Help With Blood Test Results

[Geubitelli]

Hi guys, I've been lurking on this forum for a few days now and I've decided to join.

I'm a 22 year old college student and for the last two years I've been struggling with mild depression, loss of libido and difficulty getting/keeping erections.
I was hoping you guys could help me interpreting my blood test results. I've had blood work done 3 times now and so far no doctor has been able to help.
Sidenote: I've taken Escitalopram (ssri) for depression/anxiety for 6 months with little or no result and stopped treatment 2 months ago.

Test 1 (April 2015, before ssri use)
Thyroid
TSH: 2,96 mU/L (0,27 - 4,20)
T4: 16,7 pmol/L (13,4 - 21,3)
Gonads
Test: 14,16 nmol/L (8,64-29,00) (***8771; 410 ng/dl)
SHBG: 37,8 nmol/L (18,3 - 54,1)
Free Test: 0,266 nmol/L (0,198 - 0,619)
Adrenal
DHEA: 385,7 µg/dL (211,0 - 492,0)
Androstenedione: 1,47 ng/mL (0,60 - 3,10)

Test 2 (October 2015, two weeks after quitting ssri treatment)
Thyroid
TSH: 3,751 mU/L (0,300 - 4,000)
Gonads
Test: 4,1 ng/mL (2,8 - 11,0) (***8771;410 ng/dL)

Test 3 (November 2015, six weeks after quitting ssri treatment)
Thyroid
TSH: 2,834 mU/L (0,300 - 4,000)
T4: 1,32 ng/dL (0,88 - 1,52)
Gonads
LH: 3,3 U/L (1,5 - 9,3)
FSH: 3,7 U/L (2,0 - 7,5)
Prolactin: 16,3 ng/mL (2,1 - 17,7)
Test: 4,3 ng/mL (2,8 - 11) ***8771; 430 ng/dL
SHBG: 1,66 µg/dL (0,41 - 1,98)
Free Test: 2,59 nmol/L (0,186 - 8,24)


I've seen 2 doctors & 1 urologist so far and they all just gave me another viagra prescription and told me I was probably dealing with performance anxiety, since all my test results were within range. My girlfriend and I have been together now for almost a year and we've never had problems communicating about sex. We sleep in the same bed almost every day, so I'm pretty convinced my problems aren't psychological, but my inability to have sex is certainly taking its toll on our relationship.

Looking at my test results I guess my testosterone levels are normal, but a bit on the low side considering my age. TRT probably isn't an option at my level and age, so I'm looking for other solutions (causes). I'm aware that my doctor/urologist didn't test for some essential hormones e.g. e2 (estradiol), but I could get some additional blood work done if necessary.

Any help/advice is appreciated!

 

[halfwit]

Let me guess, you want to get it on, but Mr Happy doesn't want to cooperate? Or, you can get him up, but say 5-10 minutes in, he takes a nap or goes all soft-serve on you?

I'm guessing that based on your prolactin, which is elevated (in range). Some guys are pretty sensitive to prolactin effects, and a case of the floppies is normally the result.

If it's more of a case of you just really aren't interested in sex, I'd look at free T3 (don't know why they pull T4 AND TSH when FT3 is what truly matters) and estradiol. Estradiol is easily just as important as testosterone, and SSRI use is known to mess with that too. (prolactin is my first guess, but they do often go hand in hand)

My .02c

Edit: Just to clarify about the FT3, you had a high TSH and poor thyroid function can mess with SHBG - > free testosterone. Some are sensitive to that too.

 

[Megatron28]

While you are young, you may be a candidate for treatment with Cabergoline. It had a higher success rate with older men in the following study, but younger men did still see some benefits in regard to Testosterone Levels and ED. It may also help with your mild depression. I would encourage you to read the following study and discuss it with your doctor.

http://press.endocrine.org/doi/full/10.1210/jc.2003-030852?queryID=63/111001&

In conclusion, 50% of the patients coming to our observation for hyperprolactinemia complained of sexual disturbances, whereas 96.7% of them had an impairment of erectile events per night compared with 13.7% of controls. Six months of treatment with cabergoline was successful not only in producing a rapid normalization of serum PRL levels but also in restoring and preserving gonadal function in hyperprolactinemic men. The treatment should be considered as a first choice in hyperprolactinemic hypogonadism, providing a normalizing of gonadotropin pulsatile secretion and consequently testosterone levels in most cases, thus restoring and maintaining during treatment the capability of normal sexual activity in male patients.

 

[Megatron28]

Here is another study worth reading.

International Journal of Impotence Research - Cabergoline treatment in men with psychogenic erectile dysfunction: a randomized, double-blind, placebo-controlled study

The effectiveness of cabergoline in 50 men with psychogenic erectile dysfunction was investigated in a 4-month, randomized, placebo-controlled, double-blind study with validated psychological tests, and prolactin, follicle-stimulating hormone, luteinizing hormone and testosterone serum levels. Cabergoline treatment was well-tolerated and resulted in normalization of hormone levels in most cases. In the cabergoline-treated group, significant interactions between prolactin and testosterone serum concentrations were observed. Erectile function improved significantly. Sexual desire, orgasmic function, and the patient's and his partner's sexual satisfaction were also enhanced. Cabergoline may be an effective and safe alternative agent for men with psychogenic ED.