Very High LH/FSH while on TRT

[bill24]

I take a very low dose of Androgel , about 13-15g of 1% gel per week for primary hypogonadism. Been doing this protocol for over a year. I don't take HCG or a SERM, AI, or anything else...

I got back these recent labs with LH and FSH through the roof. Shouldn't LH/FSH be shut down while on TRT? Granted my LH/FSH were high before TRT. A little concerned though that the Androgel has stopped working, or perhaps an issue with my pituitary gland being overstimulated due to problem X (?)

Test, Serum 550 ng/dl Range 348-1197
LH ~ 23.3 mIU/mL Range 1.7-8.6 (High)
FSH ~ 56.7 mIU/mL Range 1.5-12.4 (High)
Estradiol ~ 10.0 pg/mL Range 7.6 - 46.2

Also, estradiol was low, but after some searching, I can't seem to confirm whether this reading is something to worry about. I took these tests after a heavy lifting day, and don't know if that makes a difference?

Overall, I want to up my Androgel dose, or go on shots long term, but I want to try to understand these readings first.

[HRTstudent]

These results are very unusual from the "normal" stuff we see.

What did your doctor say?

It appears that you are not absorbing the gel at all. We expect that exogenous T will shut down your HPTA and LH and FSH will plummet. It's the hallmark sign that Testosterone is getting into your blood.

On the flip side, your Total T isn't even low. Perhaps you do not even need TRT at all.

[sirupate]

My endo. was never worried about HPTA suppression in me when I was on the gel. I made it a point to ask him about this possibility and he sort of dismissed it. Now I don't think my endo was all that great a doctor for TRT...but. The LH/FSH readings are very interesting. You don't see that around here...well..ever.

[steroid.com 1]

Your primary and why your LH & FSH are high.

The amount of Androgel is not absorbing or not enough dosage amount enough to cause HPTA suppression as noted.

Your total Testosterone serum is fine but I'd like to see bioavailable and/or Free T as a more accurate marker.

Your E2 is in the tank and needs to come up...it's something to worry about.

Low E2 is usually a sign of low Testosterone ...nothing to convert.

Might be time to go injection route.

hCG won't do much for you in terms of natural production as you're Primary but might make you feel better.

[bill24]

I went on TRT with T levels around 275 ng/dl, so testicles were not failing 100% but they were not working very well. I also had no sperm and my nuts are quite small, never fully developed. My LH/FSH were very high before TRT and still very high, although they had been lower at some points throughout TRT when on a higher dose. Problem is when I went to a higher dose of androgel , T shot up above 1500 ng/dl, so doc took me down to a lower than low dose.

I plan to retest T and free T asap. I'm also looking for a new endo. Mine cannot confirm whether I'm still making T (seems like it should be an easy question), and does not seem to care at all about high LH/FSH. I'd prefer to stay on TRT because I feel better, but I'd rather my protocol just shut me down, so it's not such a guessing game. Most people care about their nuts, but not me!

You say E2 is a concern? Why, specifically? I know it's low, but what does that lead to? I could not find info about the danger of low E2, only the danger of high E2 (gyno, etc.).

Thanks a ton! I do feel OK, but I just want to know what's going on!

[ecdysone]

Well for certain, your pituitary is quite active. Have you done an MRI?

You are definitely absorbing test, but it's not having any effect on your HPTA.

I must be missing something though, why don't you just increase your Adrogel dose upward a bit - that would not only put your test in a more optimal range, but would almost certainly up your E2 level. After that you could re-do the labs and see where you are.

[bill24]

Yes, it seems to make sense (whether per endo's suggestion) for me to up my dose of Androgel and retest T, free T, LH/FSH, and E2. I have enough androgel that I could up my dose on my own. I just prefer to have a doc-regulated protocol. It would seem that upping the dose should raise E2. Still don't know what the specific danger of low E2 is, but I am concerned. Anybody???

The main reason my endo lowered my Androgel dose from about 28g per week in the past was that my T was too high. Oddly, levels had exceeded 1500 ng/dl, which is a little high to cruise with for years on end. The doc could not explain those levels because Androgel normally does not work like that. He just said "it's an anomaly" and left it at that; kind of a cop out in my opinion.

I would like to do a pituitary MRI, but I need a doc to order that, so I can go through insurance. Hoping my PCP will do it, seeing him tmrw (and I will embelish symptoms if need be to get it done). I do worry about a tumor (adenoma) or something, although supposedly those present in only 1 out of 1000 people. I would also like IGF-1 and GH checked, plus cortisol, and anything else that might point to pituitary abnormality.

Did thyroid tests and CBC recently and everything looked OK.

[Vettester]

Agree with the need to order an MRI. Those levels are way too high, even for being a primary condition, which leads to suspicion in the pituitary region. Would also be curious if you have other pituitary related labs (TSH, Prolactin, ACTH, GH, ...)?

IMO, your serum score is OK, at least enough that it would (or should) cause suppression of the HPTA due to the exogenous medication being administered. If your serum were < 300 (+/- or thereabout), I might view it a little differently, but again, even normal primary hypogonadal examples don't usually exceed 12.0 - 15.0 on their LH and FSH panels. Again, strictly going off of MY OPINION, it would appear that something is hyper stimulating the GnRH functions of the pituitary. Again, other labs could help elaborate this thought to confirm or deny if it's just isolated to LH & FSH production.

Either way, stay on top of it, and by all means find a method to get that MRI.

Best!

[HRTstudent]

Low estradiol is linked with numerous health detriments, perhaps the most important is increased bone loss over time. This link is very strong and very real. You need healthy estradiol levels.

[brazey]

Low estradiol is linked with numerous health detriments, perhaps the most important is decreased bone loss over time. This link is very strong and very real. You need healthy estradiol levels.

I know you meant Increased Bone Loss.

[bill24]

I agree with what you guys have suggested. I will post again after I attempt to get the MRI and more labs.

Vetteman08, TSH was 1.46 uIU/mL, and within range (0.45-4.50). I have yet to test Prolactin, ACTH, or GH, but I can look to get those tests.

HRT, thanks for the E2 info! Before I started TRT, E2 was actually within range, so I am a little worried now.

[Vettester]

I suspect you might also be on the high side with your DHT, which could be a factor in the E2 conversion.

The other labs would be great if you had them on hand, but I would put the MRI at the top of the priority list before anything else.

[bill24]

Agreed that the MRI is priority 1. I'm also going to order my medical record to see what other tests I had awhile back.

[kelkel]

Curious, when your serum came out high when was the BW pulled relative to gel application. BW should be pulled 24hrs after application on a consistent basis. Agree with Vette on the DHT as it will block your E on three different levels. Gels are known to raise DHT levels. Happened to me.

[bill24]

I've gone 24 hours without gel and still tested above 1000 ng/dl, although the most recent reading around 550 ng/dl was taken about 3 hours after applying the T.

I almost always check T around 10AM after applying the gel, as this is what my endo suggested for consistency. Moving forward, I can test after a 24 hour off period.

I will plan to check DHT. At this point, I'd rather be on the shots!

[HRTstudent]

I know you meant Increased Bone Loss.

sure did!

(low estradiol is bad for your bones)

[bill24]

sure did!

(low estradiol is bad for your bones)

And high estradiol is bad for your boners? All kidding aside, thanks for all the posts.

[kelkel]

Post your results please. Love to see what your DHT level is now and in the future when you switch to injections.

[bill24]

Struck out with my PCP yesterday when trying to get an MRI ordered. He referred me to another endo who I am tentatively seeing in 2 weeks. Perhaps she will order the MRI. I'll also ask my current endo. Did I mention I am shopping for a new endo or new doc? Preferably one who will switch to shots.

In the meantime, I'm checking DHT tomorrow, along with T, free T, prolactin, IGF-1, glucose, e2, cortisol, FSH, and LH.

I started reading a bit about DHT. It seems I have some symptoms of being on the higher end: very high libido, and frequent urination. The urination could be do to overactive CNS (due to DHT), or less likely a prostate issue, among other things. I will repost when I get results, and continue to work on getting the MRI. I'm starting to become more active in managing my TRT, but I have yet to master working with docs to get what's needed.

[bill24]

Still working on getting an MRI, but I thought I'd update with more recent labs. Not sure if this warrants any new discussion... but DHT was high as I had expected. T also came out higher this time leading me to believe I am absorbing the Androgel . LH and FSH still very high, and did not drop when T is higher. E2 still low end of normal. Now WBC coming out a little low, although I was slightly under the weather when I had these tests.

DHT 139 ng/dl (high), reference range is 30-85
T 1295 ng/dl (high)
Free T was 34.32 mg/dl (high), 5-21
% Free T was 2.65 (normal), 1.5-4.2

LH 20.7 mIU/mL (high), 1.7-8.6
FSH 52.5 mIU/mL (high), 1.5-12.4

Prostate Specific Ag, Serum 0.5 ng/mL (normal), 0-4
Cortisol AM 11 ug/dL (normal), 6.2-19.4
Estradiol, Sensitive 11 pg/mL (low, but in range), 3-70
IGF-1 208 ng/mL (normal), 116-358
TSH 1.3 uIU/mL (normal), 0.45-4.5

WBC 3.7 x10E3/uL (low), 4-10.5
RBC 5.08 x10E6/uL (normal), 4.1-5.6
Hematocrit 47.6 % (normal), 36-50

Seeing a new doc on Wednesday... will still look into the MRI

[kelkel]

Regarding your DHT, mine shot up high like that on gels. Switched to shots and in a month it went down to 75. Regarding your excessive LH/FSH, definitly do what the guys suggested and get the MRI. There are adenomas that cause the pituitary to secrete excessive levels of LH/FSH. Find a way to get it done.

[ecdysone]

^^^ everything Kel said.

However your DHT is rather low for a transdermal application with those test levels - remembering that the "normal" range is not for individuals who supplement test.

For now, I would completely ignore it and concentrate on more important matters.

[bill24]

I am looking into the MRI now more than ever. It seems very possible that I have an LH/FSH-secreting adenoma, although fortunately, I do not seem to have an adenoma secreting hormones such as cortisol or TSH, nor does the adenoma seem to be significantly impairing vision, etc. Don't get me wrong, LH/FSH are important hormones, but given my plan to stay on TRT and likely irreversible sterility and hypogonadism, they seem pretty inconsequential at this point.

I guess the main concern is that over time the adenoma could grow and impair surrounding tissue and neural structures, which could cause vision loss or affect other pituitary hormones. Worse yet I could have a pituitary carcinoma, although very unlikely.

I'll post once I get the MRI. I think I have enough ammo now to convince the endo I am seeing on Wed. I'm hoping that if I do have an adenoma, it can simply be followed with periodic MRI, and that surgery won't be needed. It sounds like many people live with pituitary adenomas without knowing it.

[bill24]

Yep, I was happy to see that DHT was not super super high. Also, I forgot to mention that the frequent urination issue has subsided slightly, so I'm less worried about that now. I would like to bring this up at my next appointment, but I don't want it to distract from getting the MRI done.

^^^ everything Kel said.

However your DHT is rather low for a transdermal application with those test levels - remembering that the "normal" range is not for individuals who supplement test.

For now, I would completely ignore it and concentrate on more important matters.

[bill24]

MRI came back today and they found nothing abnormal in the pituitary, so the high LH/FSH continues to baffle me. Radiologist did find that my carotid arteries are slightly ayssemtrical, but this could be from birth, and nothing to worry about. At any rate, now my endo wants me to rule out aneurysm in part because I told her I was having blurred vision (to get the MRI). This seems a little unnecessary to me.

[sliceofcake]

In a VERY similar situation here.

I have been on TRT (Reandron 1000mg every 12 weeks) since '09.
Stopped injections earlier this year. It's since then that I started doing some research and found out that My LH/FSH should have been completely suppressed, however never dropped below 16 and 11 respectively.

Did you get to the bottom of this?

[HRTstudent]

Wow that is weird, what the docs say?

[sliceofcake]

Wow that is weird, what the docs say?

The endocrinologist didn't even pick up on it.
It was afterwards, speaking to people on forums that i realised something wasn't right.
From people I've spoken to it's most likely a failure at the testes or the pituitary gland.

I went and saw my GP to organise an MRI of my pituitary fossa.
I had to try and explain my concerns before he would do this.

Shaken my faith in Drs, but hopefully they're right.