Advice on blood work

[calis]

I recently had some blood tests done in order to investigate the cause of pubescent gynecomastia. Other symptoms that I have include low sex drive, severe sleep problems, generalized and social anxiety, excessive fatigue following exercise and occasional erectile disfunction.

Blood was taken at 9am, the results were as follows:
Total testosterone – 11.7 nmol/L
Calculated free testosterone – 237 pmol/L
Prolactin – 310 mU/L
Oestradiol – <50 pmol/L
SHBG – 29 nmol/L
LH – 3.8 U/L
FSH – 2.4 U/L

As testosterone was low the lab recommended a repeat of the test. The second set of results were:

Total testosterone – 14.7 nmol/L
Calculated free testosterone – 271 pmol/L
Prolactin – 143 mU/L
Oestradiol – 62 pmol/L
SHBG – 36 nmol/L
LH – 1.8 U/L
FSH – 2.2 U/L

I also had an adrenal function saliva test done, results were:

Cortisol
07:00-08:00 – 8.5 (12-22)
11:00-12:00 – 5.9 (4-8)
16:00-17:00 – 4.0 (3-7)
23:00-00:00 – 0.9 (1-3)
Total daily cortisol – 19.3 (20-40)

DHEA
11:00-12:00 – 0.38 (0.5-1.0)
16:00-17:00 – 0.47 (0.5-1.00

DHEA : Cortisol ratio – 2.2 (1.3-5.0)

As testosterone came back higher the second time my doctor did not consider it worth pursuing the matter further and did not think it worth having me see an endo. Although comparing these results to the tables on this forum even in the 2nd test my total T is equivalent to an 85 year old man.

In addition to the symptoms previous mentioned I also suffer from attention deficit disorder and social phobia for which I am undergoing treatment. Since these tests were done I have been started on Ritalin and was taking no medication prior to or at the time of the tests. As far as I know these could both be linked to or exacerbated by an androgen deficiency due to testosterone's role in attention, concentration, anxiety and confidence. Both of these problems are severely affecting my life just now and if I could improve these it would completely change my quality of life.

I was hoping someone could help me interpret my results. Are these levels at which it would be common to recommend TRT? I’m not too sure whether to see another doctor just now and pursue this further. I’m slightly apprehensive about the idea of TRT at my age (22), but if it is likely that it would help the problems I’ve mentioned it would definitely be worth it.

From the first set of results I thought it looked like I had secondary hypogonadism, however I not sure about what the changes in the 2nd test imply. Is there any relevance to the fact that there was a drop in LH, FSH and prolactin while T increased?

I’m thinking the first port of call should be to try to fix my adrenals, then see what effect that has on my hormone profile before making any decisions on TRT. So I was thinking of starting a moderate dose of dermacrine plus possibly a low dose of hydrocortisone (not too sure about that though). Does this sound reasonable?

Any advice would be greatly appreciated.

[hardasnails1973]

Originally Posted by calis

I recently had some blood tests done in order to investigate the cause of pubescent gynecomastia. Other symptoms that I have include low sex drive, severe sleep problems, generalized and social anxiety, excessive fatigue following exercise and occasional erectile disfunction.

Blood was taken at 9am, the results were as follows:
Total testosterone – 11.7 nmol/L
Calculated free testosterone – 237 pmol/L
Prolactin – 310 mU/L
Oestradiol – <50 pmol/L
SHBG – 29 nmol/L
LH – 3.8 U/L
FSH – 2.4 U/L

As testosterone was low the lab recommended a repeat of the test. The second set of results were:

Total testosterone – 14.7 nmol/L
Calculated free testosterone – 271 pmol/L
Prolactin – 143 mU/L
Oestradiol – 62 pmol/L
SHBG – 36 nmol/L
LH – 1.8 U/L
FSH – 2.2 U/L

I also had an adrenal function saliva test done, results were:

Cortisol
07:00-08:00 – 8.5 (12-22)
11:00-12:00 – 5.9 (4-8)
16:00-17:00 – 4.0 (3-7)
23:00-00:00 – 0.9 (1-3)
Total daily cortisol – 19.3 (20-40)

DHEA
11:00-12:00 – 0.38 (0.5-1.0)
16:00-17:00 – 0.47 (0.5-1.00

DHEA : Cortisol ratio – 2.2 (1.3-5.0)

As testosterone came back higher the second time my doctor did not consider it worth pursuing the matter further and did not think it worth having me see an endo. Although comparing these results to the tables on this forum even in the 2nd test my total T is equivalent to an 85 year old man.

In addition to the symptoms previous mentioned I also suffer from attention deficit disorder and social phobia for which I am undergoing treatment. Since these tests were done I have been started on Ritalin and was taking no medication prior to or at the time of the tests. As far as I know these could both be linked to or exacerbated by an androgen deficiency due to testosterone's role in attention, concentration, anxiety and confidence. Both of these problems are severely affecting my life just now and if I could improve these it would completely change my quality of life.

I was hoping someone could help me interpret my results. Are these levels at which it would be common to recommend TRT? I’m not too sure whether to see another doctor just now and pursue this further. I’m slightly apprehensive about the idea of TRT at my age (22), but if it is likely that it would help the problems I’ve mentioned it would definitely be worth it.

From the first set of results I thought it looked like I had secondary hypogonadism, however I not sure about what the changes in the 2nd test imply. Is there any relevance to the fact that there was a drop in LH, FSH and prolactin while T increased?

I’m thinking the first port of call should be to try to fix my adrenals, then see what effect that has on my hormone profile before making any decisions on TRT. So I was thinking of starting a moderate dose of dermacrine plus possibly a low dose of hydrocortisone (not too sure about that though). Does this sound reasonable?

Any advice would be greatly appreciated.

Need ranges

[calis]

Sorry, here they are with ranges:

Test 1

Total testosterone – 11.7 nmol/L (10-30)
Calculated free testosterone – 237 pmol/L (245-785)
Prolactin – 310 mU/L (60-500)
Oestradiol – <50 pmol/L (0-160)
SHBG – 29 nmol/L (6-45)
LH – 3.8 U/L (1.0-9.0)
FSH – 2.4 U/L (1.0-10.0)

Test 2

Total testosterone – 14.7 nmol/L (10-30)
Calculated free testosterone – 271 pmol/L (245-785)
Prolactin – 143 mU/L (60-500)
Oestradiol – 62 pmol/L (0-160)
SHBG – 36 nmol/L (6-45)
LH – 1.8 U/L (1.0-9.0)
FSH – 2.2 U/L (1.0-10.0)

The only thing that was ever actually out of the range was free T on the first test, which is why my doctor thought everything was fine and I wasn't sure whether it was worth checking out further. It was only comparing my levels to the tables posted by DavidZ and the symptoms I've always had that made me think I should check it out a bit more.

[JanSz]

Originally Posted by calis

Sorry, here they are with ranges:

Test 1

Total testosterone – 11.7 nmol/L (10-30)
Calculated free testosterone – 237 pmol/L (245-785)
Prolactin – 310 mU/L (60-500)
Oestradiol – <50 pmol/L (0-160)
SHBG – 29 nmol/L (6-45)
LH – 3.8 U/L (1.0-9.0)
FSH – 2.4 U/L (1.0-10.0)

Test 2

Total testosterone – 14.7 nmol/L (10-30)
Calculated free testosterone – 271 pmol/L (245-785)
Prolactin – 143 mU/L (60-500)
Oestradiol – 62 pmol/L (0-160)
SHBG – 36 nmol/L (6-45)
LH – 1.8 U/L (1.0-9.0)
FSH – 2.2 U/L (1.0-10.0)

The only thing that was ever actually out of the range was free T on the first test, which is why my doctor thought everything was fine and I wasn't sure whether it was worth checking out further. It was only comparing my levels to the tables posted by DavidZ and the symptoms I've always had that made me think I should check it out a bit more.

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