More experienced guys can answer about your lab values and the effects. I think I can answer that as far as the MRI is concerned, your doctor wants a pituitary scan to rule out pituitary problems (i.e. tumors of the pituitary) since you're so young to be experiencing hupogonadal symptoms. Pituitary is usually the first thing they suspect.
I found out by accident that my prolactin levels were elevated during a routine physical and had a pituitary mri to rule out an adenoma or prolactinoma. Your prolactin level is fine but looks like your LH and FSH are low. Probably good idea to get that done for your own peace of mind and to start figuring out what to rule out as the cause of your problems.
Could anyone chime in here please? I need to know what direction I should be heading. Really need advice.
OK bro, you need to look for a good doc, also starting TRT and stopping can f up your system. You went from 268 to 119. Your TSH indicates hypothyroid, demand more studies and research who is the most experienced thyroid and hormone guy you can go to in your area get a retest to check if the T3 reading or TSH was a flop. Start using Morton Iodized salt and avoid soy. Take your Vit D at night and try get more sunshine in the day exposing more skin to allow more absorption.
Ask for a thyroid ultrasound + antibodies and thyroglobulin. You seem to have secondary hypogonadism based on lh Fsh. I'm not a doctor, so its all bro speak, but if I were you I'd first address the thyroid vit D once thats fixed wait a bit and check test levels. If that fails then attempt some form of restart. If that doesn't cause the body to start producing test at a good level once the nolva or clomid is stopped then I'd try HCG only therapy this is all assuming your test responds favorably while taking a clomid challenge. Ask hardasnails or ksman on this board what they think, they know about clomid restarts and a lot more about everything than me.
1. Your not absorbing vitamin D because your liver is all jammed up because bile acid are not being recycle properly resulting in impaired bile flow and emulsification of fat soluable vitamins
2. You may have a potential VDR issue (viral, or pathogens) which is causing vitamin D to feed into the wrong pathway. its possible feeding down the 1,25 vs the 25 OH instead. This will put your body into a pro inflammatory state.
3. Your immune system is probably on fire from what ever stress is going. Elevated cortisol levels may be a false positive because you may have been stressed when the blood was drawn (pissed off at idiots at labs, some asshole cut you off, sight of the needs) 24 hour cortisol saliva is recommended
4. Need proper thyroid evaluation which others mentioned
5. NY depending on what part is a toxic waste dump which due to the evolution of our weakening immune system genetic expressions is being altered which is causing issues in our predisposition on how to get rid of the junk in our system. You are probably on toxic person swimming in a sea of xenoestrogens.
6. Alk phos is representation of possible anemia, low metabolism (adrenal, thyroid), or zinc, magnesium deficeincy.
7. Low SHBG typical 19 year old probably eats like shit all processed foods, loaded with chemicals, if we examined your diet probably carb based. screaming insulin resistance.
8. Been 19 you probably are out partying all night long, and drinking, but know you are playing the piper much earlier in life.
Correct lifestyles, and nutriton would be my number on suggestion...
Are you or have you ever been on antidepressants or ADHD medications?
SSRI antidepressants like Prozac are well-known for killing libido in a large percentage of patients, and sometimes this side effect can linger after you stop using them, which is why I asked.
Your SHBG is really abnormally low. VERY, VERY low. Your doctor (or maybe a different doctor) should really get to the bottom of that, since it may indicate an underlying condition. Abnormally low SHBG can possibly a sign of hyperthyroidism (that is hyPER-, not hypo), insulin resistance, or liver problems.
Oh sorry, you are right of course. Mind fart on my part. In any case, the low SHBG is the one thing I would be worried about - the average normal value for a healthy young man would be around 30 or so if I remember correctly. The low SHBG is probably the reason why your total T is low, since there is little SHBG to bind it and keep it from being quickly excreted. (Especially since your free T isn't low at all.)
If I were you I would stay away from TRT for the time being, since your free T is not low and especially since TRT tends to lower SHBG, which you don't want. The priority should be to figure out what is causing the low SHBG.