Luteinizing hormone (LH) is released by the pituitary gland and signals the testes to produce testosterone. However, a high LH level does not always equate to high testosterone levels. There are several reasons why LH and testosterone levels may not correlate:
- Primary hypogonadism: This refers to testicular failure where the testes do not produce adequate testosterone despite high LH levels. Conditions causing primary hypogonadism include Klinefelter syndrome, trauma/injury to the testes, chemotherapy, infections, etc.
- Secondary hypogonadism: Here, the problem lies in the pituitary gland or hypothalamus, which fail to stimulate testosterone production adequately despite low testosterone levels. So LH levels may be low, normal, or only mildly elevated while testosterone is low.
- Androgen resistance: The testes may produce testosterone normally, but tissues are resistant to its effects due to conditions like androgen insensitivity syndrome. This leads to high LH and high testosterone but difficulty building muscle mass and other androgen-mediated effects.
- Aging: As men grow older, testosterone levels fall while LH levels rise due to gradual testicular insensitivity to LH stimulation. Elderly males can have high LH with low or borderline low testosterone.
So when is a high LH relevant?
- A mildly elevated LH along with low testosterone suggests secondary hypogonadism. Here, testosterone replacement may help.
- A high LH with high testosterone suggests androgen resistance syndrome. Anabolic steroid abuse can also elevate both.
- A significant LH elevation along with low testosterone suggests primary hypogonadism. Testosterone replacement may help, but fertility may be impacted.
The exact values of LH and testosterone levels give vital clues in assessing the cause of
testosterone deficiency.
It is best not to assume testosterone levels solely based on LH values.
Diagnosing and managing testosterone deficiency requires a nuanced clinical approach by an experienced Renewed Balance Clinic(/) endocrinologist focusing on men's health and hormone optimization. Our all-male physician team specializes in precision diagnosis and treatment of low testosterone and related health conditions in men.
Symptoms that should prompt testosterone testing include:
- Low sex drive, erectile dysfunction
- Loss of muscle mass and strength
- Weight gain, inability to lose weight
- Fatigue, low energy
- Depression, irritability
- Difficulty concentrating
- Reduced facial and body hair
- Breast tissue growth
Causes for low testosterone apart from pituitary/hypothalamic conditions include:
- Testicular injury
- Infection
- Medications
- Obesity
- Sleep disorders
- Alcoholism, opioid abuse
- Chronic health conditions
Diagnostic evaluation for low testosterone involves:
- Detailed history and physical examination
- Blood tests:
- Total and free testosterone
- LH
- FSH
- Estradiol
- Prolactin
- Thyroid hormones
- Vitamin D
- HbA1c
- PSA
- Semen analysis
- Imaging studies in selected cases
Our clinic offers full diagnostic workup, treatment programs for testosterone deficiency, sperm preservation options for fertility, counselling and long-term follow-up optimized to individual needs under direct supervision of veteran hormone specialists. Contact Renewed Balance Clinic today to schedule your evaluation.
