Patient: Recently had blood work done because of fatigue, ED, low sex drive and my results came in all normal except testosterone 6.4nmo/l(8.4-28.7), LH 3.0 (2.0-18) , FSH 3.1 (2.0-18) , prolactin 17.9(4.0-15).. I am waiting to see a urologist but these results to me make me think I should be seeing a endo.. My appt isnt for a couple months and my symptoms are becoming difficult to deal with, moodiness, anxiety, no drive. What can I do in meantime? Or should I see another doctor? What could be causing these issues?
Symptoms: Moodiness, anxiety, no drive, ED, low sex drive, fatigue
Doctor: Hello,Thanks for the query to ATD for an opinion,As seen that your testosterone levels are low and your prolactin levels are high, both have an implication towards erectile dysfunction in men. Also,It’s important to remember that low T isn’t the only cause of ED.The most common cause of ED is reduced blood flow to the penis due to chronic conditions such as high blood pressure, high cholesterol, and hardening of the arteries. Psychological problems such as depression, anxiety, and relationship issues are also possible causes of ED. So are multiple sclerosis, spinal cord injuries, chronic back pain, and other neurological conditions.Erections depend on testosterone, but the relationship between the two is complex and not fully understood. Some men have healthy erections despite testosterone levels well below the normal range. What is clear is that low testosterone levels are linked to a number of the same chronic conditions that play a role in erectile dysfunction, such as type 2 diabetes, obesity, and heart disease. For men who do have low testosterone levels, Testosterone Replacement Therapy (TRT) has a better track record of restoring a man’s sex drive than overcoming ED.While many men on TRT do report improvements in their erections, they often need added help from ED drugs known as PDE-5 inhibitors, such as: Viagra (sildenafil), Levitra (vardenafil), Cialis (tadalafil), Stendra (avanafil). These drugs encourage erections by increasing blood flow to the penis. Some men with low T, on the other hand, don’t respond to these drugs without also undergoing TRT. Also the treatment and replacement with testosterone can increase your libido and improve a your sex life , also brightening your mood, thereby renewing your interest in sex.High prolactin levels are also a deterrent to normal testosterone levels and can cause depressive, mood changes and erectile dysfunction. Firstly the cause for hyperprolactinemia needs to be identified, possible micro-prolactinomas in pituitary gland which can be ruled out with an MRI. Once ruled out then you may be placed on dopamine agonists like cabergoline or bromocryptine to control the prolactin secretion. Hence it is suggested that you meet your physician preferably an endocrinologist for discussing your options and taking an informed decision.I hope i have answered your concerns in detail,Wishing you a healthy life,Regards
Comments / Follow Ups
Patient: I also have >5mm varicocele, can that be having an impact?
Some further info on myself, im not overweight, blood pressure good, no diabetes, thryoid good as well..Can a urologist schedule an mri to determine prolactin levels being above normal? Is TRT the only form to get levels in normal range?
Thanks for the follow up,
If you have varicocele as well then it has to be surgically treated and removed first, as varicocele per se can cause decreased sperm production secondary to decreased testosterone and then decreased libido. It is suggested that after surgical treatment of varicocele a repeat testosterone count should be done after 3 weeks to decide for TRT in your case.
But as far as high prolactin levels are concerned, the cause need to be evaluated and an MRI should be ordered, infact by any physician who suspects microprolactinomas in pituitary. This is mandatory investigation to rule them out.
Thirdly , if the levels of testosterone remain low inspite of varicocele surgery , then with such low levels of 6ng/dl, TRT remains the only choice.