Brief Answer:
Endocrine

Detailed Answer:
I am sorry to learn about your erectile / sexual problems.

I have reviewed the attached laboratory results too.

1 I would like to know your height. I see a mildly elevated Estradiol level. People who have excess body fat can have such high levels of estrogens because there is an enzyme in fat which converts testosterone to estradiol

2 When I see someone like you in my practice, I order the following tests in addition to a thorough physical examination :
CBC
Total Testosterone
Albumin
Ferritin
Prolactin

The reason for this particular selection of tests is:

A) Your prolactin levels were mildly high in 2013, so a recheck to ensure they are normal now is important because high prolactin can lower testosterone levels

B) Free testosterone test results are reliable only when performed by a special method called Equilibrium dialysis. You can check with your lab if they use this technique. If not, it is possible to indirectly estimate Free Testosterone using Total Testosterone, SHBG and Albumin levels. There is a mathematical formula to compute this, and it is acceptable scientifically.

These tests do not require fasting but are best done in the morning before 10 am, because testosterone levels normally go down as the day progresses.

Rest of your labs look ok.

I am not aware of any published literature regarding any particular food items affecting libido and causing ED.

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Brief Answer:
Follow up

Detailed Answer:
I see what you are trying to say.

Your endocrinologist has evaluated you well.

FSH LH ratios in men have not been determined to have any significance. I understand your reference to PCOS in females but even in their case, the use of ratios have been practically abandoned in latest guidelines.

Right now, it needs to be ascertained if you truly have androgen deficiency, and if so then treatment options need to be discussed with your endocrinologist. Before this causes like hemochromatosis need to be ruled out. That is why I recommended a blood test called Ferritin.

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Brief Answer:
Second follow up

Detailed Answer:
Ferritin is a blood test that screens for a rare condition called Hemochromatosis. This is one of the causes of 'Secondary hypogonadism' that your endocrinologist was also referring to. High levels of Ferritin suggest the possibility of Hemochromatosis. Further testing then becomes necessary to confirm this diagnosis

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Brief Answer:
Third follow up

Detailed Answer:
I have reviewed the animal cuts supplement information you have uploaded.

To the best of my knowledge there is no published literature in allopathic medicine that deals with the effect of animal cuts on libido/ejaculate volume. Hence I am sorry I cannot guide you any further on this subject.

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Brief Answer:
Fourth follow up

Detailed Answer:
1 You wish to make the FSH LH ratios in a certain manner.

I respect your wish but I am sorry to keep reiterating that scientifically there is no evidence to achieve this

2 Hormone levels are complicated to interpret, and there wont always be a cut-off for one to say 'normal' versus 'abnormal. SO in the context of FSH LH, the value does not reveal a lot of information. It is neither too high nor too low to give meaningful information. Besides with clomid on board the numbers seem ok.

3 You need physical examination by an endocrinologist and consider a blood test for Ferritin

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Brief Answer:
Fifth follow up

Detailed Answer:
There is no valid comparison between men and women in this situation

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