T Nation

Help. Low Test, ED Issues

Hi all, I am a 35 yr old guy with a history of Erectile dysfunction and hormonal issues that went untreated because the doctors said the tests were in range. I can’t live my life like this. So KSman and other knowledgeable folks, please help me.

During puberty I had very severe gynocomastia that was operated on twice. Also from around that time I suffer from Idiopathic Cholinergic Urticaria. I had difficulty in passing urine at one go and very weak erections. The doctors said that secondary and tertiary sexual characteristics were normal so no need to run any tests.

They said I was normal and unfortunately I believed them. I have facial hair that grow very very slowly.One shave can get me through a week.No hair on chest and back. Thin hair on forearms, underarms and legs. As for the hair on my head, they are lifeless and dull and thin.Then I went abroad to work and my weight went from 209 lbs to 165 lbs. I am 6’ tall.

I worked a moderately heavy job and I would be sore everyday. My erections were very soft and ejaculation was almost non existent. Then I started on tribulus and passion flower extract along with some saw palmetto and that made my life slightly bearable. It didnt make a huge difference but urination became easier.

I didnt have a social life, I just worked.Then I went to consult a doctor to see if I need HRT and he just looked at me and said no. I decided to run a test for E2 anyways and that came back over the limit by a lot.

Then I moved to the States and to make a long story short tried to consult a few doctors about this but to no avail. Here are some labs that I ran last year.

Test, Serum- 266 ng/dL 249-836
Test, Free- 11.1 pg/mL 8.7-27.1
DHEA Sulfate- 212.3 ug/dL 88.9-427.0
Estradiol- 36.6 pg/mL 7.6-42.6
TSH- 1.210 uIU/mL 0.450-4.500
Thyroxine(T$)- 6.1 ug/dL 4.5- 12.0
T3 Uptake- 32 % 24-39
Free Thyroxine index- 2.0 1.2-4.9

I had to move again to Asia and as soon as I could I went on Aromasin. These were my lab results after 2.5 to 3 months on Aromasin.
Test, Free- 40.1 Pg/ml 4.5- 42
Test, Serum- 718 ng/dL 166-877
Estradiol - 16.58 pg/ml < 62 pg/ml
Serum Prolactin- 6.54 ng/ml 2.64-13.13
DHT- >2500 pg/ml 250-990 pg/ml

Then I consulted an endo and he asked me to run some labs after I was off Aromasin for 45 days.Here are the results.These are the latest lab tests that I have had.

Serum Prolactin- 13.40 ng/mL 2.10- 17.70
Test, Free- 8.09 pg/mL 3.84- 34.17
Test, Total- 363.70 ng/dL 241.0-827.00
Estradiol(E2)- 25.29 pg/mL 10-50
FSH- 1.83 mIU/mL 1.40-18.10
LH- 3.39 mIU/mL 1.50-9.30
T3 Free- 3.13 pg/mL 1.71-3.71
T4 Free- 0.93 ng/dL 0.70-1.48
TSH,Ultrasensitive- 1.420 uIU/mL 0.350-4.940

Went back to see him and the endo tells me to go see a shrink as my problem was mental.According to him all my results were in range and everything was fine and dandy.

After reading the forums here I started on 500 units of HCG every other day along with 1/4 Aromasin tablet. Then yesterday I took 500mg vit B6 and that gave me a little morning wood. Then I went and got me some Cabergoline and I was planning on taking it every 3 days(1/4 tablet). But while writing this I just noticed that my prolactin results were near the high end so maybe I will dose more.

Thank you for reading this. Please give me your thoughts and suggestions as to how can I get a life worth living.

Im excited a bout this case as it is very interesting (oh plus I think we can help)

Caber for prolactin is premature. Look at your other result–it was near the bottom of the range! Did you have sex and/or masturabte or have anything near your nipples in the 24 hours prior to your prolactin test?

Your blood levels looked perfect while on Aromasin–why did you stop again? How did you feel on those levels?

Why are you taking HCG now? Your body responds and produces T with just Aromasin.

Your biggest flag here is the high DHT. This could lead to an enlarged prostate (especially in the presence of high estrogen). Did your doctor honestly not mention anything about you having DHT three times the upper range?

You need to get a PSA test. Did you have a DRE done? Any prostate hypertrophy?

Get these done or investigate them and we will talk treatment options to discuss with your doctor.

My non professional opinion is your body has too much Alpha 5 Reductase enzyme, which converts your T to DHT. Your body sensed this and has increased Estrogen, and inhibited T production to compensate. If everything checks to chart, a good possibility to explore would be an A5R Inhibitor (Propecia, Advodart, etc.).

Note you are an exceptionally rare case and I wouldn’t recommend A5RI to anyone except for this instance, and only if we’re sure its warranted.

Thank you 34 for your thoughts. Now to answer your questions.

Regarding my other test for Prolactin that came in low the answer is negative.

While on Aromasin my energy levels were fine. I walked like 8-10 miles everyday. Its just that it didnt do anything for my libido or the health of my penis, and also the endo told me to go off it before I did my labs again. Plus I had severe urination problem. When I was in my twenties I tried 2 shots of Test. Propionate or Sustanon(I’m not sure) and that really made a difference for a few days until the Estrogen rebound made me decide not to try it again.

I am trying HCG just to give my testes a bit of a boost. My scrotum doesn’t hang like normal but is pulled up tight. And thats as true now as it was when I was on Aromasin. Also I thought the HCG might increase the ejaculate volume.

lol with the way my reproductive health was/is I wouldn’t touch any DHT blocker.

I had an MRI done some time ago, everything came out normal.

One important thing I forgot to mention in my post is that in the first lab results where Estradiol came in at 36.6(near the high limit) I was using DIM, Zinc(100mg) to lower it. Unfortunately I didn’t test for Prolactin at that time. After being off Aromasin when I tested again my Prolactin came nearer the high limit. So that makes me think Prolactin might be the culprit. I have asked my cousin who is a doctor to mail me some studies on Prolactin induced gyno and ED.

Once again thank you for your help.

"Did your doctor honestly not mention anything about you having DHT three times the upper range? "

I noticed it and I guess so did the endo but he didn’t say anything about it. the whole time I was there he couldn’t even look me in the eye.He only said it was all in my head and I should see a shrink amd a urologist. Infact he even recommended a urologist who was very good and also his friend. I’ll pass.

A couple of questions.

Does Prolactin have any effect on the Immune system? If anyone has any information pertaining to this please share.

My question about prolactin and masturbation was actually in regards to your second test. I see how my wording was confusing though. Prolactin is increased by sexual activity. The fact that it was low before and high later indicates something is amiss. I would have it checked one final time, without any sort of sexual activity 24 hours prior to see if it is still high. Caber may be premature before that.

You seem to be yet another guys who seems to be impervious to AI-only therapy, despite marked improvements in bloodwork (damn near perfect actually). This is very common as most guys do not seem to do any better on it.

You may not have any choice for DHT blocker, if you do have a DHT problem. I’ve never seen one so far above the range. Did your doctor not mention this at all?

MRI is not a DRE. DRE checks for prostate enlargement. PSA also checks for prostate specific adaptagens (that could lead to cancer).

Have you seen a urologist about your urination issues and such? They would do the DRE and PSA tests.

I’m still thinking you have an A5R issue.

I will get my Prolactin checked again tomorrow and post the results here as soon as I get them. Meanwhile here are the results for PSA that should go alongwith the first set of results(done in the USA).

Prostrate Specific Ag, Serum- 1.4 ng/mL 0.0-4.0

I havn’t seen a Urologist about my issues since I believe my problem is Endocrinol. Infact I plan to consult another one but I need to educate myself before I go see her. I don’t know if its only me but most of the doctors I have met are very egoistical and have their heads so far up their asses it ain’t funny.

Btw, I will try to find where I can run labs for “Alpha 5 Reductase Enzyme” and post results here. Even I was surprised by such high levels of DHT. And once again, No, the Endo didn’t find anything in those results to comment on. I should also let you know that I carry most of my excess weight on my lower abdomen, thighs and my hips. I weigh 235 lbs now and the doctor says that is the whole cause of my problem. Nevermind that I had the same problem when I weighed 165 lbs.

You have trouble urinating, which is indicative of an enlarged prostate, which is highly correlated with high DHT.

You took saw palmetto, which is known to reduce DHT conversion, and your problems with urinating improved, which is highly correlated with lowering DHT.

Your DHT is confirmed to be THREE TIMES (!!!) the upper limit, which is by far the highest level I have ever seen (and I have reviewed probably 500+ blood tests in the past few years, and that is a conservative minimum).

Yes, you have an endrocronilogocial problem, known as high DHT, which is causing a urological problem in an enlarged prostate…which is a speciality of urologists…

I’m not following your train of thought for barking up this prolactin tree based on one blood test which was contradictory to a previous blood test.

I agree with you 34 that my DHT was really high. But that could be due to Aromasin that was leaving a lot of testosterone to be converted to DHT. While I was on Aromasin exercising was fun as I did not fatigue easily and my muscles were much more firm than they usually are.

Back when I was using Saw Palmetto my endurance and strength weren’t so good. My erections were like a soft banana. So my guess is that my DHT wasn’t this high at that time. I called a lab to see if I can run a test for AR 5 reductase enzyme and they should call me in 1-2 days. Then we will go from there.

the reason for my putting stress on Prolactin is that according to what I have studied, a lot of ED cases stem from Proalctin excess/senstivity. Again, my knowledge base isn’t as vast as yours and some of the people here(no sarcasm). I am taking semi-educated guesses and hoping that I land one shot close to the bulls eye so that I can finally resolve this and have a life. Thats all. Please don’t hesitate to share your thoughts.

Your first statement doesn’t make any sense…there are thousands of people with testosterone levels sch as yours that DONT have THREE TIMES the upper limit for DHT. You can put your head in the sand on this if you want to, but I dont understand why you arent grasping that it is a potential problem that needs investigating. Your urination problems with it, the fact that they went away when you took a known DHT reducer, everything points to you having an issue with DHT.

Why do you think you need this mythical test for A5R enzyme? What do you hope to accomplish from it? If you have normal T levels and high DHT, it is coming from conversion from Testosterone through A5R–there is no magical pathway that would give you DHT that high.

If that is the case, it is a simple fix. You take a A5RI

If your issue is with prolactin, what is the source? Your body doesn’t just decide to secrete prolactin 24/7. So that would mean you likely have a prolactinoma on your pituitary. didnt you say you had an MRI? Im guessing it didnt show a pituitary abnormality?

Thank you 34. But hasn’t elevated E2 been implicated to play a larger role in the BPH?

http://www.lef.org/magazine/mag99/feb99-bph.html

http://www.mendeley.com/research/new-quantification-method-for-estradiol-in-the-prostatic-tissues-of-benign-prostatic-hyperplasia-using-liquid-chromatographytandem-mass-spectrometry/

I have to admit that I somewhat agree with your line of thought. If you have more info about this please do share. Also what would you advice and what would our progress markers be? From what I understand you are not recommending any DHT blockers but something to lessen the production of AR 5 Reductase Enzyme. Am I correct?

No they are the same thing.

So how would I dose the AR5 blocker? Would taking an AR blocker along with Aromasin help my case? And do you think 2-3 weeks be a decent time period to gauge whether the results are going in a satisfactory direction?

Read up on Propecia and Avodart–things like that. Some other meds for BPH. That will get you started.

I think taking it with aromasin would be beneficial, but may end up being unnecessary once you get things lined out in other areas.

No idea about the timeframe, sorry. This is why you need a urologist–this is their speciality area. One of the few times I would recommend a uro.

I will try to find a urologist and in the meanwhile I will run the labs again for test,DHT and estradiol to see where I stand. Thanks once again 34.