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My testosterone levels vary every month, doctors cannot provide an explanation.

After multiple years of appointments, referrals and diagnostic tests without answers I am now resorting to the internet.

In 2019 I noticed a complete lack of sex drive, after a couple of months I realised this isn't normal for a 22-year-old so I went to the doctors and had some blood tests. These tests revealed an extremely low testosterone of 43 ng/dL (1.5 nmol/L) and extremely elevated LH and FSH (21.2 iu/L and 48.4 iu/L, respectively) indicating primary gonadal failure (testicular failure).

It's been 2 years since then and overall my symptoms have improved, however, my testosterone levels (and the associated symptoms of low testosterone) rise and fall in 'cycles' of between 3-6 weeks. I experience periods of 'normal' testosterone level (within the normal range) which is then followed by a period of low testosterone (towards the lower end of the normal range). In these periods of low testosterone, I have the following symptoms: no morning erections, decreased libido and slower facial hair growth.

All of the specialist endocrinologists I've seen are baffled and can't provide any explanations.

I've currently had genetic/chromosomal tests to rule out any genetic abnormalities, testicular ultrasounds, digital rectal examination, MRI scans to investigate potential pituitary abnormalities/tumours and LHRH tests to assess pituitary function. None of these tests have shown any abnormalities. The only abnormality that they have found is a very small varicocele (too small to remove) and an epididymal cyst on my right testicle.

Blood tests throughout the years (with the exception of the first blood test displaying extreme testosterone, LH and FSH) show that my LH and FSH are consistently at the extreme low end of the reference range (LH average = 1.3 iu/L and FSH average = 1.2 iu/L). My testosterone varies from an average of 12 nmol/L (350 ng/dL) in periods of low testosterone to an average of 21 nmol/L (600 ng/dL) in periods where I feel fine.

The duration of these periods varies greatly, they can last for as little as 3 weeks or up to 6 weeks.

I have tried monitoring absolutely every aspect of my life to try and identify what is causing it. I eat very healthy, take vitamins including zinc and vitamin D, eat enough healthy fats, work out and get at least 7 hours of sleep a night. I'm of a healthy BMI and drink plenty of water. I know for certain I am not getting any exogenous testosterone in my system through skin-to-skin contact with someone using hormonal gels (currently don't have a girlfriend). I drink once a week with friends, but I've quit alcohol for 6 months and nothing changed, I still went through the cycles of varying testosterone levels.

Does anyone have any ideas? I've now officially been discharged by my endocrinologist as they have no idea what to do or what other tests they can do. It's been going on for so long and I just want answers, it's exhausting.
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207091 tn?1337709493
I'd also want to know if you got your thyroid checked. And like Paxiled said, getting it tested at the same time of the day might show something, too.

Helpful - 0
Thyroid has been checked also, that seems to be functioning correctly. I should have specified I've had multiple full bloodworks done measuring 30+ biomarkers and none of them are out of range.
Not to say it's your thyroid, as I don't know that it is and assume it isn't as you've been good about seeing docs about it, but make sure if you look at your results that they didn't just test Tsh but checked your T3 and T4 levels.  Otherwise, it's a puzzle, that's for sure.  From the symptoms you describe, it is affecting you when it's low and not when it's normal, so it's a thing.  What thing is the problem.  If you keep looking, including finding better docs if the ones you're seeing can't or won't help, hopefully you will find out or it's also possible it will just go away as mysteriously as it came.  There are some substances that exposure to affects testosterone, but I think your estrogen would be higher, such as petroleum or petroleum products or being near a facility that works with and dumps petroleum.  Some foods are estrogenic, such as soy and red clover, but again, folks have eaten them for centuries without the problems found in the lab.  I should say, though, morning erections aren't a thing.  Some people get them, some don't.  I'm 68 and obviously not at peak testosterone, but I get them often when I wake up while I'm sleeping because of the leftovers of prostate surgery.  But I seldom ever got them at any other time of my life.  So again, that's really not a thing all men have and certainly don't get every day.  Ever get your melatonin levels checked?  Not easy to do really but some people are not cut out to go to sleep as early as you do.  Some of us are just programmed for a later bedtime, but are forced by our society to get up early.  Again, just a possibility, but a weak one given that you sleep well.  All in all, your life actually seems pretty darned good most of the time, and that's a miracle in and of itself.  Peace.
I second the point that a lot of doctors order a standard test of TSH levels and tell you that they tested your thyroid and everything is fine. That's b.s., so do make sure you had the T3 and T4 levels checked.

I'd look for a smarter or more interested doctor. It's not like this is all in your head, your records show the drop in testosterone. A doctor's job is diagnosis. (Once someone knows what is wrong, it's possible for anyone to look up what to do about it. But you need a correct assessment of what is wrong, which is why you go to the person with the M.D. or Ph.D..) If a doctor just shrugs you off, he's not doing his job... at the least, he should refer you to someone else. I'd talk with my regular M.D. and get a better referral. In fact, I'm a rattler of cage bars, so I'd go to the Mayo Clinic, or call Cedars Sinai, or look up who is writing scientific papers on the topic and ask them who is good ... I'd do *something* to find a doctor who can actually diagnose the problem. Love you that you wrote here, we are a concerned and often helpful community, but alas, unless someone recognizes exactly what you are going through and it's the very same thing that happened to them, the Internet probably isn't going to solve this mystery. You need to find an interested specialist.

Along with us, the concerned and often helpful community, that is.  :-)
134578 tn?1693250592
I'm thinking about the three- to six-week swings. Are you under a lot of stress at times that might coincide with the testosterone levels dropping? Are you exposed to any drugs or chemicals on that schedule? (Do you live or work in a place that has biosphenol A in the environment?) Do you cook with or eat out of a plastic dish that you put in the microwave that might have BPA in it?
Helpful - 0
Hi Annie, thanks for your reply.

I'm a student so I'm rarely under stress, the  3-6 weeks swings are completely random and not correlated with my exam periods (which would be my only source of stress, but even then I hardly feel stress at all - I'm a pretty relaxed person even during exams)

No workplace toxins (I've had 2 jobs since the symptoms started, both working in a bar a couple of days a week).

I do have reusable microwaveable plastic dishes but I made sure they are BPA free, as are my water bottles.

You say you're a student, but don't say how old you are.  One interesting question would be, did you always get your testosterone checked at the same time of day?  And did you ever get it checked several times in a week or month to see if it all averaged out.  Testosterone in a man who lives a "normal" schedule, meaning going to bed at night and getting up in the morning as opposed to someone who is up late into the night and sleeps into the day or a day sleeper, is highest in the morning upon awakening from sleep, thus for a very young man the morning erections.  Those don't last, by the way.  As you age, they stop, just as wet dreams and other things that the very young male can get.  Not that it never happens but it stops being a regular feature of life.  I would say the most important factors are how you're feeling energy wise and how your muscle tone is doing.  If you were low in testosterone in a way that was pathological, you would most likely be lacking energy, you might not be sleeping well, you would definitely not be a relaxed person who is rarely under stress, and you would be weakening.  When you have sex, you would have a difficult time getting and maintaining an erection.  Hormonal levels of all kinds fluctuate on a regular basis, buy the hour, day, week, and month.  They are never constant, but we don't really discover that as individuals because we never get tested frequently enough to know that unless we have a major health problem that requires that.  You also don't mention if your estrogen and/or progesterone levels are unusually high.  You also don't mention your cholesterol levels, which is essential to how the body manufactures sexual hormones and so if it were extremely low, that could be a problem just as extremely high cholesterol can be.  I'd also want to know how much zinc you're taking daily, and why.  The amount in a typical multi is low, but too much can be toxic.  Obviously, those very low counts are concerning, but as they don't seem to recur, it might have been an anomaly or a bad lab test or just a low day.  You day you don't currently have a girlfriend, but do you have sex with anyone?  Do you masturbate?  If so, do you get and maintain erections?  Is your muscle tone holding up.  If you exercise, do you still have plenty of energy to do so.  In other words, I don't know what's going on, but if you aren't manifesting any symptoms of it then maybe you don't actually have a testosterone problem but this is just how you tend to fluctuate but you even out over time, and the lack of libido might be due to something else.  I can only offer questions, unfortunately, as none of us on here are experts.  It is concerning, but it might not actually be a testosterone problem.  Or it might be.  One thing you can try if you can afford it is to see a holistic nutritionist, not because they have any magical cures but they are often the only health professionals who are willing to authorize lab tests quite often to see how you do every day.  But it will cost you.  Peace.
Thanks for your comment - I'm 24 at the moment. I should have specified in my original post that I've had multiple full blood tests (measuring 30+ biomarkers) with no abnormalities other than FSH, LH and Testosterone.

All blood tests were taken before 9am every day (between 8.30-9am in fact) as instructed by my endocrinologists in order to keep the levels comparable, because as you said testosterone levels are highest in the morning.

As I've said, I am manifesting the 'pathological' symptoms of low testosterone in those periods (low libido, decreased hair growth complete lack of morning erection, harder to maintain erection etc), but these improve when my testosterone goes back up to normal.

The zinc supplement I am taking is not too little and not too much, it's 200% of RDA.

Muscle tone in general is good, I work out. Energy levels are high during periods of normal testosterone and lower during periods of lower testosterone.

Also I have a very good sleep schedule, In bed before midnight every night and wake up between 7 - 8 am. My body is incapable of sleeping longer than 8 hours, but is usually around 7.
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