How many times have you had a blow to the head that took you off of the field? That would link to secondary that you do not seem to have.
Your high LH is why your testes are larger. And LH may be high enough that it is driving higher T-->E2 rates inside the testes. If you used anastrozole to lower E2 and the did not work well, that would tend to prove that hypothesis.
" I still train and eat the same way."
That can be quite hard on the adrenals with low-T and thyroid issues.
rT3 seems ok relative to ranges, but we do see some ranges that would make your level high.
fT4 seems low re mid-range. fT3 is the active hormone and should be tested. Also test ferritin which if low can impede fT4-->fT3.
With adrenal fatigue and elevated rT3, taking T4 meds simply increases fT4-->rT3 and one feels miserable. See thyroid basics sticky and note references to stress, adrenal fatigue, stress, rT3. fT3 and Wilson's Book.
Could your thyroid problem be from not using iodized salt? [Doctors never ask]
AST/ALT appear elevated and may be pointing to a problem that may impede E2 clearance and might also in itself increase SHBG production by the liver.
High SHBG means high SHBG+T that inflates TT and SHBG+T is not bio-available.
You have a problem in your testes. A competent doctor should examine for problems.
A test can be made with a couple of T injections. If LH does not come down, there is a defect in the top end of the HPTA where the hypothalamus cannot see T&E2 properly [using a SERM?] or the pituitary has a defect turning on LH&FSH. High sustained LH can turn off the testes if not releasing in pulses. With a single IM injection of 200mg T cypionate, LH/FSH should be turned off in 2-3 days.
List any medications that you have used in the past, Rx or OTC.
BUN can be increased by taking some NSAIDs like ibuprofen long term.
You should try to get on anastrozole to lower E2. Try 0.5mg/week in 0.25 doses twice a week. If E2 does not come down, high LH drivend T-->E2 inside the testes is confirmed. Lower E2 would normally then also be expected to increase LH/FSH and lower SHBG. SHBG lowering may be a slow response under normal conditions.
When energy levels are low, AM cortisol needs to be tested, do at 8AM or within 1 hour after waking up.
fT3 is absolutely needed
Post AM and afternoon body temps
BP and pulse.
Semen test to eval swimmers.
fasting cholesterol - can be too low
get testes examined, perhaps ultrasound.
Your case presents a number of challenges that might be best dealt with by a good endocrinologist, but that is rare with male hormone issues. An enthusiastic GP could follow my suggestions.
You state low DHEA but lab is high. Supplementing how much. In some guys, DHEA seems to DHEA-->E2 inside the adrenals. Try to get lower. You said good AST/ALT but labs are high. Take a break from training, recover muscles and muscles should not be sore for lab work.
In the future, you may need to ping me in the KSman is here thread.
Please eval overall thyroid function via last paragraph in this post.
Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
- advice for new guys
- things that damage your hormones
- protocol for injections
- finding a TRT doc
Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body's temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.