T Nation

25 Y/O with Low T and High Prolactin, Help?

@KSman could you offer your insight on my first edit at the top of my original post?

  • TSH should be nearer to 1.0, could be increased by rT3
  • T4 below mid-range, maybe needing a bit more iodine
  • fT4 is good
  • fT3 is good

Body temps last showed low, you need a series of readings as we should be setting a course based on one result.

With mid-range fT3 we need consider that low temperatures may be from stress induced rT3 and adrenal fatigue. High cortisol can be from stress, but when the adrenals start giving up cortisol can drop low creating another big problem. All discussed in the thyroid sticky.

Prolactin suggests a pituitary adinoma, often confirmed by a MRI. Easy to shrink and maintain with 0.5mg/week Dostinex/cabergoline. Adinoma typically leads to lower LH/FSH and yours does not. So a very odd situation.

No need for TRT at this time.

Focus is the thyroid stress issues and you need to investigate on your as docs will laugh at that.

Thanks for the reply, so I shall retest my body temps over several days and if they’re still low I will try the iodine replenishment and retest temps after.

As for cortisol over the last few years of several blood tests it always seems to be elevated a bit so surely if it was from stress it would have dropped very low by now? Maybe I naturally have higher cortisol levels?

The prolactin situation does seem odd. As stated I will hopefully be getting an MRI but it is a very long wait. Do you still recommend cabergoline for the prolactin even if there is no pituitary issue? I was surprised the hormone specialist recommended HCG to treat it, i still don’t really understand his reasoning behind that.

hCG has nothing to do with prolactin or the possible adinoma.

There is only a slight need for more iodine based on the lab results. You seem to be missing the need for selenium, please understand that issue.

If Vit-D3 made you feel off, perhaps it was restoring some parts of your metabolism that was stressing because your metabolism is generally weak. Think about the weak link in the chain.

Read about over training in the thyroid basics sticky and consider reading Wilson’s book on adrenal fatigue.

You do not start caber treatment now because there is a need to see what the suspected adinoma looks like on the MRI - before caber makes it shrink.

Ok thanks, I have 100mcg selenium tablets I can take with iodine.

I did think that about the vit d and I tried to continue taking it for as long as I could but it just made me feel so much more tired I couldn’t take it anymore.

I shall read about over training in the sticky thanks.

I have done my body temps again over the last few days they are as follows:

Mon am: 97.5
Pm: 97
Tues am:97
‎Pm:99
‎Weds am:97.4
‎Pm:98.7
Thurs am: 97.5
Pm:98.3
Fri am:97.2
Pm: 99.1

Mon evening I decided to take 200mcg of selenium then Tues and today I took 100mcg of selenium. I’ve also been having a cup of cranberry juice daily to get an extra bit of iodine.

Also most evenings and also this afternoon I’ve been feeling like I’m high on caffeine/ my adrenaline is pumping.

I will continue taking body temps and update you. What do you make of these temps @KSman ?

some reading about THC and hypopituitarism/high PRL
https://www.medscape.com/viewarticle/803588
https://www.mdedge.com/clinicalendocrinologynews/article/58659/pituitary-thyroid-adrenal-disorders/case-report-chronic

Thanks, I actually read some research which indicated that thc actually reduces prolactin, chronically rather than acute usage .

After reading the bottom article it looks like they claim the cannabis use suppressed his thyroid which is known to increase prolactin. Where as my ft3 and ft4 are good.

have you just started smoking pot or returned to that? Of course everyone is diffrent at the molecular level.

Just recently returned to weed approx. 4-5 months ago. Before that I hadn’t smoked it for about 5 years.

Just an update I feel like my mood/energy, erections and libido have all improved some what but still not what they should be .

Also starting to get some morning wood, not every morning but some mornings.

@KSman just another quick question. Stupidly I’ve only just thought of this for some reason.

But at the age of about 13 I started to develop hard lumps in the tube behind my left nut and it also became inflamed.

I have seen a doctor about it and had a physical examination. He said it’s just cysts and nothing to worry about. Could this also be a possible cause of my low test/ free test?

I was wondering if the high prolactin was surprising my lh/fsh somewhat and if my prolactin was lowered, could my lh/fsh then increase some what?

Perhaps as we see high LH/FSH. The other teste is not affected.

Your case is still odd…

I have some more bloods which I should have included in the original post if someone wouldnt mind taking a look at them.

Haemoglobin 166 (130-170)
Red blood cells 4.97 (4.4-5.8)
Haematocrit 0.478 (0.38-0.5)
Mean cell volume 96 (81-98)
Red cell distribution 12 (11.5-14.4)
Mean cell haemoglobin 33.4 (27-33)
Platelets 184 (150-400)
MPV 9.7 (7-13)
White blood cells 4.4 (3-10)
Neutrophils 2.18 (2-7.5)
Lymphocytes 1.78 (1.2-3.65)
Monocytes 0.29 (0.2-1)
Eosinophils 0.08 (0-0.4)
Basophils 0.03 (0-0.1)

Chloride 101 (98-107)
Glucose (fasting) 5.7 (4.1-5.9)

Kidney function
Total protein 75 (64-82)
Albumin 45.7 (35-52)
Sodium 140 (136-145)
Potassium 4.2 (3.5-5.1)
Urea 5.5 (2.76-8.07)
Creatinine 93 (62-106)
Egfr 91 >60

Liver function
Total protein 75 (64-82)
Albumin 45.7 (35-52)
Alt 39 <50
Ast 24 <50
Alp 68 <129
Ggt 11 (10-71)
Ldh 160 <250
Total bilirubin 10.3 <24

Bone screen
Total protein 75 (64-82)
Albumin 45.7 (35-52)
Calcium 2.43 (2.15-2.5)
Corrected calcium 2.32 (2.12-2.52)
Phosphate 0.98 (0.81-1.45)
Alp 68 <129
Uric acid 0.313 (0.202-0.416)

Lipids
Cholesterol 5.06 (0-5)
HDL 1.46 (1-1.5)
Triclydgerides 0.9 <1.7
LDL 3.19 <3
Chol: HDL ratio 3.47 <4
HDL cholesterol ratio 28.9 >20
Non HDL cholesterol 3.6 <4

I haven’t been on here for a while but I’m still having some issues so I thought I’d update you guys and hopefully get some more help.

I took some time away from here and the internet/social media in general. I’ve tried to improve my mood/oulook on life and reduce stress as much as possible. It has worked out and I’m now able to work out and I’m able to work as well. I still get quiet tired here and there but it’s manageable . My workout consists of just weight lifting. Heavy compound movements like deadlift, squat, bench press and pull ups. For some reason cardio makes me feel awful so I don’t do it.

Now I’ve recently started seeing someone, it’s nothing serious but I’m having regular sex. Now this is where the problem is, I’m finding it hard to get erections but I still always manage to get one. It feels softer than it should be though and is sometimes difficult to maintain. I can usually maintain it if I’m constantly stimulated but for example if I want to change positions it’s difficult to maintain. It’s the same when I masturbate so I’m pretty sure it’s not just in my head and I never used to have any anxiety about sex anyway untill I started getting erection issues. Obviously this effects my mood and makes sex alot less enjoyable.

I’m still concerned about my free testosterone level as it seems low but lh and FSH seem good? Do you think I could be primary hypo? I’ve been to see a male hormone specialist but he just looks at total t and says I’m fine. What do you guys think? Also I’ve had an MRI and my pituitary looks good. Thanks

I would expect erection trouble with estrogen low, some men need estrogen closer to 30 to maintain an erection. We get E2 from Free T and both are lower, it shouldn’t be that difficult for your doctor to figure out.

A lot of doctors take one look at the Total T and see it in range and their mind in that moment is made up and they look no deeper. This is how the sick care model works, in range, out of range, black and white. We all know there’s a grey area where symptoms are present.

The NHS doctors in the field of TRT are a bunch of retards.

Thanks for the reply. The male hormone specialist I saw was private this time actually, so yeah it’s not just as simple as going private. I guess I need to find someone who knows what they’re talking about if that’s possible…

So you agree that free t looks low? And it must be primary right? As my lh is good so my testes are being signaled just not producing enough t? Because even total t doesn’t seem that high.

If your SHBG is grabbing onto more testosterone, then total testosterone will be elevated and appear normal while free testosterone suffers. There’s a variability in the stickiness of SHBG from person to person, meaning one person’s SHBG grabs ahold hardnose to more testosterone than the next person.

I’ve seen examples of this, I’ve seen some with SHBG in the high 70’s and no symptoms of low testosterone and others who are on TRT with SHBG in the 70’s and feeling good again. Yet we have guys with SHBG below 50 and very low free testosterone.

There’s a big grey area.

You are shown signs of both primary and secondary hypo. Imagine for a moment you have SHBG closer to the top of the range and also testicles that are only starting to fail, you would expect to see lower free testosterone and higher LH. Your total testosterone doesn’t match your good LH level even with all that SHBG.

Which signs point to secondary? Cheers