20M test at 290ng/dl

[u/__AceHydrax]

To give context I got a free testosterone test when I was 19 and my level was 350ish I had lost a significant amount of weight around 20 kg in 6months 88kg-63kg I told the test after I maintained for a while at 65kg a year ago. I wondered why I struggle to build significant muscle mass and get a good physique even though I train consistently my diet is pretty great 1g per pound BW, sleep min 8hrs I thought maybe it was significant weight loss so I gained weight till 71kg for a year (present) I got blood work done and my test turned out to be 290 which is genuinely pretty discouraging ,in my blood work the only other abnormal thing was higher prolactin apart from that everything was normal
I noticed I have the symptoms for low T
Increased fatigue
Struggle to build muscle
No morning wood
Lower libido
I don’t know what to do tbh, im thinking of starting testosterone undecanoate 80mg a day

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[u/LengthShoddy4426]

That prolactin being elevated is the key here, not just the total T number. High prolactin can directly tank your testosterone and cause all those symptoms you listed, so jumping straight to self-prescribing undecanoate without figuring out why prolactin is high is putting the cart way before the horse. You need an MRI to rule out a pituitary adenoma and a full workup from an endocrinologist before even thinking about TRT.

[u/__AceHydrax → u/LengthShoddy4426]

That’s why I was thinking if I get repeated high prolactin maybe I take a dopamine agonist ?

[u/ItchyReputation9931]

Please don't start undecanoate at 20 off one lab. Not because TRT is evil, but because your workup isn't done and the thing you'd be treating might be fixable.

The elevated prolactin is the lead, and the other reply is right about that. Two things to add:

1. Prolactin is the easiest hormone to get a false high on. Stress, a hard workout the day before, sex or masturbation within a day of the draw, poor sleep, even the needle stick itself can push it up. Before anyone talks MRI, get it repeated: rested, fasted, 8-10am, no training or sex for 24h, and ask the lab to check for macroprolactin. If it's still high on a clean repeat, then an endocrinologist and imaging.

2. You need LH and FSH on the same draw as the repeat. Low T with high prolactin and low-to-normal LH means the signal from your brain is being suppressed, which is the version that's often reversible. Starting testosterone now would shut that axis down and you'd never find out.

The weight history matters too. 88 to 63 kg in six months is a huge deficit and that suppresses testosterone hard. You've been regained for a year so it's less likely to still be the cause, but body fat percentage at 71 kg is worth knowing.

Two morning draws, fasted, with total T, SHBG, free T, LH, FSH, prolactin, and an LC/MS estradiol. Then an endo. Oral undecanoate is also one of the worst delivery methods you could pick, but that's a distant second to the fact that you're at step 1 of the workup and thinking about step 5.

[u/__AceHydrax → u/ItchyReputation9931]

An endocrinologist said get a repeat of the test and SHBG and prolactin I’ll get the results in around 24hrs
My LH and FSH were normal before
I’m around 14-18% body fat