20 year old with high total/free testosterone, but symptoms of ED and fatigue. Case details below. Thank you for taking the time to look into my case.
-waist: To be measured
-describe body and facial hair: Thick, very dense body hair hair everywhere from the hips down. Sparse chest hair, but there is more dense hair around stomach and nipples. Facial hair is dense around neck, jawline, and chin, but sparser and slowly filling in on cheeks.
-describe where you carry fat and how changed: Relatively low BF for a long time and carrying fat around midsection. Has not changed in the past.
-health conditions, symptoms [history]: Erectile dysfunction - decreasing erectile strength, difficulty maintaining erection, difficulty reaching ejaculation, little if any orgasm. No morning wood or spontaneous erections. Issues are definitely not psychological. Fatigue, lethargy, fogginess although these symptoms are not as recent as the ED. Little libido. Wake up frequently at night. Muscle twitching.
No serious medical history aside from the occasional cold and frequent sinus infections.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Vyvanse 50mg, frequent ibuprofen, multivitamin, vitamin D. The extension of Rx and OTC history into my past only includes other vitamin supplements, like a B complex.
-lab results with ranges: Posted below.
-describe diet [some create substantial damage with starvation diets]: Have been bulking for the past 3 months at around 200-500 calorie surplus not meticulously counting calories or macros. Diet is strict with eggs, oatmeal, bananas, dark berries, chicken, rice, potatoes, broccoli, other vegetables, whey protein, nuts.
-describe training [some ruin their hormones by over training]: SL5x5 for the past 4 months. Spread the workout out somewhat so I am at the gym 3-5 days a week.
-testes ache, ever, with a fever: Never experienced this.
-how have morning wood and nocturnal erections changed: Cannot remember how frequent morning wood used to be, but I can at least say I never experience morning wood anymore. Can sometimes wake up in the middle of the night with semi-hard erections depending on dream.
I have been experiencing symptoms of lethargy, fatigue, and unrestful sleep for a number of years, but the ED is much more recent. Over the past half a year, I have been experiencing the above posted ED symptoms. The only thing I see having occurred around this same time period is that I may have been under more stress and I also started bulking as well. Anyway, I finally saw an endocrinologist who ran a ton of bloodwork and an MRI. He was confused by my normal testosterone levels, my low FSH, high prolactin, high SHBG, and other levels combined with my ED symptoms. I went through a testicular exam and a MRI of the brain to rule out a prolactinoma. Both of these exams yielded no results and - with the prolactinoma ruled out - my endo did not know what to do moving forward. All he did was suggest it might be familial.
Bloodwork, 6 weeks ago
Testosterone, Total: 1440 ng/dL (250 - 1100)
Testosterone, Free: 185.8 pg/ml (25.0 - 155.0)
TSH: 1.14 mIU/L (0.40 - 4.50)
Bloodwork, 4 weeks ago
Testosterone, Total: 1016 ng/dL (250 - 1100)
Testosterone, Free: 170.7 pg/mL (35.0 - 155.0)
FSH: 1.0 mIU/mL (1.5 - 9.7)
LH: 3.7 mIU/mL (1.5 - 9.3)
Prolactin: 27.8 ng/mL (3.7 - 17.9)
Bloodwork, 2 weeks ago
Testosterone, Total: 1003 ng/dL (250 - 1100)
Albumin, Serum: 4.5 g/dL (3.6 - 5.1)
Testosterone, Free, Bioavailable: 97.6 pg/mL (46.0 - 224.0)
Testosterone, Total, Bioavailable: 200.8, (110.0 - 575.0)
FSH: 1.2 mIU/mL (1.5 - 9.7) **
SHBG: 55 nmol/L (10 - 50) **
Prolactin: 20.3 ng/mL (3.7 - 17.9) **
Cortisol, Total: 17.7 mcg/dL (4.0 - 22.0)
IGF: 249 ng/mL (83 - 456)
TSH: 1.86 uiu/ml (0.49 - 4.70)
Free T4: 0.88 ng/dl (0.71 - 1.85)
CBC (missing hematology)
Sodium: 140 mmol/L (135 - 145)
Potassium: 4.6 mmol/L (3.5 - 5.5)
Chloride: 101 mmol/L (95 - 108)
CO2: 29 mmol/L (22 - 32)
Glucose (morning): 89 mg/dL (60 - 99)
Calcium: 9.4 mg/dL (8.5 - 10.5)
Urea Nitrogen: 21 mg/dL (8 - 22)
Creatinine, Serum: 0.9 mg/dL (0.5 - 1.5)
eGFR: 121.7 (60 - 120)
Total Protein: 7.0 (6.0 - 8.5)
Albumin: 4.4 g/dL (3.5 - 5.0)
Globulin: 2.6 g/dL (1.5 - 4.5)
Total Bilirubin: 0.4 mg/dL (0.2 - 1.3)
SGOT (AST): 47 U/L (5 - 50)
SGPT (ALT): 104 U/L (5 - 65)
Alkaline Phosphatase: 91 U/L (35 - 125)
Cholesterol: 188 mg/dL (< 200)
Triglyceride: 60 mg/dL (< 150)
HDL Cholesterol: 70 mg/dL (> 40)
LDL Cholesterol, Calculated: 103 mg/dL (< 100)
Iron: 156 mcg/dL (50 - 195)
Ferritin: 78 ng/mL (20 - 345)
I greatly appreciate anyone looking into my case because I have no idea how to move forward with this and neither does my current doctor. The high prolactin seems like it would cause some of my symptoms but I have no idea what’s the root cause.
EDIT: I am still working on getting the remainder of my thyroid tests, hematology, and estradiol. Also, I have never used any kind of testosterone boosting supplement. I have only ever used fish oil and various vitamin supplements in my life.