I have been lurking here for the past 2 months and finally built up the courage to make my first post after my blood work results have been done.
Currently suffering from very low libido, low energy or fatigue like symptoms, and slow metabolism. I have also recently had bouts where my body feels somewhat achy (inflamation?) and it takes longer to recover from workouts. I’m 30 and I’m in decent shape because I eat good & work out often. I feel that I’m suffering from some kind of hormonal imbalance along with either slight adrenal or thyroid problems despite having a healthy lifestyle. I suspect my situation was worsened by taking Fin about 6 months ago (only took it for 1 month), but I also abused alcohol and marijuana to some extent in the past whichI feel has affected me somewhat also.
Here are my recent blood work results with ranges and would like some opinions on what I should do next in regards to seeing a doctor or trying out meds to see if they improve my situation.
Total testosterone looks ok, considering the fairly low SHBG level, but it could be a little higher. This is confirmed by a pretty good reasonable free testosterone level.
All in all your levels here would warrant waiting with the idea that the passage of time will increase your levels a little more here.
Some would argue jumping straight into TRT, but I wouldn’t despite the total testosterone not looking great because the free testosterone isn’t too bad and six months is not such a long time.
TRT is a big jump to make and only worth consideration when in my opinion when symptoms are pretty bad and pointing towards hypogonadism, I say this because TRT is difficult to get right an not a bed of roses and should not be entered into lightly.
Your estradiol could be a touch lower considering your SHBG level, but I wouldn’t have thought it would cause much of a problem.
DHT is too low and this can cause problems relating too a lowered libido or erectile dysfunction, but this level should come back over time, particularly as your free testosterone level ishould fuel a higher DHT level over time (DHT is a metabolite and by-product of testosterone).
I personally do not place a lot of weight in progesterone as an issue at present as I have yet to see anything in the way of a quality evidence as to it being much of an issue in comparison to SHBG and estradiol for instance.
Your prolactin is a little elevated, but not high enough that it is lowering your testosterone so I would doubt that it is a a cause of problems at present. If should be tested again though in the future just to ensure it is not getting any higher.
If you were to take 50mg a day zinc supplementation it might lower your prolactin and estradiol a little. Zinc acts as a weak aromatase inhibitor and some men feel a little better when they take zinc if they have a slightly elevated estardiol level.
I think you would need a free T3 thyroid test to find out how your thyroid is functioning, TSH is not the thyroid hormone, only the messenger hormone to the thyroid. I would also say a 24 hour urinary cortisol test might be worth consideration as it is a more accurate measure of cortisol than a random cortisol blood test.
Overall then.
Your testosterone is not too bad when you consider the SHBG and free testosterone, but you might possibly require a little more. You might well be A1 in this department given time. DHT should increase over time being a little low at present. Estradiol is a touch high as is prolactin. Zinc may lower each a little and in doing might make you feel a little better. Further testing is required to rule out thyroid and adrenal issues.
Have these tests taken again in 6 months time to see how things are.
Thanks for taking the time to take a look at my blood results. I had just a few more questions. If my DHT is on the lower end, how is it that I’m slowly loosing hair in my temple region? I thought DHT is the main culprit and ussually it’s people with high DHT that causes the problem. Also, in regards to DHT as you have pointed out, I’m wondering if simply raising this would bring back my libido and cure my ED issues. I have read elsewhere that DHT is extremely important in terms of sex hormones and to maintain healthy penile tissue etc…
I’m also concerned about Prolactin on the high end as I understand that it can also be really suppressive on sex drive. Would taking a light dose of dostinex help bring this down? My FSH is extremely on the low end also, what exactly does that mean?
You also stated that TSH may not be accurate in determining a dysfuntional Thryroid. Should I go ahead and get T3 & T4 tests done in your opinion? I’m wondering if this is why I’m extremely sensitive to Carbs where I seem to put weight on very easy when eating high carb foods such as pasta & bread. I’m also somewhat gyno prone and have some fat accumulation in the chest area.
You stated that I should maybe wait this out a few more months and get more blood work. If things don’t change much, in your opinion what meds should I try as a first priority to see if it helps my situation? Thanks again for taking the time to help me out.
Male Pattern Baldness is NOT simply caused by too much testosterone or DHT, there are many men with very high levels or these hormones who have a full head of hair. Male pattern baldness is thought to be caused by a recessive gene (genetic) in combination and acted upon by these hormones, well DHT but fueled by testosterone.
I do not know a lot about the hair aspect of hormones though beyond the above which is supposed to be the situation, this has not been something I have concerned myself with. You will need others to talk to others over this.
It is true that DHT is important for libido, erectile function etc but it is best if you can derive DHT from your own testosterone production if possible, hence it better to wait and see if it gets increases with time. If you were to use DHT as a supplement it would have a negative impact on your HPTA and suppress your testosterone levels and could leave you with a variety of symptoms akin to testosterone deficiency such as fatigue and back pain etc……
Better to wait and see if your DHT it will climb higher naturally, this has every chance of happening given your testosterone level.
Your prolactin could be elevated for due to either of the following reasons;
A) It has increased as a result of finasteride and/or any other HPTA affecting drugs you may have taken.
Or
B) You could have a prolactinoma, a prolactin secreting non cancerous pituitary tumor- that can require minor surgery or drug treatment with dostinex or like drug.
Now in the latter cases we would expect to see a prolactin level that was VASTLY higher than what you have, so unless you had just started to develop a prolactinoma and if the finasteride and other HPTA affecting drugs were some huge coincidence then that is possible.
However I would rather consider the probable rather than the highly improbable, and my thoughts are that finasteride or some other HPTA affecting med has driven prolactin up somewhat.
If that medication has been removed and is no longer used then you would expect to see that prolactin level come down and look a bit better in six months time.
Prolactin can kill libido stone dead but it does this in men who have prolatin levels hundreds of times higher than your level, it does this where testosterone and particularly free testosterone has been brought to its knees, to a hypogonadal level. So Prolactin crushses libido in-directly via the reduction of testosterone. As it stands your free testosterone is not remotely low.
Your prolactin level could be having some small effect and be a modifier, add to your issues a touch, but it is not anything considerable as of right now and probably extremely unlikely to become a problem.
If anything if the prolactin increased by the finasteride, just as the DHT was lowered- then with the discontinuation of the drug you might see the former decline and the latter increase with time.
The fact of the matter is a wait and watch approach as frustrating as it may seem is FAR better in your situation than any intervention would be. To my mind it would be crazy to try dostinex or any such med at this juncture.
You can take what I have written here to any doctor or endocrinologist you are seeing and show it to them.
Follicle Stimulating Hormone relates to fertility. A low FSH level can indicate that an individual might have difficulty in conceiving a child. That said in your case the FSH and LH may both increase over time now the finasteride has been discontinued. Again FSH is another test that would require repeating in six months time. If FSH remains low then you may with to have sperm analysis to evaluate your fertility.
TSH is a very sensitive test that diagnoses most people with thyroid disorders. However it does have its limitations because it depend on the pituitary working and any thyroid problem be related to the thyroid itself; unfortunately some people have thyroid disorders because the pituitary does not send out sufficient TSH and a TSH test is not diagnostically helpful in such circumstances- hence the need to test the thyroid hormone itself. Also some people have poor adrenal function and a lack of cortisol and also cause thyroid dysfunction. I say all of this because some people believe that thyroid and adrenal disorders can occur as a result of finasteride. Whilst I have not seen compelling quality evidence of this link, it seems reasonable to test for such given the low costs of the tests involved.
The test you would want is not T3 or T4 but FREE T3 (the active thyroid hormone)….and a 24 hour urinary cortisol test.
Excess weight or a problem losing weight can be caused by a variety of conditions, one of which is hypothyroidism. The test I am suggesting should help rule that out. Gynecomastia tends to relate more to the balance between androgens and estrogens or rather the lack of balance and may well have got worse when you took finasteride given the fact it is an anti androgen and known to cause gynecomastia.
You should cross that bridge if you come to it, I would hope that you would recover and not need intervention.
If I were in your shoes I would do my best to get on with life, despite the issues involved and avoid as much stress as possible. I do not say that lightly or from an ivory tower as I have had severe medical and personal problems over a number of years, I know only too well how such things can be tough. Unfortunately the right thing to do is not always the thing that is most expedient.
Get the bloods done in 6 months time and if all is not well either symptomatically or with the bloods post again and we can discuss options that you can approach an endocrinologist with…
That is my opinion for what it is worth, but don’t just listen to me. Consult other sensible long standing members like the mods and garner their opinions also.
Agree with Hypo pretty much on all points, the only thing you might want to try (and I will be trying this myself as my Prolactin is near upper limit of range) is a natural supplement such as Mucuna Pruriens to help bring it down. I don’t know if this will have much, if any impact, but it might be worth a shot.
The other herb is Vitex (Chasteberry) but appears to be dose dependant, ie lower levels (120mg, 240mg) can increase Prolactin while higher doses (ie 480mg /day) are said to lower it:
Thanks guys, I really appreciate both of you taking the time to help me out. I’m going in to see a doctor tommorow and will probably print your responses so he can get a better idea of what’s going on. I guess its just a waiting game for now unless the doc has any other ideas of something I should do.
