T Nation

25. Elevated Prolactin, Low T, Negative MRI


#1

I’ve gotten some work done and want to post my lab results that I have so far, to make sure I’m on the right track going forward.

TT: 380ng/dL first time (250 - 1100)
FT: 80pg/mL first time (35 - 155)
*FT Direct: 5pg/mL (9.3 - 26.5) - tested this on a separate test than TT and FT
TSH: 2.1 (0.4 - 5)
T3 Free: 3.02 (2 - 4.4)
LH: 6.4 (1.7 - 8.6)
FSH: 3.2 (1.5 - 12.4)
*Prolactin: 31.8 (4 - 15.2)

Morning Temp: 98.1
Afternoon Temp: 98.6

-age: 25
-height: 6’1"
-waist: ~34
-weight: 210
-describe body and facial hair: facial isn’t the thickest but not bad. normal body hair
-describe where you carry fat and how changed: normal distribution. mainly on abs/waist, always has been when i’ve been at a higher bf%
-health conditions: never had anything other than this
-Rx and OTC drugs: never
-describe diet: started moderate deficit in the last week. other than that eggs, veggies, meat, cottage cheese, peanut butter, bread and your occasional alcohol/junk
-describe training: 3x/week weights, nothing special volume/intensity wise. run/bike a couple miles once or twice a week too
-testes ache, ever, with a fever: kind of remember this one time when I was like 15, never again
-how have morning wood and nocturnal erections changed: notice nocturnal sometimes if i wake up, but almost never have morning wood or random daily erections anymore. used to frequently

-Brain fog, no one knows what that means but everyone knows if they have it!: don’t think so
-Social withdrawal - “I would rather not go out”: noticeable impact
-Why do I have boobs? This really is depressing if prolactin is the cause!: no
-Why do I carry fat like a woman?: no
-Why am I a moody bitch?: no
-Can’t get it up?: big issue
-It is up, now it’s gone.: yep
-Why do really hot looking women and girls now look like art instead of lust?: haha definitely art nowadays
-Loss of hair on lower legs, skin below the knees is smooth and shiny.: have had hairy legs since 4th grade
-Why do I feel cold easily or all of the time?: no
-Why do really stressful situations leave me feeling physically beat up. Adrenal fatigue.: i don’t get stressed much at all, if so, no
-Dry skin, brittle hair and nails: no
-Skin on the back of hand is thin, crinkly. Pinched skin does not recover: no
-Gum disease, the ugly killer: no
-Why do I have a chronic cough [when taking a statin drug]: no
-I have visual field disturbances such as reduced peripheral vision: no
-My joints have started to ache: no
-I am not depressed, I just don’t care about anything, no joy, no motivation, no reward: absolutely

I also had panels done for metabolic/lipid/blood counts and everything was in range for what that’s worth.

The pituitary MRI came back negative and my current doctor wants to me visit an endocrinologist. What are your thoughts based off of the blood work I’ve done so far? What other blood work do you recommend? I know that I should get an E2 test with a sensitive assay. How about a more comprehensive thyroid?

I’m guessing that they’ll probably put me on cabergoline to lower prolactin. Does anybody know the success rate of caber keeping prolactin down permanently? I’m wondering if I have to stay on it forever or if temporary use can lead to permanent results.

Then I’m guessing we’ll check testosterone and everything else again and if its good, keep an eye on things down the road. If it sucks, try clomid. And if that doesn’t work, TRT? Assuming thyroid is good, is that the course I’d likely be following?

Thanks


#2

Doc may not Rx cabergoline as MRI appeared clear.

But ask for 0.5mg/week cabergoline trial and prolactin will go down and then test to see where prolactin, LH/FSH, TT and FT go. Ask your doc if he will do this. Most endos are difficult to deal with. If hormones are good, assume that a non detectable adinoma seems to be there.

Cabergoline manages, is not a cure and must be maintained.

E2 labs? ALWAYS! Do that before anything prolactin related.

Thyroid: Check oral body temperatures as per the thyroid basics sticky.
Do you get cold easier now?
Outer eyebrows sparse?
Generalized hair thinning?
You have always used iodized salt and/or vitamins listing iodine+selenium?

Please read these stickies found here: About the T Replacement Category

  • advice for new guys - post more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

TSH should be closer to 1.0
fT3 is decent near midrange. If body temperatures are low, we suspect stress/adrenal issues.

Post:
hematocrit
RBC
AST/ALT
fasting cholesterol
fasting glucose


#3

I will follow up with my current doctor and get E2 checked and also see if I can try caber. This guy is one of the physicians that also runs an anti-aging clinic so I might have better results with him, rather than dicking around with an endo. We’ll see.

I’ll also check my body temperatures and post that.

Do you get cold easier now? No
Outer eyebrows sparse? No
Generalized hair thinning? No (just male pattern baldness for a few years…rest is normal)
You have always used iodized salt and/or vitamins listing iodine+selenium? I will make a conscious effort to get more iodine into my diet, which should help.

Just looking up symptoms of thyroid issues, I can pretty confidently say that I don’t really resonate with any of them. My main symptoms are difficulty building muscle as of late (T) and sexual issues such as having weak and rare erections, low libido, and difficulty ejaculating (Prolactin + T). This hasn’t always been the case but has been for the last few years. Kind of like boiling a frog in water, it takes some time before you realize you’re fucked.

Hematocrit: 42.7 (40 - 50%)
RBC: 4.61 (4.4 - 5.8)
AST-SGOT: 21 (0 - 35)
ALT-SGPT: 22 (0 - 55)
Cholesterol: 192 (100 - 200)
Triglyceride: 63 (50 - 150)
HDL: 70 (40 - 80)
LDL: 109 (0 - 129)
Glucose: 79 (70 - 100)

Lets assume caber fixes my prolactin and T and the rest is okay. Is caber the lifelong solution? I’ve seen mixed results from the research I have done thus far.


#4

Do you take any medication?

Some medications can increase prolactin levels. Some SSI and other “psychiatric” meds, opioids and derivates, some antiemetics like metoclopramide and domperidone, etc.


#5

I’ve never taken medications for any significant amount of time. Have also never had any major illnesses or surgeries. What else…6’1" 210 around 20% bf and am working on dropping 10-20lbs to tighten up a bit. Pretty decent diet overall. Veggies, meat, eggs, toast, peanut butter, fish oil, junk. Not perfect but not terrible. Like I said, I’m going to look to get more iodine for instance.


#6

HTC - hematocrit is a bit low, even for your low T levels

Trying to get cabergoline or retest prolactin.
Avoid 48 hours before prolactin test:

  • orgasms
  • hugging puppies, kittens or babies
    If prolactin still elevated and LH/FSH low, MRI of pituitary may show adinoma.
    FSH was low, LH varies by the minute with pulsatile release

#7

I actually met with my doctor the other day and he had me retest serum testosterone and prolactin, and added igf-1 (8am). I made sure not to orgasm or do anything that could throw prolactin off. I’ll post the results when I get them.

I asked for a trial of caber, but he wanted to wait for me to see an endo. I expressed my concern that I was skeptical of a random endo, but ended up having some solid discussions and I got the vibe that he’ll definitely work with me on this so that is good. I actually asked to be put on the wait list for the endo as well so hopefully I can get in there in less than a month.

Added iodine supplementation to my diet so if/when I do a more comprehensive thyroid panel, we can see what is going on. Body temps are fine and I don’t have any hypo/hyperthyroid symptoms really. Have the dose at like 120mcg/day.

Pituitary MRI was negative. So if there is one, its small and shouldn’t change prolactin treatment if high again.

Any thoughts on using vitamin B6 for prolactin long term?


#8

Use p5p instead, there is less sides


#9

Recent labs

Free Serum Testosterone re-test: 7.8 range 9.3 - 26.5
Prolactin re-test: 25.6 range 4.0 - 15.2
IGF-1: 210 range (115 - 355)

Waiting on endo appointment which is about a month away unless I get pulled through the wait list earlier.

Prolactin is definitely high, but not THAT high. I know that tumors can bump it to 100s and 1000s. Could a number like that really make my testosterone THAT low?

I’ve read that caber use for 2 years followed by a taper down to nothing can sometimes result in the numbers staying down permanently, but not always. Have also heard similar results for testosterone shooting back up by lowering prolactin, but not always.


#10

IGF-1 is decent.

Other results confirm what we saw earlier.
FT definitely low.
FT labs are variable as T is released in pulses and FT has short half-life.

Coach says " I don’t know if you are ignorant or apathetic."
Player says “I don’t know and I don’t care.”


#11

KS

What would your thoughts be of doing a trial run of some combination (or just by themselves) of L-Dopa, P5P, or Maca? I will probably get some caber in the nearish future, but we could re-test prolactin at my next appointment after this OTC stuff.

If so, recommended dose/stack based on my levels?

If cabergoline is a long term treatment. Are these any worse? I know they are much easier on the wallet.


#12

Cabergoline is available as a research chem, but no one should be posting any sources.


#13

Ok so I want to touch base here again since I have my appointment in a week and want to maximize it (hopefully this endo isn’t a dipshit, I have to come into it with some knowledge in case he is).

Also started taking 5k iu/day of Vitamin D3 as I’m in a colder climate and don’t get out in the sun a ton, especially this time of year.

I am a little concerned about thyroid. Was taking mcg doses for a while but just started taking 50mg/day of Lugol’s (20 drops of the 2%, which I’m probably going to taper down to a lower dose) along with a few hundred mcg of selenium and will see what happens over a few weeks. I mean, hypothyroidism can cause prolactin to be high and a tumor would probably indicate much higher numbers.

It is getting colder out and I’m not running the heat yet and have noticed that I’m getting a tad cold sometimes (I work from home). There have been plenty of mid mornings and afternoons in which I’ll reach 98.6 or higher. But then just now (8pm) I was at 97.6 even though I was at 99 at 11am. I actually pulled up the report from my July doctor’s office visit and they had me at 96.7 around 11am which could be an anomaly. Maybe I’m thinking too much about this?

Decided not to mess around with P5P or anything else that would change my prolactin before this appointment.

Goals of this appointment:

  1. Get a cabergoline prescription and run with it for like 2 months? And then test prolactin, T, LH, and FSH again.
  2. Get more tests:

a. AM Cortisol (I need an afternoon one too to get the full picture, right?)
b. Sensitive Estradiol
c. Anything else vital to my case like rT3? I have a low stress lifestyle so I wouldn’t think adrenals would be an issue, but who knows.

KSMan, I’ve seen you post about tonsilloliths a couple times. I’ve been getting them since I was a teenager. What relevance do they have? Got strep a lot as a kid, but haven’t had any other tonsil issues since I hit puberty and almost never get sick. I’m gathering that your point had to do with infections leading to rT3 issues?

Thanks again!


#14

Met with the endo, he was impressed about the knowledge I had so props to KSMan and others on the forum!

Seemed like he might be alright to work with, only time will tell. He did make a comment “you need testosterone to maintain good muscle mass and you’re quite muscular”. I did mention that I thought that the reference range was bullshit and I expected to have no symptoms and be somewhere around the upper quartile at my age.

Anyways, I’m quite confident that the doc that referred me here will work with me down the road if this doesn’t pan out. Him and I had discussions about replacement if thats what it comes to. Sounded like he just wanted someone with more expertise to look at the prolactin issue since the cause is unknown.

I have a follow up in two weeks and I just did these blood tests:

Testosterone, Total and Free - 2nd time for this since free direct is a bit different
Prolactin - 3rd time, a bit redundant
LH - 2nd time
FSH - 2nd time
Metabolic Panel - 2nd time
TSH - 2nd time
fT4
Thyroid Antibodies
Cortisol

I mentioned estradiol and thought he was going to order it, but it wasn’t on the list this morning. Should I go get this independently? What would it possibly tell me at this point anyways? I don’t know. I suspect it would be low based on my T.

Neither him or I suspect thyroid issues, but good to have those labs.

He mentioned that my high prolactin could be from macroprolactin. As I understand, macroprolactin is essentially a non-effective form of prolactin on the HPTA axis?

Talked about caber and a script could be coming at the next appointment. This guy didn’t have any experience with HPTA restarts. What literature can I bring to the next appointment to plant the seed of hcg + nolva or clomid being an option at some point? I don’t think that a forum post from some ‘random’ person is going to cut it.

I’ll post my results once I get them all.


#15

Got all lab results back except testosterone (they said this would take a little longer because it goes to another facility).

Prolactin: 15.2 (4.5 - 22.5)
Cortisol: 19.3 (6.0 - 19.4)
FSH: 2.6 (1.4 - 15.4)
LH: 1.9 (1.5 - 9.3)
Thyroperox AB: 0.0 (0.0 - 6.8)
fT4: 1.0 (0.7 - 1.7)
TSH: 4.04 (0.4 - 3.99)

Sodium: 142 (134 - 143)
Potassium: 4.0 (3.4 - 5.1)
Chloride: 107 (99 - 110)
CO2: 24 (19 - 29)
Glucose: 80 (70 - 100)
BUN: 21 (5 - 24)
Creatinine: 1.14 (0.7 - 1.2)
GFR: > 60
Calcium: 10.0 (8.4 - 10.5)
Protein: 7.7 (6.0 - 8.0)
Albumin: 4.6 (3.5 - 5.0)
ALK Phosphate: 53 (40 - 150)
ALT: 37 (6 - 40)
AST: 31 (10 - 40)
Total Bilirubin: 1.4 (0.2 - 1.2) this was 0.8 (0.2 - 1.2) in July. See below
Anion Gap: 11 (3 - 15)

So this throws shit out of whack. I did have a heavy drinking weekend at a bachelor party and a couple beers the night before the test, but had a good 10 hour fast. Maybe the toll from the weekend had something to do with Bilirubin and Cortisol.

I’ve had these symptoms for years and live a pretty low stress life so I don’t think that lifestyle is a major factor. Last weekend was an exception.

TSH was way high. I’ve been taking iodine supps for the past few weeks in the microgram range. Only megadosed with Lugol’s for like two days a week before this test. No antibodies and fT3 was decent, fT4 not so much. Again, no hypothyroid symptoms. The doc did say that my thyroid was kind of firm which is why he wanted to test for Hashimoto’s.

Prolactin is now in range. I didn’t really do anything differently before this test than the others so maybe it filtered out macroprolactin? Strange since I had tested it twice before and followed the recommendations of avoiding things that can spike it.

LH/FSH were dead so I’m sure the testosterone result is going to be garbage too.

Would love to get some input on this because these results are baffling. Keep taking iodine and try the HPTA restart guide? rT3 test? E2 will be paramount before trying a restart.


#16

And testosterone results are in no man’s land.

Total 323 (240 - 950)
Free 12.3 (5.05 - 19.8)

@KSman I’d love to hear your thoughts on the above few posts and the next steps.


#17

Thyroid changed or taking iodine that pushed up TSH?

  • yes

At your age, you should try a restart.


#18

Appreciate the input. Any comment on prolactin because 2/3 times it was high. The 2 were at one diagnostics lab and the outlier (in range one) was at another. Kidneys and thyroid seem okay so it is either a tiny tiny adenoma or the labs were wrong. Test again? Maybe try a dopamine agonist for a while before trying a restart? As stated before, nothing should’ve skewed the results on any test.

Decided to start working with Defy Medical which are at the cutting edge for the most part. But will keep this thread updated.

Getting the following tested for them on Friday:

Progesterone
Estradiol
DHEA-S
PSA


#19

I have no idea what moves your prolactin around unless you are doing these before labs:

  • sex or orgasms
  • cuddling babies, puppies or kittens

#20

New lab results. Lots of repeats because panel was cheaper

PSA: .38 (0 - 3.9)
Progesterone: .66 (.27 - .9)
Estradiol: < 20 (< 56)
DHEA-S: 468 (80 - 560)

TSH: 6.88 (.4 - 4) because of iodine
FSH: 3.3 (.7 - 11.1)
LH: 3.75 (.8 - 7.6)

Other items of interest
BUN: 24 (8 - 22)
BUN/Creatinine Ratio: 21 (12 - 20)
Total Bilirubin: 1.3 (.2 - 1.2)
Direct Bilirubin: .4 (0 - .5)

Triglycerides: 85 (<150)
HDL: 70 (>40)
LDL: 112 (<100)

Clear urinalysis

I’ve normally had really good lipid numbers (old work did it for free once or twice a year). Been eating and drinking too much over the past few months but just started cutting which will mean very little alcohol and junk and shaking those bad habits. Get from 210 down to 180-190 although if they put me on a restart it would probably be a good idea to eat at maintenance. Until then…

Unless there are any new insights based off of the new labs, it will probably be a couple weeks until I have my first consultation with Defy.