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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)
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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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Can help you, kindly consult and provide detailed history for proper diagnosis and further management
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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.
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you should consult a nearby endocrinologist
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Can help you with your concern. Your concern need to be evaluated in detail with history and possible examinations. Can contact for consultation via chat
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Can help you with the next course of action and treatment plan. Would like to discuss in details. Kindly consult via whatsapp on nine zero two nine six zero zero four seven zero.
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Avoid fried food and spicy food
Water intake more
Green leafy vegetables and fruits
Fiber meal
Do connect and consult
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Endocrinologist consultation.
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Connect
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Dr. Anubha Singh
General Physician
4 yrs exp
Jhansi
If you require assistance or have any health concerns, feel free to reach out for a consultation. Your well-being is my priority, and i'm here to support you on your health journey.
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Dr. Shivam Mishra
General Physician
5 yrs exp
Mumbai
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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Dr. Manoj Kumar
General Physician
9 yrs exp
Dehradun
Need few more details
Kindly consult
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Dr. Ashita Kuruvilla
General Practitioner
8 yrs exp
Kolkata
Please consult
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Dr. Ravi Kumar Nadella
General Physician
18 yrs exp
Hyderabad
It's abnormal hormonal axis
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Dr. Chaithra H
General Physician
5 yrs exp
Bangalore
Pls have physical examination with nearby endocrinologist and have a follow up.
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