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Help with Interpreting Lab Bloodwork Results

Hello. I have recently taken blood samples which showed multiple values being elevated. In particular prolactin. I’m 25 years old and physically healthy otherwise, but struggle with anxiety, low libido, lack of motivation and energy, concentration difficulty, brain fog etc. I need help with interpreting my lab bloodwork results.

Here’s my results (Edit: ranges to the right):

IGF-1 (P) 270 μg 113-320

SHBG (P) 54 nmol/L 10-57

Prolactin (P) 2760 mIE/L 65-405

Testosterone (P) 27 nmol/L 8-31

Testosterone/SHBG ratio (FAI Free Androgen Index) (P) 50 30-150

TSH (P) 4,6 mIE/L 0,3-4,2

T4 (P) 19,0 pmol/L 12-22

T3 (P) 4,8 pmol/L 3,1-6,8

ACTH (P) 32 pmol/L 1,5-14

LH (P) 16 IE/L 1,7-8,6

FSH (P) 12 IE/L 1,5-13

Cortisol (P) 558 nmol/L 133-537

Hemoglobin (B) 162 g/L 134-170

Glucose (P) 4,3 mmol/L 4,2-10,9

MCV (B) 93 fL 82-98

Thrombocytes (B) 159 10(9)/L 145-348

Following bloodwork is from 2019:

Transferrin saturation (P) 0,54 0,15-0,60

Iron (P) 28 μmol/L 9-34

You might wanna post the ranges

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Run down the cause of the elevated prolactin. #1, there is no #2.

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Are you on any antidepressants or medications?

I will have a MRI-scan in September, I’m just curious about what my values can tell me. I want to know as much as possible. I thought that hyperprolactinemia cause secondary hypogonadism by suppressing LH (suppressing gonadotropins), but my LH is elevated and FSH is in the high range, which instead is associted with primary hypogonadism. But my total testosterone is pretty high (which I think goes against primary hypogonadism?) but since my SHBG is high too, the free testosterone is still pretty low (50 on a 30-150 range).

Why is my SHBG so high? Does hyperprolactinemia cause elevated SHBG?

No, except I’ve been taken Ashwagandha and rhodiola rosea back-and-forth, which I’ve read might downregulate prolactin and balance hormones. So if anything it should lower my prolactin, not elevate it. I’ve experienced symptoms of low testosterone and elevated estrogen before I started taking these herbs, and that’s the reason I gave them a try in the first place. Combined with a healthy anti-estrogenic diet and exercise.

I did notify small milky discharge from my nipples a couple of years ago, which strongly indicate elevated prolactin, that was before I’ve ever tried ashwagandha/rhodiola or was on any other herb or medication. The milky discharge is still there today, and when I started reading up on it a couple of months ago, I realized I have to look up my prolactin levels.

Now I realize that prolactin might be the main cause of my problems, that I’ve been experienced basically since I was a teenager, however I don’t know if it’s the source of the problem or a by-product. I’ve read that prolactin is down-regulated by dopamine and up-regulated by estrogen, too much estrogen in the first place might caused elevated prolactin and not the other way around?

When I took the latest prolactin test a week ago, that showed 2760 mIE/L, I’ve been off ashwagandha/rhodiola for weeks. However I did take a prolactin test about two month ago, when I’ve been taking ashwagandha and rhodiola recently, which showed a lower value of 920 mIE/L. It’s still way too high though. I don’t know if the lower value of the bloodwork I took in June has something to do with ashwagandha/rhodiola, or something else. Or a combination. The latest test was taken earlier in the morning, and prolactin is usually somewhat elevated in the morning. Anyway, both of my values are way out of the normal range.

I know it is hard, but you should approach this a step at a time, and the first one is determining why your prolactin is so high. You are doing that with the MRI, but until then everything is pure speculation.

To answer your questions, and further speculate, elevated estrogen can increase SHBG, and prolactin.

Is there a reason you didn’t check e2? Looks like just about everything else is on there …

Anyway, MRI is your next step. Sex hormones look fine, so if you’ve got a mass it’s not suppressing anything else right now.

Look more closely at your liver. I see a lot of guys with high SHBG needing TRT do to excessive malnutrition from cutting too many calories out of their diet.

Estrogens effect on SHBG is minimal.

The answer from the MRI came, it showed no abnormality. So it’s not a pituitary tumor that’s causing my hyperprolactinemia. So what could the reason/reasons be?

My nipples have recently (the past months) become itchy and sensitive, and according to my doctor I’ve gynecomastia (he taught it was caused by aromatase, what do you think?). Can prolactin directly induce gynecomastia, or only indirectly through elevating estrogen and lower androgen? I still haven’t checked my estrogen yet, but I will do it soon, I will call them tomorrow.

Can elevated estrogen have caused my hyperprolactinemia in the first place? (I find it hard to believe since if estrogen dominance can elevate prolactin to the extent of causing hyperprolactinemia, every female should suffer from hyperprolactinemia which isn’t the case. However perhaps it’s different when it occur in men, it might trigger another chain reaction of stress hormones but I’m only speculating here.)

My cortisol and ACTH is elevated too, and stress hormones do elevate prolactin. But perhaps it’s the other way around in my case; lack of androgen and to much prolactin and estrogen in the first place might have caused a stressful impact on my body, since puberty, either directly or indirectly. I see no reason for them to be elevated so I wounder what’s wrong here.

My LH is elevated too, hyperprolactinemia typically suppress LH and thus cause secondary hypgonadism. Elevated LH indicate primary hypogonadism. This make me wounder if my elevated prolactin is the actual cause/source of the problem or only a symptom of the problem down the chain reaction…

My TSH is elevated too, does my thyroid have problems? Can the thyroid be the main cause and cause hyperprolactinemia?

I’ve varicocele, which I’ve had since childhood, can it have caused primary hypogonadism and caused estrogen dominance during puberty? My total testosterone look fine though, is a high totalt testosterone even possible if primary hypogonadism was the cause? Since my SHBG is high too; the SHBG might store testosterone produced slowly under a long period of time, and that could explain a high value of totalt testosterone despite primary hypogonadism? (Just a thought, I have no idea)

What should I do? I feel like the doctors I’ve met so far don’t know more than I do, which bothers me. Should I focus on lowering my prolactin first? If my estrogen is very elevated (which I strongly believe), should I focus on lowering estrogen before lowering prolactin? If my hyperprolactinemia is induced by estrogen it make sense to lower estrogen in order to lower prolactin, but it might be the other way around.

If primary hypogonadism were the main issue, and it’s the lack of androgens that’s causing estrogen dominance and hyperprolactinemia, replacing my androgens extrenous would be the best treatment (TRT).

I will check estradiol, and I’ll see if I can get them to test bioavaible testo and DHT too. Is there anything else that’s missing? What tests should I take to check liver status?

Unfortunately doctors were also taught high testosterone is linked to prostate cancer, but this as been debunked. It’s a bit more complicated than just estrogen which is only one component to gyno.

No, not to this degree. I wonder could this be a lab error…