2 Tests in 3 Weeks: Low LH/FSH/E2, Fluctuating TT/FT

Pharma / TRT Testosterone Replacement
1

Hi All, first post on this site and hope someone can offer some advice. I’m 41 have lifted for a number of years. I’m reasonably strong, and lift 5 times a week mostly.

Symptoms: lifts stagnated over the last couple of years. Lower motivation in gym and work. Persistent headaches. Don’t feel myself. Possibly occasional lower moods.

I have taken 2 finger prick medichecks blood tests over the last few weeks. Can anyone explain how the TT/FT could change so much and maybe LMK if i should be concerned please?

06/09/2019

Albumin SHBG 46.6 g/L (Range: 35 - 50)
SHBG 44.1 nmol/L (Range: 18.3 - 54.1)
FSH 2.16 IU/L (Range: 1.5 - 12.4)
LH 1.31 IU/L (Range: 1.7 - 8.6)
Oestradiol <18.4 pmol/L (Range: 41 - 159)
Testosterone 10.1 nmol/L Range: 8.64 - 29)
Free Testosterone - Calc. 0.16 nmol/L (Range: 0.2 - 0.62)
Free Androgen Index 22.9 Ratio (Range: 24 - 104)
Prolactin 349 mU/L (Range: 86 - 324)
DHEA Sulphate 14.900 umol/L (Range: 2.41 - 11.6)

20/09/2019

TSH 2.32 mIU/L (Range: 0.27 - 4.2)
Free T3 5.02 pmol/L (Range: 3.1 - 6.8)
Free Thyroxine 18 pmol/L (Range: 12 - 22)
Thyroglobulin Antibodies <10 kIU/L (Range: < 115)
Thyroid Peroxidase Antibodies <9.0 kIU/L (Range: < 34)

25/09/2019

Albumin SHBG 44.8 g/L (Range: 35 - 50)
SHBG 42.2 nmol/L (Range: 18.3 - 54.1)
FSH 2.35 IU/L (Range: 1.5 - 12.4)
LH 2.36 IU/L (Range: 1.7 - 8.6)
Oestradiol 50.7 pmol/L (Range: 41 - 159)
Testosterone 20.3 nmol/L (Range: 8.64 - 29)
Free Testosterone - Calc. 0.37 nmol/L (Range: 0.2 - 0.62)
Free Androgen Index 48.1 Ratio (Range: 24 - 104)
Prolactin 410 mU/L (Range: 86 - 324)
DHEA Sulphate 13.300 umol/L (Range: 2.41 - 11.6)

03 Oct 2019 - Finger Prick (Medichecks)

Albumin 43.6g/L (35 - 50)
SHBG 44.9 nmol/L (18.3 - 54.1)
FSH 2.61 IU/L (1.5 - 12.4 )
LH 2.96 IU/L (1.7 - 8.6)
Oestradiol 44.4 pmol/L (41 - 159 )
Testosterone 20.8 nmol/L (8.64 - 29)
Free Testosterone - Calc. 0.37 nmol/L (0.2 - 0.62)
Free Androgen Index 46.33 ratio (24 - 104)
Prolactin 565 mU/L (86 - 324)
DHEA Sulphate 14.7 umol/L (2.41 - 11.6)

04/100/2019 Blood Draw (NHS)

Serum testosterone 19.8 nmol/L (8.3 - 30.2)
Serum prolactin level 135 mIU/L (73 - 407)

I took the first result straight to my GP who mentioned maybe seeing and endocrinologist and that i might need TRT. I have some NHS tests coming in the next week or two.

Really appreciate some feedback as I have no idea about this stuff.

Thank

2

You clearly have secondary hypogonadism which is a pituitary failure and is partly lifestyle and EDCs in the environment which is blocking hormone production in developed countries and the number of men affected has increased in the last 10 years.

So recovering natural well good luck, at 41 years old you shouldn’t have the hormone levels of a 100 year old man. Your LH is the stimulating hormone for the testicles which then produce testosterone, lower values will see low testosterone, free testosterone is the active hormone and total testosterone bound to SHBG and is not bioavailable.

Prolactin is elevated and can lower testosterone, an MRI is needed to check for pituitary tumors. Your high prolactin can have other causes like high TSH in response to low thyroid hormones, fT3 is the active thyroid hormone and sometimes high TSH can be high rT3 which can block fT3 since it competes for the same receptor which would then prevent fT3 from entering your cells.

Even if your testosterone was elevated to a normal levels for a 41 year old, your SHBG is on the higher end would be binding up most of it anyway, SHBG is not something you have much control over. Having optimal testosterone after 40 is a dream at a time when decline has been in play for the past 10 years.

Your adrenal glands are overactive, a tumor of the adrenal glands can result in the overproduction of various hormones.

Doctors in the EU (and the US) are mostly ignorant in normal thyroid hormone/testosterone status and follow reference ranges proven that are not normal which including those with thyroid dysfunction lowering the bar for treatment.

Your first set of labs would get you approved for TRT, you require two separate tests below range and your second set of labs may derail you getting TRT because doctors are taught in range is normal and this is true with everything except testosterone, most doctors are unaware and have procedure to follow.

Men need FT near the top of the ranges to feel good, but do to insurance greed and state healthcare trying to save funding and resources, some men are left out to dry. There are private clinics (cash only) available who have a higher threshold for approving treatment.

Cost of hormone-disrupting chemical exposure in Europe in billions

Exposure to endocrine-disrupting chemicals (EDC) is estimated to cost the European Union more than €150 billion ($209 billion) a year in health care expenses and lost earning potential, according to studies by a team of 18 international researchers, including two Harvard T.H. Chan School of Public Health faculty. Conditions linked to the chemicals included lowered IQ, male infertility.

EDCs interfere with the body’s hormones. Found in food and food containers, plastics, furniture, toys, carpeting, building materials, and cosmetics, they contain chemicals such as bisphenol A (BPA), phthalates, flame retardants, and pesticides such as chlorpyrifos. They are often released from such products and enter the bodies of humans through ingestion, dermal contact or inhalation.

“Costs in the U.S. would likely be quite similar, as exposures to EDCs are fairly similar to those occurring in the EU, although levels of flame retardants are much higher in the U.S.,”

3

Thank you for the detailed response I really appreciated the assistance. I had been thinking along these lines since the first test which i why i took the second. I have edited the OP with the thyroid test I took between then. Medichecks says it all looks good.

I think I will chase up my GP as I am a little concerned they might just take a single TT test rather then a full spectrum.

Thanks again for your help systemlord.

4

What time of day were each of these tests? Fasted? Post workout? Post drinking night? There are plenty of reasons for that swing.

5

Both were taken around 7am fasted. No alcohol or sex at least a couple of days before. Gym the previous day around the same time. I can’t think of anything I did differently for the 2 tests.

Maybe a low carb meal the evening before the 2nd one. I was thinking i didn’t sleep well before the second one but that had the higher T. I suppose i may have eaten more on one of the days.

6

I would say you need an actual blood draw, not a finger prick test. One of them is probably wrong.

1 Like
7

You’re welcome skyfall,

Often we bounce around within particular range never really staying in one spot too long and your range seems to be between 0.16 nmol/L-. 0.37 nmol/L (Range: 0.2 - 0.62) which is still suboptimal especially if you are not at that level everyday which we clearly see you are not.

More often than not most doctors pay attention to only the numbers and ignores the symptoms and this fubars the diagnosis and men are left to suffer.

The reason is simple, there is a lot of conflicting data hinting TRT may cause heart attacks, strokes and even prostate cancer, but this has been put to bed as false do to poor quality studies including men who have been castrated which are in a completely different risk category from the general population, but the impression left by these studies has taken residence in doctors minds and are fearful to prescribe TRT.

If you need these studies related to prostate cancer, heart attacks and strokes which debunk these untrue risks to show your doctor, just ask.

8

Ok thanks. I will see the GP tomorrow and try and get them to draw a full set of tests.

9

Thanks so much. It’s very helpful advice. I’ll see what the doc says and report back.

10

Visited a GP yesterday. Looked at my first results (the really really shit ones) and said that my T levels were not too bad at all. I mentioned that the previous doc (2 weeks ago) looked at the same results and said i might need TRT and to see and endo.

They said that they can only do a total testosterone and prolactin test as they are “not able to order” LH/FSH/FT/DHEA-S/E2/etc on the NHS system.

I asked what happens if the TT comes back just in range, does it mean that if i have a pituitary issue then it just gets left. The answer is to just do the tests.

I did push a bit on the potential pituitary issue and said a couple of things i’ve started to notice like occasional vision blurs (might just need glasses) and she did say I could see an optician as they have some good equipment and might be able to see something they can’t. This normal?

I’m guessing the prolactin will come back high again and the GP said I would be referred somewhere else in that case.

Thanks.

11

I am sure that you can get E2 tested there, and I would be really surprised if LH and FSH are not also available. Your GP sucks, and you should consider switching to a different one.

12

Yeah I might go to a local private GP for a 2nd opinion. The cost is quite high.

I remembered the one thing I did differently for the 2nd test. I did about 40/50 pushups to get the blood flowing hoping to get blood drips out easily. Do you think that would explain the huge change?

13

This just shows you that some doctors will see a problem while others will not. You may have to seek treatment privately and pay for it, because the average doctor is not going to be very helpful as most doctors struggle in this area of medicine.

These doctors didn’t think they would be dealing with men of all ages having lower than normal testosterone when they went to medical school 20-30 year ago and they are not prepared for it now.

Most doctors don’t even know what normal testosterone is, the poor bastards believe in range is normal. Testosterone, hormones have been ignored for too long in western medicine and now that we are at a crisis level event and doctors are struggling with it. It’s so sad.

14

I’m already seeing how much of an uphill battle it probably is.

Thanks again for the feedback. You encouraged me to push and find out a lot more info. I definitely feel much more informed.

15

T fluctuates quite substantially.
Dont believe the ‘diagnosis’ here is in this formum that you clearly have secondary hypogonadism. Somebody likes to play doctor.

Get a proper blood draw, make sure that you take it in the morning after overnight fasting and then go from there. If Prolactin is high again and T low on two tests then think about TRT, but not before.

1 Like
16

His LH is 1.31, what more do you need and FT below range.

This is hypocrisy.

17

K[quote=“systemlord, post:7, topic:261031”]
The reason is simple, there is a lot of conflicting data hinting TRT may cause heart attacks, strokes and even prostate cancer, but this has been put to bed as false do to poor quality studies
[/quote]

Wrong and misleading.

The article describes the current unterstanding of the risks associated with TRT. Its published in Nature Reviews Cardiology, one of the highest journal in this area.

https://www.nature.com/articles/s41569-019-0211-4

11

18

There are studies out there that show cardiovascular events in men on TRT, but those are old men 65+ years of age already had compromised hearts, those men were also at higher risk do to other medical problems that put them at greater risk.

The oral TRT does increase cardiovascular risk, you’ll get no argument from me, but no significant cardiovascular effects were noted with injected or transdermal TRT. That’s the problem with some of these studies, if they miss one crucial detail, the entire study falls apart.

I see no study, I see an a title making claims with a buy now option. It also says the studies finding “might” become available in a decade. Considering the standard of care for TRT being so terrible, it would keep men in a hypogonadal state seeing as they are still prescribing 200mg every 2-4 weeks.

I seriously doubt the majority of men on TRT have truly been optimized by someone that knows what their doing, the standard of care for TRT is atrocious and the majority of doctors have no clue how to prescribe TRT.

Every now and again I see guys like you on the forums comes here who is still regurgitating misleading flawed studies that didn’t take into account other risk factors or separate the oral TRT risks factors from those injected or transdermal forms of TRT . Even if this study shows what it claims, one study will not sway me in either direction, I would need multiple studies showing the same outcome.

With your previous hypocritical post, it’s very hard to take you seriously and you just seem like someone looking to prove himself and it’s almost like you’re looking for approval.

You make comments that suggest you another forum member and are using a second account. There is only one other member who uses comments such as, “somebody like to play doctor” comment on this forum.

1 Like
19

Hi Guys. I really appreciate all the input and have an open mind. What’s great is I have the confidence and a bit of knowledge to question and push the docs now.

As well as the T/LH/Prolactin issue I also have to see what’s going on with the DHEA-S (kidney). Could they be related?

In addition, I forgot to mention but after my initial GP appointment, she gave me a bunch of tests where they all came back with ‘no action’. However, on further inspection, i noticed that Billirubin [sp] was over double the reference range with an exclamation mark. The result was.

47 umol/L (range 0.0 - 21) (abnormol)

I told the other GP and we are retesting and also going to retest the full blood count and added 2 others. One is Sed Rate (no idea what this is) and can’t recall the other.

Thanks again for the responses dudes.

20

I had the same elevated bilirubin on testing which was explained that I have the Gilberts gene which is a gene in which the liver has difficulty ridding the body of bilirubin. There are no symptoms, only yellow skin. I have never had yellow skin though.

They way things are going, you may need private treatment because the EU doctors wouldn’t know normal testosterone status and are only going by what they are taught, in range is normal.

The EU doctors believe normal is in range, but the fact is most men need FT levels 75% of the range or higher to feel optimal like when you were younger.

The way things seem to always go is, guy is told he is normal, he doesn’t buy it and goes to a private clinic and gets TRT. Then within a short period of time he starts feeling amazing and all symptoms vanavish.

If this is occurring so often, doctors are getting it wrong and it’s only a matter of time before they see it and they have no choice but to think to themselves, “we got it wrong”.

It was Dr. Abraham Morgentaler at Harvard, an expert on testosterone that stated men would benefit on TRT if FT levels were below 15 pg/mL (ranges 6.8-26.5) and suggested levels below midrange 500 ng/dL or 17 nmol/L is where some men start to experience symptoms of low testosterone.