Advice on Labs? Extremely High Prolactin, Low Free T, High Cortisol

Looking for some advice on most recent labs, been suffering from ED (zero sensitivity also), tiredness, fatigue etc. for a long time now, likely around 2-3 years, not much change since my last post and conversation with KSman, doing everything i can in regards to training, diet, supps etc. but nothing seems to make a difference,
anyways i’m 21 Y.O, 180lbs, decent shape although it’s hard to maintain effort and focus within the gym with all this going on otherwise, seems pointless

Lab results as of 26/04:

Testosterone: 18.8 nmol/L ---- Range 9.90 - 27.8

Free Testosterone: 5.16 pg/ml — Range 4.0 - 30.0 (dismissed since within range)

Oestradiol: 80 pmol/L — Range 99 - 192

TSH: 1.04 mIU/L — Range 0.27 - 4.20

Free Thyroxine: 17.5 pmol/L — Range 12.0 - 22.0

FSH: 4.4 IU/L — Range 1.4 - 12.4

LH: 4.7 IU/L — Range 1.7 - 8.6

Prolactin: 655 mIU/L — Range 86 - 324

Cortisol: 601 nmol/L — Range 133 - 537

Asked to get DHT tested also and believe it was meant to be but it wasn’t on the results sheet when i was given it and doc didn’t didn’t know much about it when i asked. Been seeing a urologist for a while now and haven’t really got anywhere, puts everything down to psychological problems etc although don’t see how that’s gonna effect hormones the way they are.
Only other possibility i can think of is a left side varicocele causing hormonal problems. Initially i had an embolisation done about 6months ago in an attempt to sort it but it returned not long after - supposedly this can be as a result of pelvic floor issues which can be caused via postural issues/anterior pelvic tilt and so i’m also seeing therapists to try sort out those issues best i can.
Anyways, sorry for the long post, any input and guidance would be much appreciated, thanks in advance

Has your doctor address double range high prolactin? Some doctors just don’t take their job seriously, doctors that dismiss everything down to psychological problems ends all discussions about other causes and gives up trying to help. It’s time to move on and find a passionate doctor who is engaging and shows concern for the patient.

TSH and Free T4 looks great, confirm Free T3 measuring body temperature upon waking and at 2pm at full rest for both to confirm Free T3 levels. You should reach a minimum 97.7 upon waking and at 98.6 2pm. Any lower and Reverse T3 or Free T3 aren’t optimal.

I appreciate the reply,
To put it short, no - it was an endocrinologist that i’ve been seeing and he said that he’s not worried about my free testosterone as it was in range and I obviously questioned him and said is it not extremely low though and he said no its fine. He then went on to say that the prolactin is slightly elevated but this could be down to a number of things such as me stressing about the situation etc and that normally he wouldn’t suggest any further treatment but because of the symptoms he is going to refer me to a urologist, who is just going to do more blood tests once again i presume. It’s frustrating because i asked for a few other things to get tested along side it such as SHBG to get a wider look at things but seems he did not bother with it. Looking back on some older blood work from May last year (only previous post) and my prolactin was 28.9 which is pretty much the same although Oestradiol was 172 pmol/L - so it seems bringing that down hasn’t made a difference.
Thanks for the advice, i’ll do this again to check as I done these last year after KsMan advised it and they seemed okay

No SHBG testing which is considered the gold standard for evaluating a testosterone deficiency, it means he doesn’t understand the importance of SHBG. Together with your Total T and Free T, your SHBG according to SHBG calculator is 90 nmol/L, insanely high. By our standards 55 nmol/L is above ranges.

High prolactin isn’t the cause of testosterone deficiency, liver is cranking out too much SHBG. Most doctors in the UK do not understand anything related to SHBG and will simply dismiss what they don’t understand even when SHBG is skyhigh. They chose no action when clueless.

Thanks again System,
That would make sense. I will ring up my insurers tomorrow and see if by some way or another I am able to get that tested sooner rather than waiting to have another appointment with a doctor/uro and explain the whole story again and get more tests drawn which will no doubt take a number of weeks/month.
So if it’s the liver causing too much SHBG then what could be the cause of the elevated prolactin level? Sorry to ask as i’m aware it’s anyones guess without tests and that it’s the doctors jobs to find that out

I predict you will have to go private, the doctors in the UK aren’t trained in male hormones and they will often not care because they do not know the proper course of action and don’t have time to relearn what they didn’t learn in medical school, they must see an absurd amount of patients in an 8 hour shift so they can go home to the wife and kids.

sad how true it is and a common story for so many guys it seems. Scary thing is I am private. I reached a point last year i realised i have to as there is nothing more important right now. I guess i’ll ring them tomorrow and explain my endo said the next step is reffering me to an endo (already seen an endo through NHS but done half assed tests and dismissed/blamed psychological) though he seems in no rush.

@systemlord, after reading a few similar stories on here about elevated shbg/normal (ish) TT and as a result low free T, with guys complaining of the same symptoms, it seems the general consensus is that TRT is the only real way to go in regards to lowering SHBG, am i correct?
Looking at some of the causes for elevated SHBG, specifically the extended caloric restriction, I feel i may have caused this a long time a go, from a young age, as i have actually tried explaining to all of the doctors i have seen. I say this because regretfully, i started going to the gym at a very young age (13/14) - as i was a little chubby, not obese but just wanted to be leaner and more muscular, like anyone i guess. Although I always done everything to the max, which i also regret, from the age of as young as 15 i was tracking macro nutrients on myfitnesspal and recording my weight and was in a constant yoyo battle to get leaner and leaner or try get bigger, most of the time leaner, and therefor cutting calories/adding cardio whilst also playing football for 2 clubs and therefor training multiple times a week and playing matches. I actually still have the same myfitnesspal account and I am able to see the weight fluctuations over the years from where i’ve entered the data and its pretty ridiculous. Couldn’t understand for the life of me why i wasn’t losing weight with such restricted calories and cardio work (+still doing weight training 5/6days also), i’d say my caloric intake for the vast majority of the time was most likely 50% less than what it should be, which is obviously not ideal for development at that age - makes sense now though why i wasn’t losing any weight. Would be interesting to see first time i went to doc with this issue in all honesty but it was probably when i was about 18 (3 almost 4 years ago) and issues have been apparent ever since and has been a constant battle.
Going to try get some tests re-done and see another doc but if i get dismissed again i’ll most likely just try to sort it out of my own pocket and self-administer for an extended period of time until i at least get my SHBG down and then re-evaluate

Most aren’t able to lower SHBG over the ranges naturally, most waste time trying. Genetics, environmental, toxins and even diet play a role in elevating SHBG. I believe it’s all connected, low T, high/low SHBG, plummeting sperm count across western civilizations and hormones levels falling to all time lows in the last 100 years do to the industrial revolution.

Non western civilizations do not show the same decline in sperm count decline. You might need to go private.