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24 Y/O Low Test, High Prolact Levels [Results]


#1

Quick background: I've been suffering from various symptoms of low T for a while but never really knew what to do. My libido's been low, gains at the gym have been minimal and I've had a bad sense of well-being for as long as I remember.

Finally got tested and my doctor said that my prolactin levels were really high and the cause for my low T levels. He said everything else was in range, but I'm curious as to what you guys think:

fT4: 1.42 ng/dl Range (.8-1.73)
FSH: 1.8 mIU/mL Range (1.5-12.4)
Prolactin: 19.7 ng/mL Range (4.0-15.3)
TSH: 3.860 uIU/mL Range (.178-4.53)
Vit-D: 43.8 ng/mL Range (32-100)
LH 3.1 mIU/mL Range (1.7-8.6)

Total T: 285 ng/dL Range (3.5-5.2)
Free T: 67.47 pg/mL Range (30-150)

My doctor has prescribed Cabergoline saying it will reduce prolactin levels almost immediately and that will allow test levels to become normal in a few weeks again.

Is this accurate of how my test levels will react to a lowering of prolactin levels? Are my other levels ok? Will Caber work to the extent that I won't require TRT?

Thanks!


#2

Bump!


#3

Cabergoline will fix the prolactin levels and then T will response to what the rest of your systems dictate.

Please read the advice for new guys sticky and note comments re prolactin and pituitary adinomas.

You appear to have a degree of functional hyperthyroidism. Please read the thyroid basics sticky, check your waking and mid-afternoon body temperatures and evaluate your LONG TERM iodine intake from iodized salt or vitamins that list iodine. If you are iodine deficient, fixing that is relatively simple.

fT4 looks good, but is really fT3 that gets the job done and that might be low. TSH says that your fT3 might not be adequate. If fT3 is good, it might be getting blocked by rT3 which can be elevated from infections, surgeries, accidents, major stress, starvation over training etc. Sometimes fT3 is good and temperatures are good, but TSH is high; thyroid needs too much stimulation from TSH but is getting the job done. Your body temps and iodine history will be very useful.

Your doc might be progressive: Get E2 tested and use anastrozole to control as per the stickies. Elevated E2 can explain your complaints, but I strongly suspect that thyroid status is making things worse.

What your protocol lacks: E2 management and hCG to preserve your testes.


#4

Thanks for the advice. Do you suggest getting on Clomid at any point?

Also, just got my MRI results in - turns out I don't have any type of adenoma in the brain.


#5

Clomid for a HPTA restart? Depends on one's age, we don't even know that.
- I always recommend Nolvadex, not Clomid
- Would be a good thing for recovery

You really need to look at everything that I suggested in my prior post. You are been selective.


#6

I had basically the same experience a few years ago, although my prolactin was much higher (around 30 I think). test was close to 300. After half a 0.5mg cabergoline every three days for a few months, my levels of prolactin were non detectable and test was around 650-700. (Range was something like 200-850 or so).

What dosage did your doc recommend? Did he say how long you would have to take it?


#7

Jenz, nice data point, thanks. This shows that moderate increases in prolactin can be quite HPTA repressive. Because some cases can have very large prolactin levels, some docs might be dismissive moderate prolactin increase to upper range or higher. Another aspect is that the lab work samples used to create the normal ranges truly indicate that there are significant numbers of guys at the upper range who we can be quite confident have HPTA repression and that is considered "normal". This means that there may be 2-5% of guys on the street with prolactin issues.

Another aspect might be that cabergoline is shrinking the pituitary and that it is the mechanical change that might be a factor in HPTA recovery.

Again, prolactin increases decrease dopamine levels and cabergoline increases dopamine levels. One might notice an improvement in mood but that could easily be lost in a gush of increased testosterone. We cannot separate these factors. Caber increases dopamine production and the increased dopamine depressed prolactin levels.

I have advised that guys will mood issues that can come from decrease dopamine, which happens with age and when its severe it called Parkinson's, that they take low dose cabergoline to increase dopamine then low dose selegiline to decrease the rate of dopamine destruction. You can see the doc freaking out when you suggest a pituitary tumor[cancer] drug and a Parkinson's drug as an alternative to SSRI's.


#8

Update: Cabergoline lowered prolactin levels, but that didn’t really help with rebounding test levels. Found a doc that started me on TRT (125 mg Test Cyp/wk single dose 500 iu HCG 2x/wk)

Still not feeling very great and sex drive is low overall. Got a blood panel done and here are the results:

TT: 1050
E2: 24

TSH: 4.45
fT3: 3.2
fT4:1.4
rT3: 15 (18-25 normal range)

What could be causing these issues if my T and E2 levels are both good? Are my thyroid levels in check?

Thanks


#9

You need morning and afternoon body temps for several days. Read the thyroid sticky. Your TSH is WAY too high but we need more information. Signs and symptoms of hypothyroid? BP, resting heart rate, BMI, lipid profile?

How long have you been on your current protocol? You should be injecting T more frequently. I think the dose is too high. How long after your last injection was your blood drawn?


#10

Blood was drawn on the 7th day. My morning temperatures are usually arounder 96.8-97 and typically get to 98.3.

With my E2 levels in check I’m suspecting that something else may be the issue - would love for KSman to chime in here.

After every injection (weekly), I find that my sex drive lasts only two to three runs before I can’t do any more for the rest of the week. I also feel like the perceived benefits of test, ie: mental sharpness, energy and motivation dwindle shortly after the injection as well (2 days), alongside my sex drive. Am I metabolizing too quickly? Is that such a thing?

I have used prednisone for 2-3 years straight to control my asthma. Could this have potentially led to adrenal fatigue which lowered my testerone in the first place, and now won’t let me experience the full benefits of injections?

Haven’t tested for anything adrenal related yet, but would love anyone’s input.


#11

Continuous prednisolone or episodic? Long term use can be VERY catabolic in some cases. How does use of prednisolone stack up with your perceived time-line of hormone issues?

fT3=3.2 seems to be optimal and yet temperatures are low and rT3 does not seem to be a reason. You feel cold? Any idea how long your temperatures were low?

You have [subclinical] hypothyroid symptoms with no obvious cause. But your TSH and fT4 suggest possible iodine deficiency which you refuse to discuss [08/21/2014].

Adrenals: Do you have more energy/fatigue at different parts of the day?

You need to inject T twice per week, read the stickies please.

How long have you been on TRT?

FT would be useful. With TT=1050 at day 7, I am suspicious that T+SHBG is high and inflating TT level while FT may not be that great.


#12

Update:

Went to a new endo that told me to get off TRT asap and prescribed clomid 50mg/day for 2 months. I started this in early december and saw fairly little change in my symptoms. Throughout this whole period I would see intermittent changes in testicular size everyday; at some points in the day I would have full testicular size, but at most other times they were largely shrunken. My theory is that the testosterone my body is producing (or had received in TRT) was getting used up very quickly, so I did not perceive any benefits (I don’t know how or why this is happening)

My bloodwork a few weeks ago revealed this

Albumin - 4.5 (3.2-4.8)
FSH - 3.3 (1.4-18.1)
LH - 7 (1.5-9.3)
Progesterone - 0.3 (.28-1.22)
PSA - 0.61 (0-4)
SHBG - 18.1 (10-57)
Total Testosterone - 422 (160-853)
Free Testosterone - 11.3 (3.5-15.5)…2.7%
Estrogen - 32
Cortisol - 1.6 (8-19)…looks quite low
Pregnenolone - 45 (13-208)

So it looks like the Clomid worked at raising my LH levels, but I did not see a significant change in my symptoms or TT levels. Could the low cortisol be a reason for this? At this point I’m very confused as are my doctors and I’m not sure what to do.

[quote]KSman wrote:
Continuous prednisolone or episodic? Long term use can be VERY catabolic in some cases. How does use of prednisolone stack up with your perceived time-line of hormone issues?

fT3=3.2 seems to be optimal and yet temperatures are low and rT3 does not seem to be a reason. You feel cold? Any idea how long your temperatures were low?

You have [subclinical] hypothyroid symptoms with no obvious cause. But your TSH and fT4 suggest possible iodine deficiency which you refuse to discuss [08/21/2014].

Adrenals: Do you have more energy/fatigue at different parts of the day?

You need to inject T twice per week, read the stickies please.

How long have you been on TRT?

FT would be useful. With TT=1050 at day 7, I am suspicious that T+SHBG is high and inflating TT level while FT may not be that great.[/quote]

Continuous prednisolone or episodic? Long term use can be VERY catabolic in some cases. How does use of prednisolone stack up with your perceived time-line of hormone issues?

I’ve used it continuously, 2 x 20 mg/wk for years.

fT3=3.2 seems to be optimal and yet temperatures are low and rT3 does not seem to be a reason. You feel cold? Any idea how long your temperatures were low?

My temperatures have been low ever since I’ve started to see these issues.

You have [subclinical] hypothyroid symptoms with no obvious cause. But your TSH and fT4 suggest possible iodine deficiency which you refuse to discuss [08/21/2014].

I tried Iodoral 50 MG for several weeks, but saw no significant change.

Adrenals: Do you have more energy/fatigue at different parts of the day?

Yes. My energy levels definitely vary throughout the day. I seem to have more energy at night than the morning.


#13

bump


#14

can anyone offer their input here?


#15

With regard to everything but cortisol, any number of men might, and typically would, feel perfectly fine with these levels. That’s not to say that everything is best for you, but that they aren’t clear or likely causes of what you’re experiencing.

With regards to function of testosterone, free testosterone is what matters. The SHBG (and otherwise bound) fractions are a product only of the free concentration and the amount of SHBG (and other binding materials such as serum albumin.) Those fractions do not act as extra testosterone any more than all the testosterone dissolved in bodyfat does. Now one doesn’t want SHBG to be too low, so in that sense “good free, low total” is undesirable, but only indirectly: the real factor would be the low SHBG directly. But yours is okay.

I’m not sure I understood the quoting above, but am guessing you were saying you’ve been taking prednisolone 2x20 mg/week (20 mg twice per week) for years?

That’s a huge intervention and typically or perhaps always very disruptive, usually (not specifically that dosing protocol, but using prednisolone generally) with major adverse effect on quality of life. I would see this use, combined with the problem that caused this use to start, as the key issues here. Very unfortunately I really cannot advise on that area. I hope your new endocrinologist is one of the probably-few who would rather see you regain natural function than rely on prednisolone.

The dosing method (twice weekly) also is not good, if I understood your meaning correctly. Corticosteroid levels should fluctuate in a daily pattern, not twice-weekly. The half-life is so short that even establishing a reasonable daily pattern would require more than one dose per day. Twice per week, no! (If that’s what you meant.)


#16

So after taking clomid for about 7 months, I’ve been able to raise my T levels, but still feel very symptomatic (with no improvement).

TESTOSTERONE,TOTAL,LCMSMS 777 250-1100 ng/dL
TESTOSTERONE FREE 173.8 46.0-224.0 pg/mL
TESTOSTERONE BIOAVAILABLE 364.9 110.0-575.0 ng/dL
SHBG 19 10-50 nmol/L
ALBUMIN, SERUM 4.6 3.6-5.1 g/dL
DIHYDROTESTOSTERON,LCMSMS 34 16-79 ng/dL
CORTISOL,FREE,SERUM 0.41 mcg/dL
T4,FREE 1.4 0.8-1.8 ng/dL
TSH 3.02 0.40-4.50 mIU/L
PROLACTIN 1.0 2.0-18.0 ng/mL
ESTRADIOL 30 < OR = 39 pg/mL

GLUCOSE,FASTING 71 65-99 mg/dL
SODIUM 138 135-146 mmol/L
POTASSIUM 4.5 3.5-5.3 mmol/L
CHLORIDE 104 98-110 mmol/L
CARBON DIOXIDE 24 19-30 mmol/L
UREA NITROGEN 23 7-25 mg/dL
CREATININE 1.20 0.60-1.35 mg/dL
BUN/CREATININE RATIO NOTE 6-22
CALCIUM 9.2 8.6-10.3 mg/dL
PROTEIN, TOTAL, SERUM 7.2 6.1-8.1 g/dL
ALBUMIN 4.5 3.6-5.1 g/dL
GLOBULIN,CALCULATED 2.7 1.9-3.7 g/dL
A/G RATIO 1.7 1.0-2.5
BILIRUBIN,TOTAL 1.0 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 52 40-115 U/L
AST 20 10-40 U/L
ALT 18 9-46 U/L
EGFR NON AFR AMERICAN 85 >=60 mL/min/1.73m2
EGFR AFRICAN AMERICAN 98 >=60 mL/min/1.73m2

I’ve gone through nearly 4 doctors and it seems like nothing has worked to alleviate my symptoms. I just don’t know what to do anymore.

I do want to note that I did abuse stimulants (fat burners, ephedrine, etc) prior to these problems occurring, so I’m not sure if that did anything.