E.D.

[lnabass]

Son 17, 6'2", 250#, no puberty delay or insufficiency. Lab results all mid-range except testosterone 231; FSH 1.8; TSH .755. MRI yesterday-no focal pituatary lesion. Just started with endocrinologist who is repeating lab work (results next week) done in July by urologist, & gave testosterone injection. Should we look specifically for a pediatric endocrinologist (not local) as we begin this journey, or can a regular endocrinologist (local) be as effective? What questions should we be asking? Any other ideas?  

[Deanna L Aftab Guy, MD]

Why did they get labs to start with and what are the normal ranges for the testosterone and units (ng/dl etc)
Also yes, an adult urologist is helpful, an adult endocrinologist also but so far I am wondering why they worked him up if he is not pubertally delayed. Was it for his weight?
I would not take testosterone injections till you have a clearer picture especially if he does not need it, only should be used when there is clear gonadal failure or hypothalamic or hypopituitary problems (delayed puberty that needs hormonal replacement)

[lnabass]

MRI did reveal pituatary enlarged.

[lnabass]

His original complaint was erectile dysfunction, it took great effort to get it up and he couldn't keep it up more than about 2 minutes (according to him this was under ALL circumstances; he did not ever wake up hard or have spontaneous erections). He is a big guy with good muscles, a full beard, deep voice, and fully developed penis and testicles (according to the endocrinologist).

serum testosterone 231 L  ng/dL  241-827
free testosterone 11.64  ng/dL  8.00-15.90
% free testosterone 5.04 %  /  1.80-2.70

other levels:
FSH, Serum 1.8  mIU/mL  1.4-18.1
DHEA-Sulfate  279  ug/dL  102-341
LH  3.1  mIU/mL  0.5-5.3
TSH 0.755  uIU/mL  0.370-6.000
Prolactin  5.7  ng/mL  2.1-17.7

His follow-up endocrinology apt. was today and blood today was sent to be tested for status of SHBG. Endocrinologist says its not testosterone level (no more TRT!), but instead about distribution since he has high free testosterone which is not getting where it's needed when he needs it. Can anything be done about SHBG? He was sent home with Levitra samples to try.
Thanks for any additional information.

[Deanna L Aftab Guy, MD]

His total testosterone is a little lower but free is fine, he may just not be making enough sex hormone binding globulin, make sure his liver is fine-the liver makes proteins like albumin and other proteins like sex hormone binding globulin that carry testosterone and that which is not bound is free, so we know his testes make plenty.
A slightly larger pituitary is indicative or normal pubertal findings, so be sure it is not outside of normal range and that a pediatric radiologist is reading it.
Erectile dysfunction in the face of normal hormones is best evaluated by urology, it may be a neurological or vascular or even hate to say psychological or combine problem not necessarily hormonal per se
thyroid is perfect, puberty hormones are perfect
I agree, NO MORE Testosterone, so shbg as you mentioned increases as they enter puberty-even after age 17!!
His free testosterone is not high rather normal
find a different urologist that is not pushing testosterone and is more reassuring