I need Help with these lab results

[buckleu]

I am 35 year-old male with quite small (2 cm) testicles. My body appearance is also that of a female body, with narrow waist and wide pelvis. I also have gynecomastia. I do not take any Testosterone supplements, or any other medications. I have attached latest lab results here, any suggestions would be highly appreciated.

 

[maxadvance]

Primary hypogonadism failure? Klinefelter syndrome? Gonads are/can not produce testosterone even though high levels of LH are doing their damndest to try and kickstart production. You need a good doctor. Call Defy ====)>>

 

[buckleu]

Thanks Max.

Total Testosterone 22.0 nmol/l (Normal 9.6 - 28.8 nmol/l) or 635 ng/dl, is with in normal limits.
FSH is also normal, while LH 12.5 microIUnit/ml (Normal 1.7 - 8.6) and Estradiol 44.6 pg/ml (Normal 8.0 - 43.0) are HIGH.

Wouldn't Total Testosterone low in case of primary hypogonadism like Klinefelter's Syndrome?

 

[maxadvance]

Thanks Max.

Total Testosterone 22.0 nmol/l (Normal 9.6 - 28.8 nmol/l) or 635 ng/dl, is with in normal limits.
FSH is also normal, while LH 12.5 microIUnit/ml (Normal 1.7 - 8.6) and Estradiol 44.6 pg/ml (Normal 8.0 - 43.0) are HIGH.

Wouldn't Total Testosterone low in case of primary hypogonadism like Klinefelter's Syndrome?

I misread the T levels then, must be out of USA tests, your 'excel' style graph fooled me, disregard my comments. Still, see a doc, especially if you don't feel right

 

[buckleu]

^Thanks, i will ask around for a good endocrinologist.

Anybody else, having any idea of what to make of these test results??

 

[Vettester Chris]

Your LH is a obviously a bit over the range ... Your physician should probably look a bit deeper into the pituitary, possibly run an MRI. Yes, you are producing endogenous testosterone, but I wouldn't rule out the possibility of one (1) of your testicles under producing, which could be prompting the increased LH on the feedback loop. Between a pituitary and testicular exam, you should find some answers ...

Can't make anything out of the E2, except the lab result being marked "High". Was this a Sensitive or Ultra-Sensitive assay, and do you have the ranges?

If TSH was a reliable marker for "all-things-thyroid", then it would be good, BUT, the TSH is anything but reliable. Free T3, Free T4, Reverse T3 and antibodies (TPO & TgAb) will be need to see a full picture on this. If FT3 is pooling, then TSH can reflect a "low normal" result, when in fact thyroid hormone is not adequately getting into the body. The ratio or RT3/FT3 can provide a better picture on this, along with comparing FT4 & FT3 and their respective reference range levels.

 

[buckleu]

Thanks a lot.

Are there any other endogenous sources of testosterone in the human body besides testicles??

I do have full facial hair and excessive body hair and male pattern baldness, so that probably means DHT is normal/high.

At the same time i have gynecomastia, and lack of virilization (masculinization) and almost a female body structure as mentioned above, so does that mean it is due to high Estradiol (testosterone converting more to estradiol)?

Estradiol 44.6 pg/ml HIGH (Normal 8.0 - 43.0). I would check with the lab if it is an ulrasensitive assay.

I hope there are some answers out there.

 

[Nelson Vergel]

How can you have lack of masculinization if you have body and facial hair?

You must mean that you have gynecomastia and fat around your hips?

What's your weight, height (please US units), and do you know your free T3 and free T4?

Is your gyno that or fat build up?

Your estradiol is not high specially considering it is over estimated using the immunoassay test.

 

[Vince]

Some men do gain weight around their hips and their stomachs stay slim. Hip fat is considered good fat, belly fat is bad fat for predicting heart disease.
Why hip fat is good, but pot bellies are bad https://www.newscientist.com/article/mg19826553.600-why-hip-fat-is-good-but-pot-bellies-are-bad/

 

[buckleu]

How can you have lack of masculinization if you have body and facial hair?

You must mean that you have gynecomastia and fat around your hips?

What's your weight, height (please US units), and do you know your free T3 and free T4?

Is your gyno that or fat build up?

Your estradiol is not high specially considering it is over estimated using the immunoassay test.

Thanks a lot for your reply.

I can send you a video of my body if you want as a private message.

I am 5' 10" tall and i weigh 168 Ibs/78 kgs.

I have development of breast tissue, rib cage narrows at the waist and then there is a wide pelvis with pelvic bones sticking outwards. There is fat in the lower belly and also the hips are round, but pelvis is mostly bony. I have very thick body hair on the chest/abdomen and also back/arms. Pelvic hair form a triangle with base upwards.

As i mentioned above, i have small testicles, they are soft and measure 2 cm at the most.

I was a chubby kid starting at 7-8 years and was also chubby at puberty (13 years) and remained fat till i was 16, that's when i decided to lose weight. But i regained all that weight and around 26-27 years of age i was 260 Ibs, i lost that weight around 3 years ago.

 

[buckleu]

Some men do gain weight around their hips and their stomachs stay slim. Hip fat is considered good fat, belly fat is bad fat for predicting heart disease.
Why hip fat is good, but pot bellies are bad https://www.newscientist.com/article/mg19826553.600-why-hip-fat-is-good-but-pot-bellies-are-bad/

I don't think i am one of those, i have a very disproportionate body for a man.

 

[buckleu]

I think i may have mild or Partial androgen insensitivity syndrome (PAIS). Only thing that goes against this diagnosis is thick facial and body hair?

 

[CoastWatcher]

Thanks a lot.

Are there any other endogenous sources of testosterone in the human body besides testicles??

I do have full facial hair and excessive body hair and male pattern baldness, so that probably means DHT is normal/high.

At the same time i have gynecomastia, and lack of virilization (masculinization) and almost a female body structure as mentioned above, so does that mean it is due to high Estradiol (testosterone converting more to estradiol)?

Estradiol 44.6 pg/ml HIGH (Normal 8.0 - 43.0). I would check with the lab if it is an ulrasensitive assay.

I hope there are some answers out there.

Outside of the United States you are unlikely to have a sensitive/ultra-sensitive assay run when estradiol is tested.

 

[buckleu]

One more test result came back...

Estrogen level 289 pg/ml HIGH (NORMAL FOR MALES 60-190 pg/ml).

Anyone has any idea what does it mean??

 

[Vince]

Yes, your estradiol is high. I wonder what the Sensitive assay for estrogen would be. Estradiol (standard vs. sensitive)

 

[CoastWatcher]

One more test result came back...

Estrogen level 289 pg/ml HIGH (NORMAL FOR MALES 60-190 pg/ml).

Anyone has any idea what does it mean??

You ran ESTROGEN (Total Estrogen?) rather than ESTRADIOL (Sensitive Assay)?

 

[buckleu]

You ran ESTROGEN (Total Estrogen?) rather than ESTRADIOL (Sensitive Assay)?

BOTH:

ESTRADIOL 44.6 pg/ml HIGH (Normal 8.0 - 43.0).

ESTROGEN 289 pg/ml HIGH (NORMAL FOR MALES 60-190 pg/ml).

 

[CoastWatcher]

What, to date, have your doctors raised for consideration as they are working up a diagnosis? Where do you live, what country?

 

[buckleu]

What, to date, have your doctors raised for consideration as they are working up a diagnosis? Where do you live, what country?

No recommendation yet, just many tests, they are waiting for Karyotype test. I get results from the portal. Next appointment is in March and that's when my primary doctor will refer to endo, if needed. I am in US.

 

[CoastWatcher]

No recommendation yet, just many tests, they are waiting for Karyotype test. I get results from the portal. Next appointment is in March and that's when my primary doctor will refer to endo, if needed. I am in US.

Do you have confidence in your doctor? There are excellent practitioners that members of this Forum could recommend.