Seeking help with investigating symptoms. Zero sex drive, ED, High Prolactin, Low F.S.H, High Estrogen,

[Gunnar92]

Hello all
I would really appreciate if anyone could provide some advice or point me in the right direction as to what could be going on.
I have not managed to get anywhere with the health professionals where I live in the UK, so I thought to seek advice on here since their is plenty of people here with a wealth of knowledge and experience when it comes to male health and hormones
I just wanna start by saying that I have never taking and form of performance enhancing drugs or ever been on TRT
Im a 31 year old male and I live a clean life style and keep fit.

I have been struggling with extremely zero sex drive, ED, dick feels dead and lifeless, numb penis that feels no different to touch then my elbow, pleasureless orgasms, flaccid penis doesn't hang, testicles often feel soft and retract tight into body. My first blood test that was done in 2012 which was to investigate these symptoms at the age of 20.

my most recent blood tests show more information and will be more useful to look at but I have included every blood test I've had since 2012.
Everything highlighted in red is out of the given range

The first thing that got my attention that could be causing my symptoms is the high prolactin, because of this I took a 0.25mg dose of cabergoline after the 5/5/23 blood test which showed prolactin to be 462 mIU/L, as a result of the cabergoline the following prolactin test came back at 33 mIU/L, I had no resolution or improvement of my symptoms during this period.
prolactin is now back up high out of range shown by my most recent test.

F.S.H has always been non-existent below the range, could this be the cause of zero sex drive?
even though F.S.H is low, LH and testosterone are not which rules out any form of hypogonadism, is that assumption correct?

Oestradiol also is high and with its ratio in relation to my testosterone, is this optimal and could this be causing my issues?

I'm at my wits end with this

I'm very grateful for any advice and help I can get from you knowledgable people, I appreciate it a lot
thanks

 

[Systemlord]

I have been struggling with extremely zero sex drive, ED, dick feels dead and lifeless, numb penis that feels no different to touch then my elbow, pleasureless orgasms, flaccid penis doesn't hang, testicles often feel soft and retract tight into body.

This sounds a lot like Post Finasteride Syndrome, have you ever taken Finasteride, anti-depressants or Accutane?

Do you under eat, in other words do you cut or starve yourself to stay fit?

What does a weekly workout routine look like for you?

I have your Free T at 11.6 ng/dL, unlikely to be the cause of your symptoms, considering the severity. you want to check the free testosterone directly (equilibrium dialysis method/not in UK) or calculate it using a Free T calculator using the Total T and SHBG.

 

[Gunnar92]

This sounds a lot like Post Finasteride Syndrome, have you ever taken Finasteride or Accutane?

I have your Free T at 11.6 nmol/L, nothing to brag about but unlikely to be the cause of your symptoms, considering the severity. No one uses free androgen index, we checked the free testosterone directly (equilibrium dialysis method/not in UK) or calculate it using a Free T calculator using the Total T and SHBG

Hi there
many thanks for the reply
no I have never taken Finasteride or Accutane before.
yer testing here in England is pretty poor especially if you're relying on the NHS to do your testing.
where about would Free T sit in the acceptable range at 11.6 nmol/L?

Thanks again

 

[Systemlord]

Hi there
many thanks for the reply

You’re welcome!

where about would Free T sit in the acceptable range at 11.6 nmol/L?

Sex hormones is a little trickier, everyone has their own normal range where they operate best.

Without extensive genetic testing, all you’ll get are our opinions and guest work.

A testosterone deficiency should be diagnosed based on the symptoms and relevant bloodwork.

Experts recommend against a rigid cut off.

My apologies, I meant to type 11.6 ng/dL.

 

[Gunnar92]

You’re welcome!


Sex hormones is a little trickier, everyone has their own normal range where they operate best.

Without extensive genetic testing, all you’ll get are our opinions and guest work.

A testosterone deficiency should be diagnosed based on the symptoms and relevant bloodwork.

Experts recommend against a rigid cut off.

My apologies, I meant to type 11.6 ng/dL.

Ok thanks

Are you aware of anything that could possible cause such low F.S.H consistently? and
Could low F.S.H cause sexual dysfunction?

With my Oestradiol levels I wonder if it would be worthy to try a AI to see if that could help symptoms by lowering estrogen?

Thank you

 

[Systemlord]

Ok thanks

Are you aware of anything that could possible cause such low F.S.H consistently? and
Could low F.S.H cause sexual dysfunction?

With my Oestradiol levels I wonder if it would be worthy to try a AI to see if that could help symptoms by lowering estrogen?

Thank you

Men on TRT have almost undetectable, FSH and LH, and have raging sex drives and fully flaccid erections.

Be careful with aromatase inhibitors, try to micro dose.

 

[Gman86]

So u’ve basically been dealing with these symptoms since 2012 when u first got ur blood work done?

What’s stopping u from trialing TRT?

ive been very into health and fitness since I was around 12-13, and I still ended up with low T around 27. I tried everything I could to resolve the issue naturally, and did so for about a year before hopping on hcg monotherapy, and then ultimately TRT. If u’ve been struggling with these issues for years now, I personally don’t see any reason to not at least see if TRT can resolve some, or all of ur symptoms. Worst case scenario u don’t end up liking TRT, u simply stop, and u should return to baseline within a month or two

 

[Gunnar92]

So u’ve basically been dealing with these symptoms since 2012 when u first got ur blood work done?

What’s stopping u from trialing TRT?

ive been very into health and fitness since I was around 12-13, and I still ended up with low T around 27. I tried everything I could to resolve the issue naturally, and did so for about a year before hopping on hcg monotherapy, and then ultimately TRT. If u’ve been struggling with these issues for years now, I personally don’t see any reason to not at least see if TRT can resolve some, or all of ur symptoms. Worst case scenario u don’t end up liking TRT, u simply stop, and u should return to baseline within a month or two

Yer I have been dealing with this since 2012, so my while adult life.
Yer I have been thinking about giving TRT a go, perhaps maybe just HCG first.
However my testosterone is high in the range so I'm worried it may harm me further.
Problem I don't know how to go about getting TRT or HCG in the UK

Thank you for the response

 

[Gman86]

My total test level was pretty high in the range as well. Around 600-700. It was my free T that was very low and causing all my symptoms. I was easily able to get treatment with low free T levels. At least in the U.S. I think @Belekas lives in the U.K. Maybe he can offer some guidance on how to get prescribed HRT where u live

 

[zancek0]

You said you havent taken accutane or finasteride. What about: SSRIs, benzos, antipsychotics? Or what about: saw palmetto, lions mane? Before 2012, have you been taking any medications (antibiotics) or supplements (overdosing on zinc?)? Used any psychedelics, or other drugs? Were you poisoned anytime back then?

There's many things looking off here. Sex steroids aren't gonna be useful here. No, high prolactin or estrogen isn't to blame, they are just consequences of something else going wrong. Check for cortisol, whole thyroid panel, active vitamin D, DHT (!), ceruloplasmin (!), homocysteine, insulin, electrolytes in blood and urine.

I might get laughed at but to me this looks like heavy metal toxicity or other kind of toxicity, maybe chronic infection if all other usual suspects are missing. Or maybe there's a genetic disease at play. (Mentioned symptoms never happen in non-iatrogenic (or not induced by hormonal disruptors) hypogonadal situations.)

What other non-sexual symptoms are you dealing with?

 

[sammmy]

Your cabergoline trial was too short - I would try 2 months and see if symptoms improve.

If that doesn't work, then try supplementing DHEA - it might override the problem. Again a few months trial.

If that doesn't work, try an aromatase inhibitor like Arimidex but make sure it doesn't drive the estrogens into the ground - side effects.

 

[sammmy]

Low FSH can be caused by a problem at the pituitary (pituitary adenoma) or the hypothalamus:

Follicle-Stimulating Hormone (FSH): What It Is & Function

Follicle-stimulating hormone (FSH) is a hormone that plays a role in sexual development and reproduction by affecting the function of the ovaries and testes.

my.clevelandclinic.org

Pituitary Adenomas: Definition, Symptoms & Treatment

Pituitary adenomas are benign tumors on your pituitary gland. They’re noncancerous but can interfere with normal pituitary function and cause health conditions.

my.clevelandclinic.org

Have you done an MRI scan of the head to rule out such problems?

 

[zancek0]

I believe this approach cannot work. This is how mainstream medicine works. Patching up symptoms, making you worse in the long run. It's avoiding treatment of underlying issues.
Worse, this cannot work even short-term.

A "cabergoline trial" is dangerous. If prolactin elevation is not caused by a prolactinoma, cabergoline can lead to DAWS. Nightmare material just reading such reports.

DHEA suggestion is misguided too. His steroids are fine. If hormone levels would be non-existent, there would be some sense in trying DHEA (a precursor to sex steroids among other stuff). Its effects as a neurosteroid and a neurotrophin will likely give only very short positive benefits.

Taking arimidex would likely damage him further. Excessive elevations of E2 indicate body's need for anti-inflammatory effects of estradiol.

Low FSH could be related to a nonmalignant tumours, chronic infections, mineral deficiencies, heavy metal toxicity etc...

 

[electrify]

Arimidex is powerful stuff and E2 is needed for the brain. People have messed themselves up with AIs. Unlikely that high E2 is even the issue.

 

[zancek0]

Arimidex is powerful stuff and E2 is needed for the brain. People have messed themselves up with AIs. Unlikely that high E2 is even the issue.

(Me being one of those people, lol)

 

[Systemlord]

Arimidex is powerful stuff and E2 is needed for the brain. People have messed themselves up with AIs. Unlikely that high E2 is even the issue.

(Me being one of those people, lol)

Arimidex, even a pinch from a 0.050 dose wrecks me.

 

[sammmy]

Until the real cause of the condition is found (which with contemporary medicine could be never) one can only try to override the problem and having that in mind, I suggested cabergoline, DHEA, and Arimidex.

In cases these work, it is not necessarily because the problem is high prolactin, high estrogen, or low testosterone/adrenals. Nobody knows exactly how these work in such circumstances because the exact biochemistry of these is not clarified.

The doses used should be low to moderate to keep the prolactin and estrogens in the middle of normal ranges for males. Research of used low doses should be done beforehand, not just taking random doses based on broscience in bodybuilding forums.

 

[electrify]

(Me being one of those people, lol)

Its only in recent years I learned there is a Post Aromatase Inhibitor Syndrome like PSSD/PFS. Rare but I did use arimidex occasionally way back in 2015 at like 0.1 mg but thank god I never got that. Only a handful of times used it. I think it must be to do with neurosteroid estradiol rather than blood levels itself.

Estradiol acts at AMPA like Ket and is itself an MAOI. I wonder if these can be useful in such a syndrome.

Ketamine and Ketamine Metabolites as Novel Estrogen Receptor Ligands: Induction of Cytochrome P450 and AMPA Glutamate Receptor Gene Expression

Major depressive disorder (MDD) is the most common psychiatric illness worldwide, and it displays a striking sex-dependent difference in incidence, with two thirds of MDD patients being women. Ketamine treatment can produce rapid antidepressant effects ...

www.ncbi.nlm.nih.gov

Tissue-specific effects of estrogen on monoamine oxidase A and B in the rat - PubMed

Estrogen replacement therapy is widely used in postmenopausal women. The current study examines the effect of varying concentrations of estrogen on the levels of activity of monoamine oxidase A and -B in brain and in other tissues. Adult female rats were ovariectomized and randomized to receive...

pubmed.ncbi.nlm.nih.gov

 

[zancek0]

Its only in recent years I learned there is a Post Aromatase Inhibitor Syndrome like PSSD/PFS. Rare but I did use arimidex occasionally way back in 2015 at like 0.1 mg but thank god I never got that. Only a handful of times used it. I think it must be to do with neurosteroid estradiol rather than blood levels itself.

Estradiol acts at AMPA like Ket and is itself an MAOI. I wonder if these can be useful in such a syndrome.

Ketamine and Ketamine Metabolites as Novel Estrogen Receptor Ligands: Induction of Cytochrome P450 and AMPA Glutamate Receptor Gene Expression

Major depressive disorder (MDD) is the most common psychiatric illness worldwide, and it displays a striking sex-dependent difference in incidence, with two thirds of MDD patients being women. Ketamine treatment can produce rapid antidepressant effects ...

www.ncbi.nlm.nih.gov

Tissue-specific effects of estrogen on monoamine oxidase A and B in the rat - PubMed

Estrogen replacement therapy is widely used in postmenopausal women. The current study examines the effect of varying concentrations of estrogen on the levels of activity of monoamine oxidase A and -B in brain and in other tissues. Adult female rats were ovariectomized and randomized to receive...

pubmed.ncbi.nlm.nih.gov

Thanks.
Yeah, estradiol does a lot of stuff. Once you understand how much stuff it's involved in and what it does you understand it's not wise to mess with it. I learned that a bit too late. But I will fix this sooner or later.
I think PAIS isn't of one type. Just like PFS and PSSD aren't. PAIS induced by arimidex is different from the once induced by aromasin. It's a matter of finding each person's focal points which needs addressing. In general, I think AIs can induce dramatic shift in metabolic rate so recovery will likely include getting thyroid function back into proper order.