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Low free testosterone, low libido and weak erections - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Men's Health
Answered by

General & Family Physician
Practicing since : 2008
Answered : 2690 Questions
User :   I suffer from an unimpressive libido, weak erection, too little energy. Blood tests show testosterone of 750 (range 250-100), free testosterone however is only 16 (range 9-26).
The real concerns I have are with prolactin, which I have tested between 16-21 (range 2-14) and my LH is through the roof at 14 (range 1-8).
Endocrinologists are unhelpful and I am losing faith. Can you give me some answers???
Doctor :   HI
Doctor :   I am Dr. XXX
Doctor :   What is your age?
User :   I am 28/male
Doctor :   Since how long are you suffering from this problem?
User :   For a couple years, all the blood tests are within the last 6 months
Doctor :   Did your endo suggest you these?
Doctor :   How many times did you get them done?
User :   Just a general nurse practitioner did, endo was worthless
Doctor :   Did you get the blood drawn at 7AM in the morning for these tests?
User :   it was within an hour of waking up on a Saturday. The LH is almost double the high end of the normal range. This is not normal. I need answers.
Doctor :   I agree LH is elevated
User :   And I have had three tests showing elevated prolactin, two showing elevated LH
User :   Every test I have had for either of those values was abnormal.
User :   I need help.
Doctor :   Ok
Doctor :   Do you take any medicines for any other problems
Doctor :   like antidepressants etc
User :   None
Doctor :   Ok actually the testosterone values decrease with age
User :   I am 28!
User :   And it is mainly LH and prolactin I am concerned with... though I do wish free test was higher... total test was fine.
Doctor :   What I suggest you further is
Doctor :   Estradiol and CT scan Brain
User :   Done both
Doctor :   To check if it is the pituitary that is problematic
Doctor :   Ok
User :   Estradiol was around 24 or 28, can't remember which... scan showed no pituitary tumor, everything noraml
Doctor :   Ok
User :   I really need some answers... I have been dealing with this too long.
Doctor :   Did you see a Urologist?
Doctor :   I can really understand the situation
User :   No, I have seen an endo, family doctor, and nurse practitioner.
Doctor :   Any testosterone replacements tried??
User :   No, haven't tried those. That is the kind of stuff I need info about. Do I really need test replacement if my total test is 750? Does high LH indicate my testes aren't working, even though my test is decent? What about medication to lower prolactin?
Doctor :   Checking the size of testes is important
Doctor :   I do not know if the size and texture are checked
User :   They never feel "full"
Doctor :   Do you have Gynecomastia ( fat around nipples)
Doctor :   OK
User :   No, I don't think so.. I work out... in decent shape
Doctor :   Ok
Doctor :   Yes
User :   What do you think?
Doctor :   High LH is a greater issue
Doctor :   The small testes is concerning
Doctor :   You can speak to a Urologist
Doctor :   and about the free testosterone trial
Doctor :   to see if symptoms improve
User :   So testosterone could help even though mine is 750? What about prolactin? I know that is a libido-killer.
Doctor :   YOu might have gone through it by your thorough internet search that total testos is an entity and the other is free testos as most of the testosterone is boung to proteins
Doctor :   The percentage of the free testosterone is important than the total one
Doctor :   The free testosterone itself acts
User :   My free test has been tested at 13 and 16 with a reference range of 9-26
Doctor :   free testosterone assays are not trustworthy unless the test is performed using the equilibrium dialysis method which is the gold standard. You may wish to check with your lab where you had your testosterone values drawn, to see what method they deploy.
User :   i have no idea what they used
Doctor :   You can check
User :   still hugely concerned with LH and prolactin... and libido and energy
Doctor :   I am more concerned if proper time ( 7AM to 8AM) is the blood drawn and which method is done ( Equilibrium method)
User :   it was in the morning... and the LH is ridiculously high... prolactin has been consistently high three times
Doctor :   My gut says you have a good free testosterone level
User :   Then why am I lacking in libido and energy?
Doctor :   We have to rule out other causes of hypogonadism
User :   Wait a minute... if I had a good test/free test level... then I wouldn't have hypogonadism, right?
Doctor :   But you say that the testicles are small
Doctor :   on physical examination
Doctor :   We count more on the physical features rather than onthe lab values
User :   Yeah, they are too small for my liking and sac not "full" enough
Doctor :   The doctor should treat the clinical symptoms and findings rather than the lab values, I think you agree
User :   Yes, I agree
Doctor :   What I suggest for you now is
User :   And penis also appears small in flaccid state but is at least average size (6+) erect, is that a concern???
Doctor :   No not at all
Doctor :   THe size of the penis does not matter at all
Doctor :   It can be as short as 3 inch and have good erections to satisfy a woman
User :   When flaccid, both penis and testicles appear kind of small.
Doctor :  
1) Check with the lab if the method done is right for free testos
Doctor :   2) Check Albumin levels
Doctor :   3) Meet a Urologist and get examined for testicle findings
Doctor :   4) Ask him if a trial of testosterone can help you with alleviation of symptoms
User :   what are some possible courses of action? i have been dealing with this too long
User :   would testosterone bring down LH? increase testicle size? what about prolactin?
Doctor :   Why do you bother about the labs again
Doctor :   Your questions shoiuld be direct
User :   because there has to be a reason for my ridiculously high LH levels and high prolactin levels
Doctor :   If the testosterone replacement shall relieve you of your symptoms
Doctor :   Hypogonadism can explain
Doctor :   Kliene Felters syndrome
User :   even the prolactin?
Doctor :   are potential
User :   i have never heard of that
Doctor :   LH and Prolacatin have no importance
Doctor :   Once an early morning testosterone is documented in the range of normal, further work is deemed unnecessary so one would not read too much into your LH levels.
Doctor :   WWW.WWWW.WW [push]
Doctor :   You may want to ask an Endocrinologist on line
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