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Forum Name: Endocrinology Topics

Question: hormone analysis


 Popescu - Fri Feb 03, 2006 11:01 am

I'm a man, 22 years old and I have this results for hormones:

FSH 2.57 mlU/mL

prolactyn 42.96ng/mL
------------------------------------------

testosteron 4.90 ng/mL
TSH 1.84 micro l U/ml
LH 2.31 mlU/ml

Estradiol 108,0 pg/ml
-------------------------------------------

FT4 0.86 ng/dl

can anybody tell me what might be the problem?
I haven't taken any kind of medication, except some vitamines and I also have a problem with minerals:
Ca(8,3 mg%) and Fe(22 micro g/%)[/img][/u]
 Dr. Shank - Tue Feb 07, 2006 4:38 pm

Dear Popescu:

Your free T4 (FT4) is fairly low and suspicious for hypothyroidism, but your thyroid stimulating hormone (TSH) is normal. In other words, the main thyroid hormone level is low enough that the pituitary hormone controlling the thyroid would be expected to be higher. This is often seen in non thyroidal illness, but there are complicated combinations of other problems that could cause that pattern, as well.

For your age, your total testosterone is relatively low, but the pituitary hormones that control testosterone production (LH an FSH) are not elevated. This most likely means that the proteins that carry testosterone in the blood are low, so that more of the testosterone is "free" or readily available to have an effect. Again, more complicated explanations are possible, however.

Estradiol is high for a man. This can be seen with advanced liver disease, but is more commonly seen in men who are very much overweight. In the first case, the liver can not bread down normal amounts of estrogen that are formed, and in the second, the fat cells convert too much testosterone to estrogen.

Your prolactin level is relatively high. However, it is within the range that it could be normal or abnormal. I would recommend that it be repeated. Often, pain or anxiety with blood draws will raise it that high, in which case the levels may be much lower when repeatedd. On the other hand, sometimes the pituitary gland produces too much prolactin, which can interfere with sexual functioning in men (cause menstrual irregularity and infertility in women) and lower testosterone levels. If your prolactin is consistently that high, it should be treated by an endocrinologist.

Your calcium may be low, but that depends upon the level of albumin in the blood that carries most of the calcium. If your albumin is low, then the total calcium will probably be low, even if the calcium that is readily available ("ionized calcium") is normal.

The low "Fe" iron suggests iron deficiency, but that needs to be confirmed by additional testing.

It would be helpful to know more about you--especially what problems you were having that led to these tests being done.
 Popescu - Wed Feb 08, 2006 10:24 am

First, I would like to thank you for your kindness and for your time.

Regarding testosterorone level, I’m not overweight (183 cm – 75 kg) so I should understand that the low level might be generated by a liver disease or the high level of prolactin. About a year and a half I’ve started to have some sexual problems. For a period of time my libido was very low and it was verry difficult to obtain an erection and to maintain it long enough. However, if this would happen then would interfeare precoce ejaculation and no more sexual disire. Those problems apeared suddenly after a period of time in wich I felt very healthy and everything was normal. I thought that I had to deal with a saturation, because of excesses I’ve made (for 3 months I had sex with my girlfriend at least once a day). Lately my libido has grown (still not normal, I think), but I still have precoce ejaculation. This problems, the fact that I’m not very phisical mature at my age (my facial hair is kind of sporadic(it’s present only on the chin) - and I need to shave at 6-7 days, also the chest hair is sporadic) and I’ve reached puberty at 16-17, led me to an endocrinologist and to these tests being done. My doctor has seen the results of these tests but said that it is hard to find out the causes that led to them. I would appreciate if you would recomand me what more tests should I do, what other investigations. Thank you very much
 Dr. Shank - Thu Feb 09, 2006 5:56 pm

Dear Popescu:

You need not worry about "wearing it out." The more sexually active you are, the better your sexual functioning should be.

If you were my patient, I would perform a "free testosterone" and a "free T3," and repeat the "free T4" and prolactin. If it appears that you really do have a testosterone deficiency, I would do iron studies to exclude hemachromatosis, which can affect the testes directly and other endocrine glands, including the pituitary. If you have a confirmed pituitary abnormality, I would screen for other pituitary abnormalities and consider an MRI of the pituitary with dynamic imaging. Depending upon what your physical examination shows, consideration might also need to be given to genetic testing, but I do not routinely do that.

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