T Nation

42 with High SHBG, Prolactin, TSH. Normal T


#1

Just got my first BW back. Prolactin and SHBH are high, TT seems ok at 800 and E2/TSH are at the higher end.

I am 42, 142 LBS, 5’8" with 30" waist. Very few facial or body hair. Not bald but my hairline have been slowing receding over the years.

I started to notice ED issues about 6 years ago. Sometimes the junior goes from super horny to nothing in a matter of seconds while having sex. I do still have morning woods if I have enough sleep.

This BW is ordered by a male clinic doctor. I have an appointment with him later this week. Need help to understand what I should expect from the doctor.

@KSMan

TT, Serum 800 345-1195 ng/dL
E2 28 7-43 pg/mL
Prolactin 25 4.0-15 ng/mL
SHBG, Serum 55 16-56 nmol/L
TSH 3.8 0.45-4.5 uIU/mL

Iron Saturation 62 15-55 %
Iron, Serum 170 38-170 ug/dL
Uibc 105 110-343 ug/dL
Iron Bind.Cap.(Tibc) 275 250-450 ug/dL

AST (Sgot) 22 0-40 IU/L
ALT (Sgpt) 28 0-44 IU/L

HBA1C 4.6 4.9-5.7 %

LH 3.0 1.8-8.9 mIU/mL
Prostate Specific Ag, Serum 1.6 0.0-4.0 ng/mL

MCV 106 80-98 fL
MCH 36 27-34 pg

WBC 4.5 3.5-11 x10E3/uL
RBC 4.5 4.2-6 x10E6/uL
Hemoglobin 15.8 12.8-18 g/dL
Hematocrit 46 37-50 %
MCHC 34 31-35.8 g/dL
RDW 12.4* 12.2-15.2 %
Platelets 195 150-380 x10E3/uL
Neutrophils 42 %
Lymphs 43 %
Monocytes 11 %
Eos 2 %
Basos 1 %
Neutrophils (Absolute) 2 1.5-7.0 x10E3/uL
Lymphs (Absolute) 2 0.8-3.2 x10E3/uL
Monocytes(Absolute) 0.5 0.1-0.9 x10E3/uL
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL


#2

I really need some help here. Anyone?


#3

Where are you located? Affects diagnostic and therapeutic options.

Labs:
Can you get FT [free testosterone] tested?
Kidney function labs?
Better to test LH and FSH. But with TRT, both should be near zero and are not needed. So I have to wonder about a doc who ordered LH while on TRT. One exception would be testing on TRT one time to detect a FSH secreting testicular cancer.

SHBG is elevated by higher E2 levels and lower FT. E2 is not remarkable, makes me wonder where FT is.

LH=3.0 on TRT suggests that free and bio-T are very low.
Thus I ask this:

  • How much T, in mg’s do you inject and how often?
  • Are you self injecting?
  • When were labs done relative to prior injection?

With TRT, both LH and FSH are expected to go to zero, not LH=3.0
With SHBG=55, FT may be low and there will be more SHBG+T, that is not bio-available that is inflating the TT number.

You seem to have too much iron.
You need to avoid iron fortified foods: bread, pasta, cereals vitamins
Iron overload can cause low-T and can harm vascular organs: liver, kidneys …

MCV:

  • What B vitamins are you taking as supplements?
  • Is your diet weird?
  • What medical conditions and what medications?

Your T levels have never been high.

Prolactin can lower LH/FSH and thus T.
Prolactin can be elevated by some meds as well as recent orgasms or cuddling babies or puppies etc.
Prolactin can be elevated by a prolactin secreting pituitary adinoma, more something that happens at a younger age, but maybe it has been lurking there. Prolactin is easily managed with 0.5mg/week Dostinex/cabergoline. The problem with the adinomas is that they can get large enough to press on the optic nerves. Is you peripheral vision less that 180 degrees?

TSH:
Should be nearer to 1.0, there is a problem from a lack of iodine or a thyroid issue. What is your history of using iodized salt? The thyroid lab ranges are insane and most docs will not see a problem. Pleases eval your overall thyroid function - see last paragraph in this post.

Please read the stickies found here: About the T Replacement Category

  • 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.

That is a lot to cover. Try to respond to all issues. The first sticky listed will help with terminology etc.


#4

What to expect from your doctor:

  • your T is normal
  • your thyroid is normal
  • your prolactin is not very high

Doctors are typically very disappointing and they are the biggest problem that you will face. Endos are often the worst. You have to start managing the diagnostic and treatment directions your self as been passive hardly ever works. You have a lot of challenges. Understanding the stickies will take some time, but then you will be equipped to know more about what you need.


#5

Thanks @KSman for your reply. I haven’t started TRT yet so the BW are pre-treatment baseline.

  • I am in Seattle area
  • Doctor calculated my FT based on my TT and HSBG. 13.4 and 9.89 ng/dL in two separate BWs.
  • I don’t have kidney function labs. Any recommendation of which Labcorp code to use?
  • TSH - wife cooked with sea salt. After I started to read on this forum weeks ago I have added iodized salt to my diet. Haven’t observed any change though. My oral temperature is between 98.0 - 99.2 depending on the time of the day.
  • Iron - my diet doesn’t seem to be iron-fortified. I don’t eat much sugar (bread, pasta, cereals). I take one multi-vitamin, fish-oil, B complex and Calcium each in the morning. I do eat good amount of red meat though.
  • Doctor thought the high MCV/MCH are due to high iron in blood. He suggested that I may have hemochromatosis but he asked me to see my physician to follow up. I have hepatitis B so regular blood donation is a no go. Any other cheap alternative?
  • Doctor said he is not concerned of my low 4.5 (4.8 - 5.6) hA1c
  • Doctor said my high 54.1 HSBG is the reason I had elevated 27.6 E2 and high 25.0 Prolactin

The appointment with my TRT doctor today didn’t go well. With my 805 and 668 TT he didn’t think I need TRT treatment. Instead he asked me to cut back my alcohol consumption and reduce soy intake. That’s it! The problem is I have had ED issue for 8 years, way before I started to drink frequently. I don’t do any drug or smoking.

@KSman you are absolutely right on what my doctor would say to me. He refused to give me any treatment even after I pressed him 3 times. I even mentioned AI to lower my E2 and he said it’s not necessary. I was in and out of the clinic in 15 minutes. This is more than frustrating. I plan to get my kidney function, TSH, fT3, fT4 test done.

Anyone can recommend a good doctor in Seattle area?


#6

Higher E2 elevates SHBG and higher FT/Bio-T lowers SHBG, you are screwed both ways. Is he confused about this or you?

You have never checked FT directly, you should do this.
Your high SHBG is creating abnormally high amount of SHBG+T that is inflating your TT and TT is not a good measure of your T status.

Your E2=28 certainly does not explain why SHBG is so high.

What meds are you on? Continuous anti viral?

As hep B is a liver disease and SHBG is made in the liver, that can the cause of high SHBG. http://www.medscimonit.com/download/index/idArt/501606

To depress SHBG, TRT with high FT as a goal may be effective. You will need to keep E2 near 22pg/ml with anastrozole.

Is your doc simply guessing?

Search this forum for Seattle.