T Nation

High Prolactin & Low Testosterone 20 Y/O

Hello guys,
I made a post exactly 1 month ago about some symptoms I had and some blood test results. I was told that getting more labs was a good idea so that’s what I did.
Previous post / Results : 20 Yrs Old. Confused and Need Help

I still have the same symptoms and at some times I am really struggling to maintain a normal life so in some cases I feel like it is getting worse. I have had another blood test done and have now been refered to an endo.

Age: 20 (2nd April)
Height: 6ft 1
Weight: 160lb (Seems to be fluctuating a lot, goes up a lot then returns to normal)
Body and facial hair I get facial hair but not a lot. This is only recent in my life, I’d say about a year but very little amounts.Have a small amount of chest hair.
Fat I carry most of my fat around my waist, its always been around this area.
Medical history / Symptoms In my family we have a history of thyroid problems. My dad has Hypothyroidism and Hashimoto disease. His parents also have hypothyroidism. I have been a tired reasonably low libido person for easily 2 years but never really thought much of it as I thought it was just me growing up. I have had blood tests over the years and they always came back as ‘fine’
Recently over the past 3-4 months, my symptoms have got progressively worse to the stage where at times I have thought I have been going insane, but then at other times, I don’t feel as bad just lethargic. Symptoms include:

  • Concentration lacking massively / brain fog. (almost feel like I am not here a lot of the time, kind of like I’m in a dream/imagination)
  • Low libido - No interest at all - Get erections but seems to be getting less.
  • Legs ache a lot and fingers seems to ache?
  • Very tired most of the time, falling asleep in places I shouldn’t be
  • Anxiety and depression has increased a lot
  • Feel like I am just passing time at the moment with not much point and direction in life
  • Weight goes up a lot then back down
  • Headaches
  • Vision feels like it has got worse over the last 6 months
  • Mood swings
  • Forgetful
  • Disengage from social activity
  • Brauxism - daytime and night teeth clenching and grinding
  • Seem to get very hot at times but only for a short period of time maybe 10 minutes
    The list goes on…
    Drugs Have smoked weed in the past but not frequently, no more than 2 times in one month. Also finished some medication of terbinafine for 6 weeks about 1.5 - 2 months ago. The last time I drank alcohol was about 3 months ago due to not wanting to go out anymore (Supposed to be going out tonight, I want to but just don’t have the energy/right mindset.
    Diet + Fitness I was going the gym regularly from the new year for about 2 months (with a good diet counting macros etc around 3000cals) I have been to the gym on and off for 2 years made very small improvements, even though I eat well and train well. My diet when going to the gym is always high cals. The reason I cannot maintain going to the gym consistently without having to stop is because after a couple of months I am completely drained and I just have all of these symptoms. My training is a Push,Pull,Legs 2x a week and I used to run a bro split beforehand (5-6 days for both)
    Supplements Been taking vitamin D as my levels were low now well within the range. Dont take any others. Dont use iodized salt.
    Damage Never had any head damage
    Dehydration I have had issues in the past with dehydration from a young age which I have been to the hospital with (was a lot younger) I seem to get dehydrated easily - feel like I have to worry about drinking enough fluids more than others. - have to drink more recently
    Results
    I tried to get as many values as possible but these were the only ones that i was able to get.

!! Serum prolactin: 571mU/L (86-324)
Serum testosterone :12.2 (9-29) - On my other post I had the test done at 12:30, this was done at 8:15, which is why it is slightly higher
Serum FSH: 1.6iu/L (1.0-12) - Low?
Serum LH: 4.6iu/L (1 - 10 )

Serum alkaline phostphate: 77IU/L (30-300)
!! Serum albumin: 50g/L (35-48)
Serum calcium: 2.36nmol/L (2.2 - 2.6)
Serum C reactive protein level <1mg/L (0-9)

Serum folate: 7.7 (2.1 - 26.8)

!! Serum B12: 738NG/l (190 - 660)

Erythrocyte sedimentation rate: 2mm (0-7)

Vitamin D: 108.9 (>50) - Was 35 1 month ago, before supp

Haemoglobin: 145g/L (130-170)
White cell count: 4 109/L (4-11)
Platlet count: 275 10
9/L (150-400)
RBC count: 4.87 1012/L (4.5-6.5)
Haematocrit: 0.448 (0.400-0.540)
MCV: 92.1 fL (78-99)
MCH: 29.9 (27-32)
MCHC: 324 g/L (310-360)
!! Neutrophil count: 1.8 10
9/L (2-7.5)
Lymphocyte count: 1.6 109/L (1.5-3.5)
Monocyte count: 0.4 10
9/L (0.2-1.4)
Eosinphil count: 0.1 109/L (0-0.4)
Basophil count: 0.1 10
9/L (0-0.1)
Nucleated RBC 0

My results from last month can be seen on the link.

I understand that many results are missing but that is all i could get. Is the endo likely to measure the missing ones - A full test?

What should my next steps be when i see the endo and do these extra values give any more of an idea on what the issue could be.

Thankyou

Bump,

I went to see an endo, and was told that my levels were perfectly normal with some new blood results coming in at:

Total test :12.2nmol/L (9-29)
SHBG: 26nmol/L (17-56)
Free androgen Index: 62.7
FSH: 1.7 iu/L (1-12)
LH: 7 iu/L (1-10)
Prolactin: 442 mU/L (86-324)

He said that my testosterone was not low as the FAI, was a healthy amount meaning that i had a good amount of free test.
Also prolactin was lower.
FSH/LH/SHBG was said to be good levels

He stated that my urea level was 6.8 (2.5-6.7), meaning that i was dehydrated and he thinks this could play a part??

Do people agree that these levels are ok, and put my symptoms down to other illnesses like depression, or do you think that i should continue with the endo route?

You’re not normal, men in their 20’s normally have high testosterone levels in the 600-800 ranges and slowly start declining as we age, your levels are seen in retired elderly men in their 70-80’s. Most doctors are brain dead when it comes to TRT and fail to understand what constitutes a healthy levels for young men, they believe that it’s alright for a young man in his 20’s to have the same testosterone levels as someone in their 80’s.

Whenever I see nmol/L measurements a profound sadness falls over my mood, I know that a years long battle with doctors is looming. Doctors in your country are the problem and most so called specialists are decades behind in understanding of male hormones. In reality the entire world has only scratched surface in understand hormonal problems in men and women. It seems like doctors are playing catch up and most don’t even care to learn.

Thanks for the reply, Do you think that what is causing the low t is something that could be caused from mental conditions like depression, anxiety, stress?
The reason i ask is because, due to him saying my hormones are normal, he is saying that it is caused mentally. Personally, i feel like something else is causing the low t.

I mentioned a scan on my pituitary and he said that he thinks it is very unlikely that he would be able to get one done as he thinks that they would not understand the reason for the test because there is no evidence to point towards needing one.

I don’t really know where to go next as i feel that every time i try to explain how i feel, to doctors and even the endocrinologist, i am told that i am ‘normal’. I don’t really know what to do next and am completely fed up with the way that i feel. Any advice would be appreciated.

Also, at the moment I am supposed to be getting in contact with him in 4 weeks to see if symptoms improve which I am not very optimistic about, as i feel that simply drinking more water is not the answer, and am hesitant to see the doc about the mental side of things because i dont want to be treating something which is not the root cause of the issue.

You have primary hypogonadism, your LH is high and testosterone is low, your testicles are damaged and failing, you may already be infertile. This is what I’ve been saying, few doctors understand male hormones as there is no training in medical school so you can’t expect them to understand these things.

Absolutely, doctor failed to test estrogen. Low estrogen is dangerous and can cause depression, anxiety and osteoporosis. Your doctor is following his training which is the blame everything on depression which ends any further decision but fails to understand that low hormones can cause all these issues. High prolactin is a concern.

Research is showing that optimal hormones are essential for wellbeing and those with less than optimal hormones suffer from psychological problems in the same way a woman in menopause suffers from depression and anxiety.

Look you’re 20 years old and you should be at your peak in life, instead you have the hormone levels of an 80 year old. You may need to go private.

The endocrinologist that I was referred to from my doc didnt have an appointment till late July. Due to my bad symptoms, I wanted to pay private to get it treated faster, so he is private. :frowning:

In which case, I could either try to get some more tests done by him or I could switch endo.

If I ask for estrogen, are there any other levels too?

It’s probably a good idea to get the proper diagnosement of primary hypogonadism so if at a later date you fall on hard times you have the diagnosis in hand. You can get diagnosed by a private doctor and be treated for TRT, Clomid and HCG will do nothing for your natural production/testicles, however HCG might help with mood and wellbeing.

Estrogen labs are important diagnostic tool in managing estrogen and Arimidex may be needed. Estrogen needs to be between 80-100 pmol/L to be optimal. I also suggest freezing any sperm you may have before starting TRT.

Don’t ignore thyroid labs, TRT require optimal thyroid hormones, typically Free T3, Free T4, Reverse T3 and antibodies are as through as one can get. Checking body temps using a glass thermometer per thyroid sticky can reveal thyroid issues.

The problem for me is getting the diagnosis, as I am constantly reminded I am normal from even private.

As you and many others on here still think the levels are not right I may have to try some more private endos but I don’t have much money to keep throwing at this to get turned away considering my age.

Thankyou for your knowledge, I will use this for my next meeting whenever it will be. I feel that they are not taking my age into consideration with the diagnosis.

If you or anyone has any more advice to add it would be greatly appreciated!

The average doctor in regards to male hormones is pretty stupid, it has to do with they are not taught male hormones in medical school and have very limited knowledge in male hormones. You need to keep pushing forward to get TRT, eventually you find someone who knows what their doing.

Your doctor has stated some pretty outrageous things, drinking more water comment deserves a slap in the face. You gotta knock some sense into these people.

Ill most probably see him again and ask for more tests to be carried out and if I don’t get anywhere I will change endo completely.

Do you think it’s worth getting a pituitary scan?

Yes.

That’s standard practice when prolactin is elevated.

Ok thanks for your help guys, means a lot. Ill update this thread at a late date, hopefully after some progress :confused:

I have recently realized that i have a varicocele on my left testicle which has become quite obvious. I have had this since my symptoms started, but never thought anything of it as it never caused me pain or discomfort. Recently it aches and is uncomfortable, and feel like this could be the cause of my problems as i have read that low testosterone is related. The ache travels up the left side of the groin more so than the testicle.

I know it seems stupid to have only considered this now, but i just never really thought it was a problem as i have had it for so long (probs since puberty) with no main symptoms, and didnt even know what a varicocele was.

I am going to bring this up to the doc next week, and was wondering whether people this could be a likely cause to my problems - considering i have had it years and i think it has got worse?

Thanks

Ultra sound of the testicles will determine the degree of how bad it is. Then from there can form an opinion if it can affect your t levels.

Feel like im going thru the samething. Everything starting to make since. Every since I found out I had Varicocele, I havnt been the same. Guess its the side affect like u mention. The only way im guessing is to have surgery

Nice to know I’m not the only one, I’m seeing the doc next week as I’m getting more labs anyway, I’ll ask their opinion on it and hopefully will send be off for a scan. I feel that my testosterone production is being limited from it, but I would have thought that my LH and FSH would be elevated? I will have to see what they say

I have some more results since my last post. (Taken 9am fasting)

!!! Thyroid Peroxidase IgG AB: 75 IU/ml (0 - 24.90)
Cortisol: 313 nmol/L (133 - 537)
T4: 18 pmol/L (10 - 22)
TSH: 1.7 mu/L (0.3 - 5.5)
!!! Iron: 26 umol/L (11-25)
TIBC: 59 umol/L (45 - 72)
Transferrin saturation index: 44% (15 - 45)
Oestradiol: 44 pmol/L (41 - 159)
SHBG: 25 nmol/L (17 - 56)
FAI (Free Androgen Index): 70.78
Testosterone: 17.7 nmol/L (9 - 29)

Although my TFT was “normal”, I asked to be checked for thyroid antibodies as my dad has Hashimoto’s. Turns out they are elevated…
My testosterone had increased from my last blood tests, Why is it fluctuating? - Could be to do with the varicocele?
Iron slightly higher

Anyone able to analyse these results? Does this point towards Hashimotos, or is it not elevated enough, as i know that the range for this test can vary a lot?

Symptoms still the same, with increasing weakness in legs and general fatigue (gets worse through the day), increased thirst etc

Any recommendations on next steps?

Thankyou

Testosterone levels aren’t static, they will fluctuate day to day week to week. Get less sleep one week and watch levels drop. You need more thyroid testing checking Free T3, Free T4 and Reverse T3. Expect to fight doctors on getting these important tests. Diabetes mellitus can help explain increased thirst, no A1C or fasting glucose.

Estrogen is low , should at a minimum be above 80 pmol/L. Bone loss is expected with low estrogen Ferritin is also important for thyroid function, not tested. While testosterone is low for your age and can explain minor symptoms in those ranges, thyroid stands out as the likely cause of increasing weakness and general fatigue. Thyroiditis can cause extreme thirst and weakness.

Thyroiditis can cause inflammation of the thyroid that causes stored thyroid hormone to leak out of your thyroid gland. At first, the leakage increases hormone levels in the blood, leading to hyperthyroidism, a condition in which thyroid hormone levels are too high.

You can tell a lot about the quality of care by simply looking at labs ordered, the care you’re receiving is subpar.