libido following restoration of something approaching therapeutic testosterone levels. I know for a certainty that cabergoline helped significantly.

My point is that libido - as is stressed here regularly - is a complex phenomenon; subtle changes can have a significant impact (on the positive and negative side of the ledger). I don’t have any idea what his dose of cabergoline was, and you don’t want to crush your prolactin. But...I’d take another long look at that value.