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Fsh and pituitary and HPA axis
18 years male . Gynochamestia since 12 . Low libido issues and never had morning erections . Tested for total and free testosterone . Total testosterone came normal around 850 ng/ dl . Free testosterone came very low around 1.7 ng / dl . Which is less than 0.2% of total testosterone. Checked fsh ,lh and prolactin . LH and prolactin came normal with both in mid range but FSH came back less than range around 1.4 miu/ dl which the lab says to be more than 1.6 miu/ dl . Had history of eating disorder during puberty . No doctors near me seem to understand the importance of free testosterone . They just look at total testosterone and dimiss my concerns . Fact of FSH and free testosterone being very low makes me fear of developmental issues in pituitary and other glands . Don't seem to understand the next step , i don't want to be too late as it is already very late .
Answers (15)
Hello! Your concerns are valid, and your symptoms along with low free testosterone and FSH suggest a possible issue with the hypothalamic-pituitary-gonadal axis. Since your total testosterone is normal but free testosterone is low, it indicates a possible elevated sex hormone-binding globulin (SHBG), which reduces active testosterone levels.
Recommended Next Steps:
Further Investigations:
SHBG levels to assess if excess binding is reducing free testosterone.
Estradiol (E2) to check for estrogen dominance.
Thyroid profile (TSH, FT3, FT4) to rule out thyroid dysfunction.
MRI Brain – Pituitary Protocol if pituitary dysfunction is suspected.
Management Approach:
Lifestyle modifications: Ensure adequate protein intake, resistance training, and proper nutrition.
Check for insulin resistance or liver function issues, which can elevate SHBG.
If hypogonadism is confirmed, further hormonal therapy or medical management might be needed.
Your concerns about delayed intervention are understandable. Please consult an endocrinologist for a comprehensive hormonal evaluation. Let me know if you need further guidance.
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Hi.
I understand that you have significant concerns and you need a systematic evaluation with an endocrinologist
Just FSH, LH and testosterone alone won't be enough to pin point onto the problem. You will need a complete Clinical history and examination by a physician or an endocrinologist.
Following that you need a complete workup along with stimulation testing if required.
I would suggest you take an offline consult for this rather than online.
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Due to low testosterone you develop gynacomastia.
Other disorder may found later.
YOU MUST CONSULT AN ENDOCRINOLOGIST WITH MD PHYSICIAN.
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Low free testosterone is responsible for high estrogen activity,which is female hormone.
Thats why enlarged breast occurs in male.
Causes of low free testosterone and gynaecomastia:
Damage to cells in testes,
Inflammation in testes,
Swelling in testes,
Radiation and chemotherapy,
Disease of pituitary gland in brain,
Anabolic steroids for weight gain.
Health Tips
you should consult a nearby endocrinologist
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