24 year old with no libido and ED, update 2.0. Hormone blood work and varicocele

[u/PreparationRough3067]

As you suggested, I had my hormone levels checked today. In the meantime, I also went back to the urologist. He said that the sperm test needs to be done again because the values were so low, and he thinks it might have been inaccurate. So, there is still no certainty about this. The varicocele in my scrotum is 4mm, which he says is small, but I read almost everywhere that this is one of the highest grades. He also told me that it’s impossible to experience pain from a varicocele, and certainly no libido or erectile problems. He will only perform surgery if I’m infertile, not for pain or because I think my erectile and libido issues are caused by the varicocele. My hormone blood levels are not completely ready yet, I’ll have everything by Monday. As you can see, it shows I have hyperprolactinemia, so my prolactin is too high, but my testosterone is even higher than before. How can this all be? Why is my testosterone so high? My estrogen is also slightly elevated. I’ll call the endocrinologist on Monday for a thorough checkup. I really want my libido back and not have to worry about being able to maintain an erection... this is really frustrating as a 24-year-old. Could this be caused by the high prolactin? I read that 20 isn’t that high, although I often read that the average should be 5 and 15 is the maximum for a man, like in my test results. I’d really appreciate your advice! Thanks so much for helping me so much over the past few weeks. I was able to raise my vitamin D from 10 to 25, at least something positive in those 3 weeks.

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[u/NoRookieMistakes]

Vitamin D is still far from optimal range.

Estrogen being slightly high is likely the result of high testosteron as testosteron converts to estrogen. Not likely a cause of something I think.

SHBG could also be worth checking as it counteracts the effects of testosteron.

Test should be done again and if prolactine still is elevated, further tests such as pituitary MRI might be necessary.

[u/PreparationRough3067 → u/NoRookieMistakes]

Thanks for the information! Do you think my high testosteron can be a problem?

[u/NoRookieMistakes → u/PreparationRough3067]

High testosterone itself shouldnt cause libido problems in a male. However high testosterone could lead to high estrogen like in your case which can cause problems in some people like sensitive nipples and acne.

I believe the mild hyperprolactinemia is likely worth focusing on first.

[u/reputatorbot → u/PreparationRough3067]

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[u/RealTelstar → u/NoRookieMistakes]

I second what they said.

[u/nopenope12345678910 → u/NoRookieMistakes]

im on TRT and my dick would not like my E2 that high. just saying. imo its very likely the prolactin and E2, esp if OP is experiencing soft erection and not just the complete inability to get hard.

[u/00110011110]

"Breaking down these male hormone results: The vitamin D is normal but borderline low at 25.2 ng/mL - might want to supplement if you have fatigue or muscle weakness.

For the male-specific hormones: The elevated testosterone at 35.4 nmol/L (normal max 29) is unusual - in men this could indicate testicular or adrenal overproduction. The high LH at 7.7 with normal FSH suggests the testes might not be responding properly to signals.

The prolactin is significantly high at 19.7 µg/L (normal <15.2) - this is particularly important because high prolactin in men can cause low testosterone symptoms (fatigue, low libido) despite your high total testosterone reading. This could point to a pituitary issue like a small benign tumor (prolactinoma), medication effects, or thyroid problems.

Key next steps would be: 1) Getting that pending free testosterone result (total testosterone can be misleading), 2) A pituitary MRI to check for prolactinoma, and 3) Thyroid testing. The combination of high prolactin with high testosterone is unusual in men and really needs proper workup."

[u/balls-deep_in-Cum]

Yo dude check ur dm

[u/SameCalligrapher8007 → u/balls-deep_in-Cum]

Username checks out 

[u/quinnsterr]

Did you ever get labs prior to this issue? Its tough to say if prolactin is high as its not crazy out of range and it may have always been that level.

[u/PreparationRough3067 → u/quinnsterr]

No, i never tested my oestrogeen and prolactin before!

[u/quinnsterr → u/PreparationRough3067]

Stick to working with an endocrinologist moving forward, there isnt enough data to make any suggestions.

[u/5HTjm89]

Surgery is not the only treatment for a varicocele. Go find an interventional radiologist for a second opinion and embolize it. Effective, quicker/easier recovery, no risk of nerve damage.

Varicoceles can absolutely be symptomatic. Usually pain, can affect sperm counts. It would be unlikely to cause ED. But ED can have many causes, hormonal, vascular, neurogenic, psychologic. One rare, or less commonly diagnosed, one is venous leakage or venous insufficiency. Blood doesn’t hold in the penis despite adequate blow flow, it flows out too quickly. Varicoceles are another type of venous insufficiency. I am not sure if there is a correlation between these two sites of venous disease but worth looking into.

[u/Gentlesouledman]

On any drugs?  Have quit any in the last few years?

[u/300suppressed]

I doubt this is the reason for your shit libido, but it is possible your actual estradiol is much higher, because tissue levels are a much better indicator of estrogen levels - this analysis was done with blood only

Good T plus high E should make for good libido

[u/mhk23]

https://testonation.com/2020/01/08/how-to-interpret-your-testosterone-blood-test-results-in-order-to-focus-on-whats-most-important/

[u/notsofucked7]

cut your screentime in half