25. Elevated Prolactin, Low T, Negative MRI

Started with Defy and am doing an 8 week trial of:

.25mg of cabergoline twice a week
12.5mg of clomid daily + some anastrozole compounded in

Pretty much what I wanted to do for the last four months. Yay for doctors

Will do these labs around week 7. We wanted to do more work on thyroid because of the somewhat elevated prolactin along with less than ideal numbers:

TT
FT
E2
LH
FSH
Prolactin
TSH
fT3
fT4
rT3 (new)
Thryoid Peroxidase Antibodies (new)
*already did thyroglobulin antibodies so not doing them again

Taking 10mg iodine + 400mcg of selenium twice a week along with 5000iu of Vitamin D daily still

Just wanting to keep things updated. Probably won’t comment unless I get some weird sides until I have those labs. Or maybe if I get a libido again for the first time in years :slight_smile:

Labs:

TSH was 2.1 and my free T3 was a bit below the top quarter of the reference range and free T4 wasn’t quite in the upper half of the reference range. I ran iodine + selenium supplementation which jacked my TSH up for a while (normal). It has since started coming back down and the supplementation has improved my free T4 :slight_smile:

Started with Defy and ran with those drugs. I wouldn’t say that my symptoms have improved though. I think the most obvious would be morning wood daily and frequent daily erections + a libido change. Not any different.

Sounds like I won’t have another appointment for like 3 weeks, which kind of pisses me off, they could be more proactive with scheduling existing patients. Got another weeks supply of these meds then I’m out.

Observations. That Free Test, wowza! Estradiol (sensitive) is higher than it should be, probably need more anastrozole if I continue clomid. Prolactin is too low, maybe I could cut that dose in half. I had a previous TPO Antibodies test that came back negative so no autoimmune problems with the thyroid. Then there is reverse T3:

Iodine fixed free T4, but reverse T3 seems to be blocking free T3. Why is this high? I’m not sure, but there is no way in hell that this could be responsible for having whacked my testosterone levels and driven up prolactin, for the past 5-7 years or so as I suspect.

Lifestyle wise, I’m not stressed at work, haven’t been cutting weight, and am not overtraining. I drink one night a week and probably have one or two nights a week where I don’t sleep optimally (trouble falling/staying asleep), which I don’t think is too abnormal. Beyond that, I can’t see how lifestyle would be an issue.

Dr. Saya said my liver function, metabolic panel, and lipid panels were great. I’ve never used other meds. I do get tonsil stones occasionally which could cause inflammation theoretically, although I never get sore throats and have never had tonsillitis.

My DHEA-S looks good. I had an 8am cortisol test a few months ago and that came in right at the top of the reference range where it should. Adrenals look good from that perspective, not that a single cortisol test is the be all end all.

Maybe I need to use more selenium and get ferritin, b6, b12, and zinc tests (started using vitamin D a few months ago).

At the end of the day though, I’ve likely had testosterone issues for 5-7 years. High prolactin from low thyroid function makes sense since I don’t have a prolactinoma or renal failure. And then low thyroid function from a lack of micronutrients, which is where this all stems from? Seems a little far fetched to me. Will obviously have to see what happens at the follow up, but that is what I’ve come up with now on my own.

Thanks

Too much clomid for you, LH/FSH too high, driving high T–>E2 inside the testes and anastrozole cannot manage that there. Docs will not understand.

You really do not have much of a choice, less clomid!

rT3 is a problem
see thyroid basics sticky for references to:
daily stress and major stress events
over-training
adrenal fatigue
rT3
Wilson’s book
Cortisol - can be stressed high, then fatigues down

Try to find how excess phosphorus might be getting into your diet/supplements.
Also: Hyperphosphatemia - Wikipedia

Phosphorous was 3.7 in December on the same scale. Vitamin D was listed in the wiki, 5000iu/day. Thats the only thing that rang a bell.

I’d prefer TRT + HCG over using Clomid long term. Maybe just caber is an option to try too. Clomid at least proved that my testes are working.

I’ve read about everything I’ve could on rT3 and adrenals. I have not been running a caloric deficit or overtraining, very low stress lifestyle overall. Haven’t had any major illnesses or illnesses in general.

Do you have a suggestion on labs to check? Like I said, I’ve had DHEA-S checked and a single 8am Cortisol, both looked good. I could start supplementing iron, zinc, and b12. 4x day cortisol panel, what else, ACTH?

Something is strange with your thyroid. The fact that doc noted as firm suggests enlargement. fT4 is elevate re mid range, ft3 is at mid range and oral body temperatures are as expected re fT3. Something is making your thyroid work harder than expected. We can let this issue slide, but need to keep rT3 in mind as an unresolved problem.

Cabergoline will lower prolactin rapidly. Effects on LH/FSH would happen quite soon too, but Clomid blasts negates that observable.

Firm thyroid potentially from the fact that I started iodine replenishment around that time?

Defy didn’t really have much to say on thyroid, I started supplementing more iron, zinc, b6, and selenium as deficiencies can all contribute to rT3 issues. Deficiencies are about the only thing I can think of that would contribute to it after looking at all of the root causes I could find.

They also wanted me to discontinue cabergoline. I pressed to just do .25mg week caber with no clomid and see if that would get prolactin in the sweet spot since .5mg was too much. I pressed this pretty hard and had Dr. Saya review it once more and still decided they didn’t want me on it. That being said, prolactin may not be an issue as it was at a good number the third time I tested it (all before ever touching caber).

I talked to the nurse and she said that double the top end range prolactin wouldn’t suppress LH/FSH so much that it would give a 26 year old test levels in the 300s. I think she’s wrong.

My line of reasoning though is high prolactin suppresses LH which suppresses testosterone. My testes clearly responded from higher LH so it would make sense to get prolactin in a sweet spot, which should raise LH which should raise test. Pursue this further?

Running another month of clomid but 12.5mg EOD now with .2mg anastrozole. I don’t know how I’m ‘supposed’ to feel, but I can’t say I feel any different. I certainly don’t expect sparks to be flying out of my ass with better hormone levels, but hard to really put a handle on how you feel. I still rarely have morning wood and NEVER get random daily erections still.

Not too impressed so far. Warming up to the idea of TRT + HCG. Body doesn’t produce enough naturally, fuck it, cut to the chase. Only issue with HCG would be if I wanted to go hike the Appalachian Trail or something that would keep me away for an extended period of time. Could figure out a way, or just go off it for a while.

You could switch to clomid when you cannot have hCG on hand.

It has been a while since I’ve updated this.

Been rolling with 160mg cypionate, 80iu hcg, and .8mg anastrozole since April. Initially started going twice per week, now I do hcg one day and test + anastrozole the next, repeat. Due to the low SHBG (wish I would’ve pulled it before TRT)

Benefits of this protocol have been better morning wood, muscle mass, strength, and (though it is subtle or placebo) assertiveness. Still need help in the libido department and had occasional ED issues so I eventually just started using Viagra every time for now.

Concerns:

  1. Low SHBG

  2. High rT3 - which could contribute to #1

  3. E2. The recommendations seem mixed. Some people like 20-30pg/mL while ExcelMale seems to support a 14-20 ratio (TT in ng/dL divided by E2 in pg/mL). With the low SHBG, my free E2 might actually be quite a bit higher than you’d think.

Here are my labs about a month ago before the latest consult with Defy (with a nurse, will go doc next time). I verified that the E2 is the LC/MS/MS assay - lab #30289 at Quest. This was done injection day, before injection, when I was on the 3.5 day schedule.

Concerned about low SHBG, I went to insulin resistance, iron, and thyroid. Thyroid results this year:

TSH - 2.6 (0.4 - 4.0)
fT3 - 3.7 (2.3 - 5.0)
fT4 - 1.6 (0.6 - 1.8)
rT3 - 26 (8 - 25)
Thyroglobulin AB - < 1 (<=1)
TPO AB - 0.0 (0.0 - 6.8)

Adrenal, iron, insulin labs:

Morning DHEA-S last fall, prior to Clomid or TRT + HCG - 468 (80 - 560)
Morning DHEA-S June 2017 on TRT + HCG - 362 (80 - 560)

AM Cortisol blood last fall, prior to Clomid or TRT + HCG - 19.3 (6.0 - 19.4)
4x Cortisol saliva July 2017:

8:15am: 12.8ng/mL (3.7 - 9.5) HIGH
1:15pm: 2.1 (1.2 - 3.0)
6:15pm: 1.3 (0.6 - 1.9)
11:15pm: 0.8 (0.4 - 1.0)

Also read Dr. Wilson’s Adrenal Fatigue book and took his test. Did not show adrenal fatigue, for what that is worth.

AND

HgbA1C - 4.8 (4.2 - 6.0)

I also had Leptin tested with the above and am awaiting the results. I have a history of doing a few bouts of psmf dieting which could contribute to an issue. It doesn’t quite fall within the timeline of things going south for me though so I wouldn’t call it a root cause by any means. I haven’t ran much of any caloric restriction in the past year, and have gained 10 pounds in the last few months due to TRT.

Edit: Leptin Imgur: The magic of the Internet

Sorry that it is a little scattered. @KSman do you have any thoughts. Much appreciated

have you resolved you PRL/rT3/libido issues?

Yeah, rT3 went down by the last time I tested it. I was a bit low in iron so I supplemented that, maybe that helped. My thyroid seems good and so does prolactin.

E2 was a tad high so we lowered my testosterone dose a little bit after the last labs a few months ago. My libido is through the roof and I’m feeling great! I don’t think there is anything else to really optimize or change much. I’ve been on T and HCG for over a year now and I think that some of the benefits take that long to really come through.