Hypogonadism? Need help understanding Lab results

I need a bit of help understanding the results of my blood work.
Doctors only check if you are out of range but some of the results here I think could help me understand my/our condition.

First of all one thing that the Doctor agreed on is that I have hypothyroidism:
TSH > 6.22 mU/L (above range)
TPO Antibody 146 IU/mL (above range)

Other levels that are out of range but did not alarm the Doctor:

Progesterone (Above range) > 0.7 nmol/L Although it got better I used to be 1.6 at a year mark post finasteride, I am now at 5 years post finasteride.

Chloride (Below range) > 97 nmol/L
Ferritine (Below range) > 49 ug/L

Now onto the meat of this post and the reason why I’m unsure if this qualifies as Hypogonadism:
FSH > 1.9 U/L (very low end)
LH > 4.5 U/L (mid-high end)
Free T4 > 16.4 pmol/L (mid)
Testosterone Total > 23.2 nmol/L (mid-high end)
SHBG > 33.3 nmol/L (a little above mid range)
Testosterone Free > 473 pmol/L (a little above mid range)
Testosterone Bio available > 12.5 nmol/L (High end)
Prolactin 12.8 ug/L (high)
Estradiol 130 pmol/L (high)

I am not taking any test boosters or supplements.
My test seems fine as LH is in good range but what do you think about having really low FSH when your LH is actually at a healthy range?

My sperm looks ok, I tend to masturbate once a week and it is very opaque and tacky.
Of course, I would not believe there is something wrong with my endocrine system (HPTA) if I did not have ongoing symptoms: erectile dysfunction (difficult to maintain an erection), low libido (yes even with mid-high testosterone), numb penis, fatigue, and the classic neurological symptoms.

Can the high Prolactin & Estradiol has a feedback loop on the FSH production? and be the cause of sexual problems?

I don’t have much knowledge in this area and I know a lot of people on this forum have…so I’m wondering if some of you are familiar with that kind of endocrine profile with PFS.

From what I have read there are 2 types of hypogonadism:

  • Primary: Low test but high FSH & LH
  • Secondary: Low test and rather low FSH & LH

Nothing about normal LH & low FSH.

Since it is still in range doctors won’t bother investigating but there must be something wrong that explains the difference between these two and also why the Prolactin and estradiol are high.
Unfortunately, I could not get DHT bloodwork recommendation from the doctor. I have called private labs but apparently, here in Canada you also need a recommendation from the doctor for that.

Care to share your two cents on this?

It would be much appreciated, as I would eventually try a protocol like (DHT/PCT), I ruined my last two relationships because of PFS and I’m now seeing a girl I really bond with and won’t be able to postpone the “intercourse” for months. Hence why I would like to attempt something.

I have made improvements over the years, especially in the neurological area, but not enough improvement to engage in sexual activity with a partner.

Any clue what your bodyfat % is? You might be able to bring down your estrogen and see if that helps.

I don’t know the %age, although I have been gaining a bit of fat this past year because my main sport is swimming and pools have been closed since the beginning of covid. But it’s true that elevated estrogen can be also a cause for putting on wieght. I don’t look overweight, I used to be athletic and now I look normal.
thanks for the advice.

(EDITED) A lot of the people on this forum (correct me if I’m wrong) are having symptoms without showing any abnormalities in their hormonal profile.

Also, if your prolactin is high but still within range then it is most likely not responsible for your sexual symptoms.
Only when your prolactin truly skyrockets (multiple times above range), there could be serious indication of a hyperprolactinoma, which is a small tumor whose cells produce prolactin.
A while back, I had more than twice the maximum prolactin range and had an MRI scan of my brain, but no prolactinoma to be seen.

Thank you very much for sharing your opinion.
Doctor said the test shows hypothyroidism (elevated TSH) but want me to see an endocrino to get a prescription, I am on the waiting list and Im scheduled in May (4 month from now). So if I get medication for this it’s not going to be anytime soon, and I had PFS symptoms before having elevated TSH (except genital numbess, which came gradually). Hopefully getting thyroid hormones in range will get me a little better but for that reason I do not believe this will cure me from PFS.

The reason I ask if I have hypogonadism is because of the low FSH (yet still in range). You say my testosterone is low…but all levels are above the mid range…what makes you think I have low test? Maybe you are used to other measures in europe (here it’s either nmol & pmol) .

Good to know about your elevated prolactin story. Hope you got that fixed.

You are right. I didn’t look at your levels correctly, my mistake. If you are not having low testosterone then I would say you don’t have hypogonadism. But I am not a doctor of course. So forget what I said about it.

I have no clue about my prolactin by the way. Haven’t checked in a long time. Doctor said that it can be natural for guys to have higher prolactin sometimes. They basically sent me home with a “try to exercise more and see if helps”. (in other words, they simply don’t know)
It was quite a few months ago I’m not sure what my hormonal levels look like right now.

Yes in the same way doctors told me it’s normal for some people to have progesterone 3 times the higher limit. Can’t blame them they don’t have our blood references when we used to be balanced without symptoms.

Yea I totally regret not having a hormone profile from before PFS. GP said it was completely safe. So not a worry on my mind when I took the poison.