T Nation

Hormone Imbalance/Pituarary Problem?

I’m a 30 years old male and have had ED for over ten years which i take levitra for, urologist says he thinks i have a venous leak but over the last few months my sex drive has become non existent and my ED meds have stopped working.

I’m very healthy…eat really well balanced diet and excercise 5 times a week both cardio and weights…can’t seem to put noticible muscle/weight on though. If i stop doing weights i become really skinny. I still have quite a lot of fat around my lower back, love handles and bum though which doesn’t seem to shift.

My blood tests have come back as :

FSH 2.9 IE/L (1.0-12.0)
LH 10.0 IE/L (1.0-9.4)
Prolactin 212 mIE/L (30-600)
Testosterone 16 nmol/L (11-35)

I’ve noticed that my FSH is too low and my LH is too high which after looking on the internet i can’t make any sense of…ive only found info on LH/FSH together being too high or low…Can someone please enlighten me on this please??

Also is my testosterone in normal range for my age?

do i need TRT to get my sex drive back???

You need an MRI of your pituitary gland, which will most likely reveal that you have a pituitary macro adenoma;Also called a prolactinoma. Before you get worried, it’s “the best tumor to have”!! Really, I have one too. You will take .25mg of cabergoline 2x/week and it will shrink the tumor significantly.

I would say you have secondary hypogonadism (your testes work, but there is a disruption in communication), which means that your pituitary gland thinks everything is fine so it’s sending normal signals. It doesn’t realize there is a tumor blocking that signal.

It sucks that your doctor treated the symptoms without finding the cause. That couldn’t saved you some hassle. Regardless, here is where you are and the road to recovery is ahead.

I had almost completely lost the ability to gain an erection. It happened so slowly (over the course of 10 years) that I didn’t even really know there was a problem. If I was having intercourse, I needed constant stimulation to maintain an erection. Sound familiar?

You’ll need to post lab ranges before we can know you need TRT. Given your elevated prolactin, the tumor has probably been inhibiting your pituitary for years, so yes will probably be the answer. Also, if you do go on TRT you’ll need to read up about hCG and anastrozole on this board. That’s a whole other battle, but it will come.

The TRT will help with the fat deposits around the mid-section and “bum”.

Have your doc order you a brain MRI. It’s a little unnerving but you’ll be fine. You won’t even need levitra when this is over. :))

Interesting, I have a similar problem with low FSH and high LH. I can’t add much to the above reply except to give you some encouragement. Pitutiary adenomas are almost always benign and treatable with cabergoline. If that doesn’t work they can be removed through the nose. Hang in there.

Thank you for your very helpful response.

This range is in different units from the usual ug/l, apparently the normal range for prolactin is 30-600 mIU/l and mine is 212. Does this mean i can still have a pituitary anonema?

Is that your first prolactin lab?

Edit your opening post and add the lab ranges, read the advice for new guys sticky.

Without lab ranges, we are left with this: http://en.wikipedia.org/wiki/Prolactin#Inter-method_variability

Normally in this situation, one would suggest primary hypogonadism as that should increase LH in compensation, however, it is my expectation that FSH would also be high and that is not the case here.

ED drugs improve the blood flow plumbing response when there is [desire] a mental sexual stimulus and basic libido. ED drugs do not create the mental state. Hormones have a great role in that. When you get on TRT, your E2 levels greatly control your libido. -see that sticky

So you need estradiol [E2] as part of your labs when on TRT. You should test:
TT
FT
E2
prolactin
TSH
fT3
fT4
Vit-D25
DHEA-S
fasting cholesterol
fasting glucose

Suggested actions:
-do more labs

My post was based on your prolactin levels with a range of (4-15) or something similar. With a prolactin level of 200 in that range, you almost certainly do not have a prolactinoma. I apologize if I alarmed you.

Since you have been experiencing these symptoms for 10 years, if you were to have a prolactinoma your levels would be closer to 7,800 on that scale. This is great! However, it still leaves us searching for an answer.

What time of day were your blood tests performed? Did you fast the morning of the test?

They were taken at 8am and yes I had not eaten anything. It doesn’t make any sense to me that only LH is raised. I think that means its working overdrive to produce testosterone but my testes are not responding properly. Do you think I can go on TRT for this even though my testosterone is in the lower end of normal? I don’t know how else I can increase my libido as I lead a healthy lifestyle etc

Before you start TRT it would be best to get more lab work done. Read through this:

It’s best to get these values prior to starting TRT, because TRT will effect certain blood tests like PSA, LH, etc.

To answer your question “Do you think I can go on TRT for this even though my testosterone is in the lower end of normal?”

Yes, but get more blood tests first.

LH is released in pulses and has a short half life, so the levels are always changing. We do not know if you happened to sample a peak or your levels are really high. FSH has a longer half life and its level is more indicative of pituitary output of gonadotropins. FSH is a bit low.

Because [subclinical] hypothyroidism has most of the same symptoms of low T and because low T can lower thyroid function and vice versa, we would like to see thyroid hormone lab results. You can take your waking and mid afternoon body temperatures and post here. And also describe your iodine intake, iodizes salt, iodine in vitamins. That info can also be useful.

And adding to what Kaynon331 states above; you need to be looking for causes that can be treated, not be starting TRT to cover up one of the symptoms of another condition. Doctors are mostly going to skip this step.

latest results back…please advise as i think looking at values i may need an AI?..i’ve never taken steroids so i dont understand my high end estradiol…still have non existent libido etc… please see other post above for other values…

E2 119 (<130) too high for 30yo?
SHBG 23 (15-40)
Free Androgen Index 87%
Free t4 14 (9-25)
magnesium 1.02 (0.7-1) slightly high?
albumin 46 (35-50) quite high?
total chol 4.3
fasting glucose 4.5 (3.3-6)
TSH 2.6 (0.3-5)
cortisol 534

Elevated E2 could be because of your body fat. Losing some of those deposits around the midsection should lower that number. LH is above normal, which could suggest a degree of primary hypogonadism; where the testicles stop working, but this doesn’t seem consistent with primary because of the low FSH level. Your T level is well below optimum.

“Primary hypogonadism is caused by testicular failure and is characterised by low serum testosterone and high LH and FSH concentrations. For this reason, primary hypogonadism is also known as hypergonadotropic hypogonadism. Primary hypogonadism can result from testicular injury, tumour, or infection; genetic defects affecting testicular development (e.g. Klinefelter syndrome), as well as chemotherapy, radiation treatment or alcohol abuse”

Are these the only labs you have gotten? What is the range for the cortisol test and when was it done?

You need to be proactive with this and do tons of research. Get a thyroid panel ASAP. All the tests you need haven’t been done. You need to figure out what’s causing the problem before you ever start TRT.

Print the list of necessary labs out from this site and take it to your doctor.

I’ve had all necessary blood tests taken which are all well within normal range including thyroid. cortisol taken at 0900 (138-620)

i’m 6’2’ and 12 stone so not near to being overweight…My bmi is good, i’ve only got a bit of fat round my belly which i cant shift and cant seem to define my pecs.

i’ve been to the doctor and consultant but they cant find a solution. I cant get an explanation on the high lh/low fsh…so posting on here was my last hope.

i was a heavy cannabis user for a fews years and dabbled with cocaine and MDMA for a while but that was several years ago…could that have permanently affected my hormones and is there a solution to this?

have i got any other options please?

I searched around and couldn’t find anything about having high LH and low FSH. Could you possibly see and endocrinologist? They should be able to provide the best insight as to what’s going on.

On the bright side, if you DO start TRT those two numbers will be depressed and won’t matter anyway. At that point you should be injecting hCG to mimic LH to keep the testes from atrophying.

MDMA and cocaine could be the culprit. If you see an endocrinologist you will want to explain to him the extent you used these drugs. He’s there to treat you medically; not judge.


Thank you very much for your response…i’ve got a follow up with urologist next month and i’ll ask him to refer me to an endo (even though he said all my hormone levels are within the acceptable range)

I’m not planning on starting TRT now as i dont want it to convert to even more e2. i was still thinking of taking a small dose of aridimex though to lower e2…is this a wise idea?

It won’t hurt you. You could start with something like .25mg 2x/week and see how you feel. I will say that I don’t have a lot of knowledge concerning the use of anastrozole without being on TRT. Just be wary if you start feeling achy. Means you’ve dropped too low. Also, depending on how your libido is doing right now it may take that away from you by lowering your DHT.

TSH 2.6 (0.3-5) is a problem, read these stickies:

  • advice for new guys
  • thyroid basics

Do not know what your total cholesterol and cortisol are without ranges.