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High Prolactin, But High Test, Low Sex Drive?

Hey guys,

New here. Hoping somebody can help. For the past 3 years I’ve been suffering with very low sex drive and shrinking balls(i think?) and have seen multiple urologists/ endocrinologists with differing opinions See lab results below. Consistently, I’ve had a slightly elevated prolactin on multiple lab tests but for some reason, my Testosterone always comes out normal and sometimes even high.The first endo I saw theorized because my Prolactin is high, that I may have a prolactinoma. An MRI scan showed that I indeed do have a microadenoma. His treatment suggestion was Cabergoline/ Dostinex. However, he was not able to explain to me why my T is totally normal. The prolactinoma should be suppressing Testosterone levels… Something didn’t add up. Could the tumor still be effecting the way I feel, even without directly suppressing T? Other doctors have suggested that Cabergoline won’t do anything and that I see a psychologists/therapist. I highly doubt that this is psychological, it just cant explain why everything just tanked for me suddenly.

Things that stand out to me in the labwork is that Estradiol is slightly high or in the mid-upper range on multiple occasions.

Other possibly important facts: Also I took accutane for 6 months in 2005. I had no sexual issues during and after the 6 month course whatsoever. Everything was fine from 2005- 2015. Then in 2015(10 years later) my libido tanked. A year later In 2016, I took a self administered “ultra-low” dose of accutane in 2016 for a year. I’m not sure if the accutane is related.

I would appreciate any help or feedback. Thanks!

EDIT:
June 6th 2018 (Lab #5)
Testosterone: 526 ng/DL (264 -916 ng/ dl)
Free T (direct) 32.5 pg / mL (9.3 26.5)
Prolactin: 21.5 ng / ml (4.0 -15.2)
SHBG: 42.5 nmol/L (16.5-55.9)
FSH: 3.1 mIU/ml (1.5 0 12.4)
LH: 5.8 mIU / mL (1.7 - 8.6)
Estradiol: 34.8 pg/mL (7.6 -42.6 pg/mL)

February 1st, 2018 (Lab #4)
Testosterone 478 ng/Dl (264 -916 ng/ dL)
Free T (direct): 50 pg / mL (9.3 26.5) wtf why so high? herbs maybe?
Prolactin 13.2 ng / ml (4.0 -15.2)
FSH 3.1 mIU/ml (1.5 0 12.4)
LH 6.6 mIU / mL (1.7 - 8.6)
Estradiol 40.4 pg/mL (7.6 -42.6 pg/mL)

PSA, Serum 0.9 (0-4) ng/mL
Ferritin, Serum 155 (30-400)
Transferrin 236 (200 - 370) mg/dL

July 14th, 2017 (Lab #3)
Testosterone 585 ng/Dl (250-1010)
Free T 109 pg//mL (35-155)
Prolactin 18.2 ng / ml (4.0 -15.2)
FSH 2.8 mIU/ml (1.5 0 12.4)
LH 5.6 mIU / mL (1.7 - 8.6)
Total Estrogen 205.8 pg/mL (60-190)
DHEA 22.4 (1.8 - 12.5)

June 20th,2017 (Lab #2)
DHEA, Serum 15.4 ng/mL (1.8 -12.5)
Testosterone 524 ng/dl (300-1080)
Free T 109 pg//mL (47-244)
Prolactin 18 ng / ml (4.0 -15.2)
FSH 3.2 mIU/ml (1.5 0 12.4)
LH 5.7 mIU / mL (1.7 - 8.6)
Estradiol 39.1 pg/mL (10 -42 pg/mL)
Hemoglobin A1C: 5.4 (<5.7)

TSH, Ultrasensitive: 1.380 uIU/mL (0.270 -4.200)
Free T4: 1.47 ng/dL (0.93 - 1.70)
T3 Uptake 36.6 % (24.3 - 39)
Free T3: 3.29 pg/mL (2.00 - 4.40)
Thyroperoxidase AB TPO: 20 Iu/ML (<35)
Thyroxine Binding Globulin: 14 ug/mL (13.0 - 30.0)
ACTH 22 pg/mL (7-69)
Calcium 9.2 mg/dL (8.6 - 10.5)
Cortisol 13.7
Vitamin B 12 378 (211-911)
Vitamin D, 25-OH Total 27.7 (30-100)

April, 2017 (Lab #1)
Total T: 354 ng/dL (250 - 1100)
Free Testosterone 42.6 pg/ML (35.0 - 155.0)
Cortisol: 7.5 ug/dL
DHEA, Serum 11.5 (1.8 - 12.5) ng/mL
SHBG 37 (19.3-76.4)
T4: 7.5 (4.5-12)
T3 Uptake 37.2 (24.3 - 39)
Free Thyroxine Index, Calc 2.8 (1.6 - 3.7)
TSH, Ultrasensitive 0.851 (.270 - 4.200)

Cholestrol 105 (100-199) mg/dL
HDL 57 (>=40) mg/dL
LDL, Calculated 34 <130 mg/DL
Triglycerides 68 (20-149) mg/dL

Your problem is your Total T is low when compared with your SHBG (TT 526+SHBG 42.5) which puts your free testosterone at 9.540 ng/dL = 1.81 %, 2-3 percent is normal. You must understand unless your Free T is consistently elevated, you will experience symptoms, doctors tend to forget these labs testing are snapshots in time and do not show what’s going on 99% of the time.

The majority of endocrinologists and urologists will fail at anything related to sex hormones, it’s not typically the type of thing they do on a regular basis. Endos are more into thyroid and diabetes and uro’s are about prostate and procedures and neither learn about sex hormones in residency and medical school.

Prolactin barely over the ranges is nothing to be concerned about. Were these Free T score measured directly or calculated?

Your estrogen testing is for females, ranges are a dead giveaway and Roche ECLIA methodology is for women and the LC/MS/MS method (8-35 pg/mL) is for men. As it stands you have no clue what your estrogen levels are.

Your estrogen is likely lower than stated, which is why we use the Liquid Chromatography–Mass Spectrometry because it is more accurate for us men.

Fluctuating thyroid hormones (Free T3) can increase, decrease SHBG levels which might explain massively fluctuating Free T levels. Free T3 speeds up every cell in the body which can push the liver to produce more SHBG, if Free T3 levels drop so to does SHBG and therefore Free T would increase dramatically.

A full thyroid panel checking TSH, Free T4, Free T3, Reverse T3 and antibodies should be done.

You can continue playing the doctor lottery and hope one day you find a competent hormone doctor or you can go private and seek the care from someone who has been doing TRT for decades.

I had to go private because all my endo’s are TRT ignorant, they don’t even know which tests are for females or males. The guidelines are so many years outdated doctors have nowhere to turn for guidance.

I went with Defy Medical, a telemedicine anti-aging clinic that is well known for expert level hormone doctors. All medicines are mailed to me and is pay as you go. Dr. Saya has been doing TRT for over 20 years on a regular basis a ton of clinical experience.

SHBG calculator http://www.issam.ch/freetesto.htm

Your E2 test is not necessarily worthless. See below an example of the LC/MS/MS test actually indicating a higher E2 level than IA.

Look to any high E2 symptoms. Yes, sexual function is part of it. What about water retention, puffy nipples, tender, itchy? Mood or anxiety? I also think you need to take a detailed look at thyroid function, if you haven’t already. What about DHEA? IGF-1?

Without knowing the entire picture, I would not think it out of reason to give TRT a try. Some need to run testosterone higher to feel good. Hopefully, you can find a local doctor to work with you. If not, check your state telemedicine laws, most require the doctor to be licensed in the state in which the patient resides and also, the first visit must be in person face to face. Good luck.

Hey guys, thanks so much for the input.

Forgot to add some stuff in the initial post including thyroid levels…See updated original post with more lab values. See Blood tests on July 14th, 2017 and April 2017.
I am a 28 year old male, 140 lbs, and 5 "11.

Symptoms:
Low Sex Drive (but fully functional, and can orgasm fine, just no interest and no feeling). I do not have ED.I don’t have any other symptoms. I used to get an aching pain sensation in the testicles a few years back. At the time, I was taking a low dose of accutane (2016 - early 2017) for my acne and I feel that contributed to the testicular pain as well as lowered my T levels (see April 2017 Labs). When I got off the accutane, I jumped on some Chinese Herbs, and the ache/pain went away and my T levels went up. My sex drive never improved though. In addition to low libido, I have poor cognition, and aweful memory. can’t remember what i ate for breakfast half the time.

@systemlord my thyroid seems fine right? Thoughts?
I will look into LCSMS. Yes all the Estrgen readings in the lab it actually says roche method. Thanks for that info. I’ll look into it but symptom-wise I dont have anything high E symptoms.

Are age clinics like Defy expensive? I’m still a young guy, hoping for other ways aside from TRT but not ruling it out.

I’m not sure if I understand what you mean by my free T percentage being at 1.81% via the calculator, when the latest blood test literally shows it to be 32.5 pg/ML, which is way high. I should be feeling amazing at this level.

@highpull
See updated original post with labs. DHEA included and thyroid panel. Thoughts?

Thanks

Accutane may be responsible for your hormonal imbalances, it’s similar to post finasteride syndrome by blocking DHT. Accutane causes all sorts of hormonal imbalances.

Google “Accutane: 30 Years of Trading our Sex Lives for Clear Skin”. There are some who are resistant to hormonal therapies do to receptor damage.

If you calculate your Total T and SHBG, you come up with a percentage of Free T, it’s known that 2-3 percent of our testosterone is bioavailable or free. Your set of labs shows below 2 percent.

Your T levels increased after stopping Accutane, I think that’s proof enough that it was causing problems.

Thyroid looks fine.

Defy is on average $100-$150 per month, it includes consults, medicine and labs.

You’re a good TRT candidate.

Thanks for the info. Clinic might be worth a shot.

I have looked into the effects of Accutane and sexual dysfunction. t I took accutane in 2005, which was 10 years ago and didn’t have ANY sexual symptoms whatsoever during and years later. Then 10 years later, in 2015 my libido tanked. I was hoping maybe the two aren’t related. Since usually people suffer with sexual issues WHILE they are on accutane or shortly after.

I also took another Accutane course on my own in 2016 and I do feel it made me feel worse. Since stopping drug, T shot up but libido still bad. May have been foolish …sigh