T Nation

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

@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

I just really don’t know what to try next. I would rather not have to go on trt for the rest of my life , but if that’s the only way to live a fulfilling life then so be it

What does prolactin look like now?

I haven’t had any bloods done recently, but as lh is normal doesn’t that mean prolactin can’t be effecting test?

What do you think I should do next? Is it worth trying cabergoline?

Get your prolactin tested and if elevated try cabergoline, but don’t make moves while blindfolded and no labs.

Ok thanks man much appreciated!

Looks like I should be able to get some caber tomorrow and I’m getting prolactin tested at the same time.

If prolactin is still high what dosage should I start on? 0.5mg a week? And should that be split into two 0.25mg doses? Thanks

You got an MRI of pituitary already? Sorry did not read up. If not should.

Yes pituitary MRI came back fine

Hello mate, I realise your post was a while ago but I thought I would share what I did in regards to lowering prolactin. I had blood work done before I started my first cycle of 400mg test p/w and it came back at:

Prolactin 550 mU/L 29/08/18 with normal ranges being 86-324

I did some research and started supplementing with;

Vitamin E
Vitamin B6
Ashwagandha
Zinc

8 weeks after my PCT i did some more blood work and my prolactin was:

Prolactin 244 mU/L 20/02/19

Hope this helps.