T Nation

Unresponsive LH


#1

-age = 30
-height = 6 foot/ 183 cm
-weight = 218 lbs / 99 kg
-body fat % = 20% approx
-Location = Australia
-describe body and facial hair = Plenty

-describe where you carry fat and how changed = mostly around midsection

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever = none in last 3 years prior to that was a small amount of xanax

-describe diet [some create substantial damage with starvation diets]
Diet is approx 2700 calories per day average

-describe training [some ruin there hormones by over training]
mostly just walking , previously was 4 weight training sessions per week but gave up after making no progress

-testes ache, ever, with a fever? = occasional ache but Dr did inspect them said i was ok

-how have morning wood and nocturnal erections changed = was a rarity before treatment but a few more since starting

Thyroid:
TSH: 1.7mIU/L (0.40 - 3.50) Oct 2013
1.8mIU/L (0.40 - 3.50) May 2013
I did ask for a full thyroid panel but this is all that was done unfortunately

Iodine: i use very little salt but purchased bottle of iodoral 12.5mg x 90 pills and have almost finished the bottle

Temperature: ranges from 36.2- 36.8 Celsius or 97.2 to 98.2 Fahrenheit

Ok the fun stuff: i'm currently on doctor number six, an endocrinologist and this one is specially qualified in andrology.

Was first placed on Andriol 40mg for 3 months by local GP till i saw a specialist , that specialist then changed me to patches and referred me to my current doctor. That doctor took me off patches for two months as they wanted blood work that was lower. apparently my results were low but not low enough to qualify for cheaper prescriptions. Now i have a prescription for axiron.

All tests were done between 8:30 and 9:30 am

Prior to Treatment:

Testosterone: 8.6 nmol/l (11.5 - 32.0)
SHGB: 16 nmol/l (15 - 50)
ALbium: 44 g/L (39 - 50)
LH: 1.1 IU/L (0.6 - 12)
FSH: 1.3 IU/L (1.0 - 12)
Oestradoil: 50 pmol/L ( <160 )
DHEA-S: 11.5 umol/L ( 3.0 - 16)

On patches : about 5 months later (3 month andriol, 2 month patches)

Testosterone: 24.2 nmol/L (11.5 - 32.0)
SHGB: 16 nmol/l (15 - 50)
LH: 1.1 IU/L (0.6 - 12)
FSH: 0.5 IU/L (1.0 - 12)
Oestradoil: 50 pmol/L ( <160 )
Prolactin 416 mIU/L (85 - 500)

Two Months after ceasing patches:

Testosterone: 10.6 nmol/L (11.5 - 32.0)
LH: 1.4 IU/L (0.6 - 12)
FSH: 1.8 IU/L (1.0 - 12)

Ok so after all that , my question is what could be causing the LH to be so unresponsive i expected it to drop to near zero during treatment but it barely moved, and when it was time to respond upwards after ceasing treatment it barely moved again.
I raised this issue to the doctor and she acknowledged there seems to be an issue in the feedback loop but had nothing to add beyond that.
What does everyone think?
Are there any studies i should read similar to this ?


#2

I am concerned with your elevated prolactin. That can suppress the HPTA, lowering LH and FSH. Cause can be a prolactin secreting pituitary adinoma. Can then be treated with 0.5mg/week Dostinex/cabergoline.

The strange LH/FSH labs also might be indicating something wrong with your pituitary.

With younger men, secondary hypogonadism cannot be ignored as a symptom of an adinoma.

Larger adinomas [can be shrunk with cabergoline], there can be pressure on the optic nerves, creating visual field distortions [not refractive/focus]. That is typically seen as a reduction in width of peripheral visions [which should be near 180 degrees].

When prolactin goes up, dopamine goes down and vice versa. With lower dopamine, one can be somewhat depressed and lethargic. Your reward system becomes weak and one can find activities less worth doing.

There is nothing more to do with iodine replenishment. You will need to manage a maintenance level, 6.5mg every week or two would be good.

Your unchanging E2=50 is odd. A reporting floor? Bogus labs?


#3

Thanks for the reply KSman i was hoping to hear your opinion

I just had an MRI done, Everything came back clear
From the report:
"Pituitary gland is normal in appearance, there is no pituitary adenoma"

I spoke to the doctor who said there could still be damage to gland that doesn't show up in images but had nothing to add beyond that

Yes the E2 is wrong , but that's my fault i mixed up the reports
The second Oestradoil reading should have been:
E2: 102pmol/L ( <160 )


#4

Your LH is shut down because you have done nothing to restart your HTPA..
You went cold turkey on the TRT correct ??
A SERM would have given your LH a kickstart..


#5

Correct it was cold turkey
But that was a deliberate attempt to push testosterone lower, as a lower testosterone result would qualify me for cheaper prescriptions

I may try a restart in the future but for now i just want to understand why the LH moves so little, i expected LH to drop to zero while on trt

I've struggled to find any studies or experiences similar to my situation