I convinced my father to get his hormone levels tested: he got normal T3 3.87 ng/l (2.2-4.4), T4 11.6 ng/l (9.3-17), LH 8.8 U/l (1.7-8.6), FSH 13.5 U/l (1.5-12), Prolactin 9.85 ug/l (4.0-15), E2 27.7 (27.1-52.2), Testo 6.31 ug/l (1.8-7.4), free Testo 5.34 mg/l (1.4-17.55), SHBG 69.6 nmol/l (20.6-78.7)
What could the combination of elevated LH and FSH yet normal Test levels mean?
They are not extremely elevated and FSH/LH, especially LH, change frequently. His SHBG is high and his free test is not great although perfect adequate. I don’t see why his HPTA wouldn’t be signaling to produce more test. I think this is a situation where you retest in a month.
Thank you very much!
A slightly different take would be the high end SHBG being caused by probably lifestyle meaning his free t isn’t great.
His hpta is telling his balls to go full bore to try and get the t elevated as his body feels a bit low on t as its all getting shbg bound
I had similair- often had elevated fsh and pretty robust total t levels. My balls couldn’t produce enough as my liver is overproducing SHBG
The elevation in LH is probably in response to the lower Free T which is low due to the high SHBG for which TRT is the solution. TRT is will decrease the overly high SHBG, increase his Free T and relive his symptoms of low-T.
In your father’s case, he doesn’t suffer from secondary hypogonadism (pituitary problem), in fact his pituitary gland is functioning like a champ trying to get more testosterone into the body, but the liver is producing too much SHBG which is decreasing his usable testosterone.
Your father’s pituitary gland will struggle to deal with the naturally elevated SHBG, TRT is the appropriate course of action.
The above range FSH could point to infertility.
How you feel with your labs ?
He feels okay but low energy. He is 62y. Would you recommend TRT?
SHBG typically increases with age, but things will only continue on a downward trajectory. The truth is testosterone has important cardiovascular benefits and lower levels will cause problems down the road, so yeah I would recommend TRT.
You can’t just go to any ordinary doctor for TRT, find someone who does it for a living. Please be careful some of these TRT clinics (T-mills), a lot of them are just looking to make a buck and the health of the patient is an afterthought.