Odd results, high FSH, high LH but normal testosterone

[Nankie]

Hi

I'm a 46 year old man and I've had a series of strange hormone results over the last few years, although I have been discharged from the endocrinolgist I still have unanswered questions, as does my doctor. In fact, I was told I was in the normal range even though i clearly haven't been.

I have high FSH which has ranged between 403 ng/dl to 5912 ng/dl. My LH has been between 314 ng/dl to 695 ng/dl but my testoserone is always at a good level, currently 496 ng/dl but this has dropped from 648 ng/dl in three years. My free testosterone is also low but that doesn't seem to be an issue in the UK from what I can gather.

Other issues I've had is recurrent prostate infections, kidney infections and water infections which often cause my left testicle to swell about 4/5 times its normal size. When not ill my testicles are small and I had a late pubity at 21, I've had an enlarged prostate (on and off) since being a teenager. My body is unusually smooth, I'm unable to grow a proper beard and my joints ache but there's no swelling. I'm constantly fatiuged and I have poor sleep.

I recently paid for some private blood tests and I've got a follow up apointment with a GP but after the brief conversation I've already had, and the conversations with other doctors I know he is at a loss as to the cause of these test results. I'm looking to see if anyone else has had similar results to try to understand if this is the cause of my phisical issues/fatiuge etc. Any help and advice either way would be very useful.

Many thanks

 

[Systemlord]

have high FSH which has ranged between 403 ng/dl to 5912 ng/dl. My LH has been between 314 ng/dl to 695 ng/dl but my testoserone is always at a good level, currently 496 ng/dl but this has dropped from 648 ng/dl in three years.

I would post your labs because you seem confused about the difference between LH and Total T.

I'm constantly fatiuged and I have poor sleep.

This is a common symptom of low-T.

My free testosterone is also low but that doesn't seem to be an issue in the UK from what I can gather.

Guidelines on Adult Testosterone Deficiency, with Statements for UK Practice

A concise summary of BSSM advice on the symptoms, diagnosis, and management of testosterone deficiency and the benefits and risks of treatment

www.guidelines.co.uk

• BSSM guidelines also state:
  • a FT level lower than 225 pmol/l (0.225 nmol/l) provides supportive evidence for testosterone therapy in the presence of appropriate symptoms

If your Free T is low, then your testosterone isn't at a good level. Also you can experience symptoms sooner than these cutoffs, because no consensus has been reached showing a clear threshold for TT or free T defining a testosterone deficiency.

The UK (NHS) is still in the stone ages with regards to male sex hormones.

You need a private clinic like Balance My Hormones or Men's Health Clinic.

 

[Interrestingly]

I'm 27 and interestingly I had similar labs from 4 years ago. My LH and FSH were high but my Total T and Free T were both within normal limits. I always had visceral obesity, poor beard and muscle growth, fatigue and, even more recently, low sperm count. So I'm confused as well. My doctor dismissed those symptoms in the past, and I'm concerned that it maybe an issue for me, as I developed prediabetes (despite being thin, apart from the visceral obesity that I have). I am trying to reestablish with another doctor and see if I can get repeat labs and perhaps a better answer.

Please update us if you get an answer. Thanks

 

[Systemlord]

My LH and FSH were high but my Total T and Free T were both within normal limits.

Unfortunately, no consensus has been reached regarding the lower TT threshold defining TD, and there are no generally accepted lower limits of normal TT [60]. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not.

Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men - PMC

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter ...

www.ncbi.nlm.nih.gov

More Science-Based "Low Normal" Testosterone Facts

• "Low normal" total testosterone concentrations are associated with reductions in motivation, initiative, self-confidence, concentration and memory, sleep quality, muscle bulk and strength, diminished physical or work performance, feeling sad or blue, depressed mood, mild anemia, and increased body fat and body mass index.
• Low normal serum testosterone concentrations are associated with reduced male sexual desire, function, performance and potency.
• Low normal serum testosterone concentrations increase the risk for premature death from any cause.
• Low normal serum testosterone concentrations increase the risk for death from cardiovascular disease, and increase the combined risk for suffering a first stroke or first transient ischemic attack.
• Low normal serum testosterone concentrations increase the risk for both memory loss and developing clinical depression.
• Low normal serum testosterone concentrations increase the risk of developing an increased level of systemic inflammation.

Defining "Healthy" Testosterone

Multiple peer-reviewed papers state that "testosterone deficiencies" are more prevalent and "desirable testosterone" levels in men are actually much higher than what is currently being considered as "normal" in doctors' practices across the country. Case in point: A cross-sectional study of Swedish men ages 69 to 80 years showed the risk for premature death from any cause26 and the risk for suffering a major cardiovascular event were inversely correlated with the total serum testosterone concentration (i.e., the higher the testosterone levels, the lower the risk of death).

Specifically with regards to cardiovascular events, men in the highest quartile of testosterone (at or higher than 550 ng/dL) had a lower risk of cardiovascular events compared with men with lower testosterone.

More importantly, details from this study show that it did not matter if a man's total testosterone was very low (below 340 ng/dL ) or moderately low (up to 549 ng/dL ) – all men with T levels below 549 ng/dL had a similar increased risk for suffering a cardiovascular event. Only when total testosterone exceeded 550 ng/dL did cardiovascular risk drop.

This is truly alarming, as cardiovascular disease is the No. 1 killer of men in the United States and even more – this study was published in the Journal of the American College of Cardiology. These researchers documented a 30 percent reduction in cardiovascular events as well as a decrease in cerebrovascular disease incidence. Men with the highest total testosterone had a 24 percent reduced risk of transient ischemic attack or full-blown stroke. Clearly, based on this study, the only target for "healthy testosterone" is to maintain total testosterone at or above 550 ng/dL.

 

[Interrestingly]

Informative thread! My testosterone levels 4 years ago was 528 ng/dL. That maybe a reason to initiate TRT. Thank you!

 

[Cataceous]

Informative thread! My testosterone levels 4 years ago was 528 ng/dL. That maybe a reason to initiate TRT. ...

No, it's not a reason to start TRT. You need to measure free testosterone by equilibrium dialysis, or at least test SHBG along with total testosterone to estimate free testosterone. Studies based on total testosterone as referenced above are potentially confounded by problems linked to low SHBG. Based on your description it seems possible that your SHBG is low. If so it would imply your natural testosterone production is adequate, and you should instead be focusing on other ways to avoid metabolic syndrome.

I would post your labs because you seem confused about the difference between LH and Total T....

Or you're just unaware that LH and FSH can be measured in ng/dL.

 

[JmarkH]

Informative thread! My testosterone levels 4 years ago was 528 ng/dL. That maybe a reason to initiate TRT. Thank you!

I'm 63 and had similar labs results with all the ADAM symptoms. I too, was 35 pounds heavier than I should be and considered prediabetic. My men's health provider chose not TRT but HCG and Clomid. That helped dramatically with the symptoms and bumped me up from high 500 TT to mid 700 TT. They changed me to enclomiphene and increased the dose and now I'm 976 TT and on the upper end with FT. At 6 months into the protocol, I've lost 25 lbs, gained muscle, have better mental clarity, and have recovered motivation. In other words, there are more options than just TRT. Find a good men's health provider.

 

[Nankie]

I'm 27 and interestingly I had similar labs from 4 years ago. My LH and FSH were high but my Total T and Free T were both within normal limits. I always had visceral obesity, poor beard and muscle growth, fatigue and, even more recently, low sperm count. So I'm confused as well. My doctor dismissed those symptoms in the past, and I'm concerned that it maybe an issue for me, as I developed prediabetes (despite being thin, apart from the visceral obesity that I have). I am trying to reestablish with another doctor and see if I can get repeat labs and perhaps a better answer.

Please update us if you get an answer. Thanks

Hi, sorry for the delay getting back to you. I haven’t really got any further as I had Covid followed by long Covid which wiped me out. I’ve decided that I’ll try to address the imbalance with various supplements which will address one or some of the issues. I started a few weeks ago and my intention is to leave it a few months and repeat the blood tests. My main goal is to increase my free T, although it’s within ‘normal’ range I’m thinking the issue might be that there’s a bigger gap from my precursors (LH and FSH) to the end result (free T). There really isn’t any information out there so this is my best guess and like someone above said, there’s no real consensus on what is low free T. I’ll comment once I’ve had repeated tests.

Interestingly I’m told I’m high risk for diabetes but my blood tests say different so I’m confused about that too.

 

[Systemlord]

My main goal is to increase my free T, although it’s within ‘normal’ range

Just because Free T is in the normal ranges doesn't mean this is normal for YOU.

Interestingly I’m told I’m high risk for diabetes but my blood tests say different so I’m confused about that too.

Your at risk for a lot of other diseases besides type 2 diabetes if Free T is low normal.

 

[Nankie]

Just because Free T is in the normal ranges doesn't mean this is normal for YOU.


Your at risk for a lot of other diseases besides type 2 diabetes if Free T is low normal.

Re my free T results, I agree normal doesn’t really mean anything so I’m looking to find what works for me. Regarding diabetes, I’m a little confused still because my HbA1c is fine and always has been. Also, my doctor doesn’t know what my free T is as I did this privately. Again I agree I need to find my balance for my free T for many health reasons and well-being. After a couple of weeks taking supplements I feel I have better sleep, a little bit more energy and I’m not experiencing joint pain as much. And let’s just say mornings have become more interesting again too.

 

[Systemlord]

Regarding diabetes, I’m a little confused still because my HbA1c is fine and always has been.

It is now, that may not be the case later.