Confused With My Lab Results

Four years ago I was diagnosed with low testosterone, low thyroid, and high prolactin. The low prolactin was due to pituitary adenoma. For 4 years I am taking levothyroxine and cabergoline and somewhat felt better with medication for the past few years. My libido was on/off and my lab results always have been very confusing. My doctor doesn’t agree that I am having low T. I feel great for a few weeks and notice issues with erections and feeling low libido after that. It takes 2-4 weeks again to restore the libido things back to normal. My testosterone level is not consistent. These are my previous lab reports for the last 18 months. Do you think I need to start TRT to improve libido? My testicle size has been reduced and semen analysis came back as positive, the Sperm count is 50 million. My wife and I trying to make a baby this year-end. Do you guys suggest waiting for TRT until my wife become pregnant?

Oct 2019
TESTOSTERONE, TOTAL 548.59 ng/dL 240.24 - 870.68 ng/dL
PROLACTIN 1.0 ng/mL 2.6 - 13.1 ng/mL

August 2019
TESTOSTERONE, TOTAL 475.23 ng/dL 240.24 - 870.68 ng/dL
PROLACTIN 0.8 ng/mL 2.6 - 13.1 ng/mL
LH,SERUM 2.2 mIU/mL 0.6 - 12.1 mIU/mL
FSH,SERUM 3.91 mIU/mL 0.95 - 11.95 mIU/mL
TSH 3.062 uIU/mL 0.350 - 4.940 uIU/mL
THYROXINE,FREE 0.98 ng/dL 0.70 - 1.48 ng/dL

July 19
TESTOSTERONE, TOTAL 241.05 ng/dL 240.24 - 870.68 ng/dL
LH,SERUM 1.1 mIU/mL 0.6 - 12.1 mIU/mL

Feb , 2019
TESTOSTERONE, TOTAL 527.92 ng/dL 240.24 - 870.68 ng/dL
FSH,SERUM 3.33 mIU/mL 0.95 - 11.95 mIU/mL
LH,SERUM 1.9 mIU/mL 0.6 - 12.1 mIU/mL

Jan 2019
TESTOSTERONE, TOTAL 377.40 ng/dL 240.24 - 870.68 ng/dL

August 2018
TESTOSTERONE, TOTAL 466.63 ng/dL 240.24 - 870.68 ng/dL

Feb 2018
TESTOSTERONE, TOTAL 334.45 ng/dL 240.24 - 870.68 ng/dL

Your last lab was almost a year ago. You need new labs.

CBC
CMP
Lipids
Total T
Free T
SHBG
E2 Sensitive
PSA
FSH
LH
Prolactin
Vitamin D
TSH
FT3
FT4
TPO antibodies (if not already diagnosed with Hashimoto’s)

These TSH levels are not what I would expect to see of someone optimized on thyroid treatment, your doc may be undertreating you, to find out if free thyroid hormones are ideal, Free T3 (active hormone) would need to be tested and should at least be midrange or preferably slightly higher.

The TSH which is a stimulating hormone and Free T4 are not active hormones and are part of the chain of hormones that eventually lead to the active hormones → Free T3. I would also test Reverse T3.

You really want TSH under 2.5 preferably close to 1-1.5 which is closer to the median value and those without thyroid problems.

What you are seeing is a natural daily variation in hormones levels and is completely normal, however some of your labs are unacceptably low. I’m not seeing any Free T testing, the active portion of testosterone, if you have SHBG on the higher end, your Free T would be dreadfully low on days of some of your testing.

It sounds like you need a doc that knows what he’s doing because I don’t think yours does, no Free T or SHBG and the fact LH is low on every single test.

What time of day are these labs being drawn?

If you want zero risk you could try out clomid for now, get the wife pregnant, freeze sperm and go on TRT. There are many ways to address fertility while on TRT, HCG and FSH injections in conjunction with your TRT, or stopping TRT and starting a clomid protocol will usually do the trick, then you could hop back on TRT once the wife is pregnant the second time around.

Fluctuations like that are pretty normal.

How much cabergoline are you taking? Your prolactin looks super low, which can also cause libido issues. You also probably need more thyroid hormones to get your tsh down. Reduced tsh can help reduce prolactin as well (though I don’t know to what degree to be honest, but there is a relationship between them).

I’d increase thyroid meds and reduce the caber first.

It’s been almost 10 months since I started this thread. I am still struggling with low libido and fluctuations in my Testosterone levels . My doctor still doesn’t agree that i have low T values since Free testostrone is above low but in the middle of the scale. My wife and i are trying to have baby this year, so my endo presecirbed Clomid to increase my testosterone levels. I also took semen analysis before start taking clomid. Below is the semen analysis report. The results shows that i am fertelie and making good amount sperm to make my wife pregnent. Does clomid really helps to increast T values and improve libido/sex drive? Are there any precautions that should i follow while i am clomid?
Semen analysis
Concentration (mil/ml) 69.0
Total Count (mil/ejac) 241
Ph : 7.0 It should be above 7.2
Morpholpgy : 6
Progression rate 2. This is low It should be in between 3-4

These are my lab results for the past one year.
02/20/2021
Testosterone, Serum 252 ng/dL 264 - 916 ng/dL
Testost., % Free+Weakly Bound 56.3 % 9.0 - 46.0 %
Testost., F+W Bound 141.9 ng/dL 40.0 - 250.0 ng/dL
TSH 2.550 uIU/mL 0.450 - 4.500 uIU/mL
T4,Free(Direct) 1.60 ng/dL 0.82 - 1.77 ng/dL

10/28/2020
Testosterone, Serum 426 ng/dL 264 - 916 ng/dL
Testost., % Free+Weakly Bound 48.6 % 9.0 - 46.0 %
Testost., F+W Bound 207.0 ng/dL 40.0 - 250.0 ng/dL
Prolactin 2.0 ng/mL 4.0 - 15.2 ng/mL

07/31/2020
Prolactin 0.9 ng/mL 4.0 - 15.2 ng/mL
LH 3.1 mIU/mL 1.7 - 8.6 mIU/mL
FSH 4.2 mIU/mL 1.5 - 12.4 mIU/mL
Testosterone, Serum 368 ng/dL 264 - 916 ng/dL
Testost., % Free+Weakly Bound 46.9 % 9.0 - 46.0 %
Testost., F+W Bound 172.6 ng/dL 40.0 - 250.0 ng/dL
T4,Free(Direct) 1.35 ng/dL 0.82 - 1.77 ng/dL
TSH 2.870 uIU/mL 0.450 - 4.500 uIU/mL
Triiodothyronine,Free,Serum 3.2 pg/mL 2.0 - 4.4 pg/mL
Dhea-Sulfate 215.0 ug/dL 102.6 - 416.3 ug/dL

I am taking 0.25mcg of cabergoline per week. In my recent lab test results TSH looks normal.
TSH 2.550 uIU/mL 0.450 - 4.500 uIU/mL
T4,Free(Direct) 1.60 ng/dL 0.82 - 1.77 ng/dL

I am sorry for the late reply. Can you please check my recent lab results in the above post and let me know what do you think of those values?

For one, I would take as little of the caber as possible. Slightly elevated prolactin is better than taking extra caber. That drug is not good for you and not good for your heart. How high was your
prolactin that caber was prescribed? It seems like you might not need it given your last blood test shows prolactin low, but I guess that’s relative to how high it was when the pituitary adenoma was diagnosed.

A direct measurement for free T+Weakly bound T isn’t necessarily accurate. You really should measure SHBG to give you a better picture of your free testosterone.

That looks like too much (.25mg I’m assuming). See if you’re doc can Rx you Enclomiphine instead of Clomid, it’s better tolerated.

No it doesn’t because clomid blocks estrogen from crossing the brain barrier and estrogen is needed for libido. You might have libido for a short time on clomid, but it will disappear after a while.

started taking 25mg of clomid 3times per week. Started the medication on last Sunday. How many days does it take to make an effect on body if it does at all?

Yes it is 0.25mg. I stopped taking Cabergoline last year for 2 months and immediately noticed the increase in the prolactin levels, so my doctor recommended to continue to use it. Two months ago took the second pituitary MRI ( the first MRI was done in 2016 when diagnosed with high prolactin) and there is no evidence of Pituitary tumor in my brian.

Within a week. Keep us posted on how you feel. Add yes if your testicles work clomid will increase your testosterone.

It been 2 months since i started taking clomid. I am taking .25mg thrice a week. I felt very good for the first two weeks and feeling tired after that. I don’t feel motivated to have sex at all and i hardly get erections. Before started taking clomid i used to get erections but my libido was not great. My wife and I planning for kids this year. Because of low T symptoms and lack of libido i am unable to have sex with wife during mid cycle and missing my wife’s menustrual cycle. I have an appointment with my endo next week. I am thinking of starting T supplements with HCG to maintain fertility. I would like to take Testersone until my wife conceives a child. What are the other options that are available to have a baby if don’t want to start T replacement therapy. Should i increase clomid and also start E2 inhibitor to increase the T values. Before started taking clomid these are my T numbers. My endo thinks my Free T is normal, so he don’t believes that i need T supplement.

Testosterone, Serum 252 ng/dL 264 - 916 ng/dL
Testost., % Free+Weakly Bound 56.3 % 9.0 - 46.0 %
Testost., F+W Bound 141.9 ng/dL 40.0 - 250.0 ng/dL

I don’t think clomid is working for me I completely lost libido after 2 weeks . Is it due to high ESTRADIOL ? I will be getting lab test this week for my next appointment.

It doesn’t have to be estradiol. The medicine itself has sides.

Still do the labs so you know what it did to your numbers. Your numbers may look good when you go labs but still feel like crap.

Are you able to masterbate? Do you have more volume?

Can you conceive now? Take Viagra and do your thing.

Am sure you fsh went up on clomid you should be very fertile.

^^^^^.

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If Clomid blocks estrogen then why do the doctors prescribe Armidex while on Clomid. I thought Clomid increases Estrogen which impacts libido even with higher T values. Am I wrong here? Any suggestions on how to deal with my situation?

@systemlord [quote=“aryad, post:14, topic:267783, full:true”]
It been 2 months since i started taking clomid. I am taking .25mg thrice a week. I felt very good for the first two weeks and feeling tired after that. I don’t feel motivated to have sex at all and i hardly get erections. Before started taking clomid i used to get erections but my libido was not great. My wife and I planning for kids this year. Because of low T symptoms and lack of libido i am unable to have sex with wife during mid cycle and missing my wife’s menustrual cycle. I have an appointment with my endo next week. I am thinking of starting T supplements with HCG to maintain fertility. I would like to take Testersone until my wife conceives a child. What are the other options that are available to have a baby if don’t want to start T replacement therapy. Should i increase clomid and also start E2 inhibitor to increase the T values. Before started taking clomid these are my T numbers. My endo thinks my Free T is normal, so he don’t believes that i need T supplement.

Testosterone, Serum 252 ng/dL 264 - 916 ng/dL
Testost., % Free+Weakly Bound 56.3 % 9.0 - 46.0 %
Testost., F+W Bound 141.9 ng/dL 40.0 - 250.0 ng/dL
[/quote]

I believe clomid blocks the effects of estrogen not the production.

So the hpta does not “see” the estrogen so it keeps pumping out LH and FSH hence why you t goes up.