Misdiagnose?

[Raindog]

Hi-

I was diagnosed with secondary hypogonadism in '18 based on these labs:

LH (1.5-9.3 IU/L) 2.5
Testosterone (241 - 827 ng/dL): 292
Free Testo (47-244 pg/ml): 35
% Free Testo (1.6-2.9%): 1.2%
SHBG (15.0-87.0 nmol/L): 66.3
Prolactin (2.1-17.7 ng/ml):
Estradiol 17-B (<=40 pg/ml):

Ive never felt right on TRT, trialed several dosages and protocols. I ended up switching PCP's, (tried Defy for a few months in between) & eventually my new PCP sent me to an Endo in '20. After reviewing my initial labs from '18 the Endo advised I was missed diagnosed initially. I was still w/ Defy at the time and I think the Endo hated that. Advised me to get off trt for 3 months and get tested. After three months off my results from my new doctor:

LH (1.5-9.3 IU/L): 4.5
Testosterone (241 - 827 ng/dL): 270
FSH (1.4-18.1): 6.3

I felt a little better in someways but in most ways I felt awful. I kept my PCP but found a Naturalpath doc to get me back onto TRT. But I still don't feel great. I worry about my pituitary causing other symptoms. I don't think Im regulating fluids well, I think its causing mental health shit and freaking me out a little. Diabetes Insipidus specifically.

Question is- when I stopped TRT my LH almost doubled compared to my diagnosed lab work in /18. Is that indication that my pituitary is working properly and my problems is most lilley in my balls and not my brain? Or does LH test results tell us anything at all in this case?

I ran it by my Naturalpath and he said... "you want to get off it? I can help you with that but I don't think you'll be happy" which really didn't answer my concern directly....

I understand the test results from my new PCP are too limited for a broader discussion. Its all he ran and then I ran from him to the naturalpath. But the LH and pituitary, can we tell from just that?

Dave

 

[Cataceous]

LH is delivered in pulsatile fashion, so you shouldn't read too much into variations in test results from low-normal to normal. Overall your lab numbers do suggest hypogonadism, and the normal LH values suggest that testicular dysfunction is not the cause. Do you have measurements for prolactin and estradiol? High levels of either could point to an underlying cause. For completeness it can be good to get some other tests. In particular you want to ensure thyroid function is ok and that you don't have pathologically low levels of vitamin D or zinc.

If no treatable underlying cause is found—a common occurrence—then I suggest taking a step back and considering less intrusive forms of therapy. These include a trial with either testosterone nasal gel or enclomiphene. Either of these options should be less disruptive of your overall hormonal situation than regular TRT.

 

[Systemlord]

But the LH and pituitary, can we tell from just that?

A high LH would point to primary hypogonadism, secondary is lower LH. You don't know if LH is consistently spiking upwards, so one value doesn’t tell you much.