T Nation

25 Y/O with Low T and High Prolactin, Help?

Hi, I’ll start with my symptoms:
Low energy

Feeling the cold easily ( although I always have done)

so I have recently gotten exhausted with trying to get help on the NHS and have recently seeked help from a private male hormone specialist. He had some fresh blood tests done which are as follows…

13th march 2018

Fsh 6.3 (1.5-12.4)
Lh 6.7 (1.7-8.6)
Oestradiol 58 (41-159)
Testosterone 21.3 (8.64-29)
Shbg 48 (18.3-54.1)
Free androgen index 44.4 (24-104)
Prolactin 615 (86-324)
Cortisol random 565 (113-456)
Tsh 1.71 (0.27-4.2)
T4 total 97.5 (66-181)
Free T4 16.7 (12-22)
Free t3 5.24 (3.1-6.8)

He has recommended that I try to get an MRI on the NHS as I can’t afford it private at the moment. His recommendation is that I try some HCG for the prolactin.

I asked about cabergoline but he says he doesn’t like to use it as it just covers the problem up rather than deal with it. Which I’m not so sure about as if the problem is a pituitary tumor then there isn’t really much alternative as far as I’m aware.

However he hasn’t ruled out cabergoline and said he would talk to the doctor he works with about it.

He also said he wouldn’t want to start me on any treatment yet incase it skews my MRI? Which I’m unsure how it would?

So I guess my question now is what do you guys think of the recent bloods and the specialists idea of possibly treating me with HCG? Thyroid seems good as far as I can see? Thanks

My blood work:

4th August 2017

Serum total 25-oh vit d 84 (75-200)
Serum albumin 45 (35-50)
Testosterone 16.2 (8-26.1)
Free test 0.335 (0.17-0.59
Sex hormone binding glob 34.9 (17.3-65.8)
Prolactin 596 (45-375)
Ferritin 60 (15-300)
Oestradiol 100 (0-145)
Cortisol 758 (140-690)
Tsh 2.1 (0.35-5)
Creatinine 108 (64-104)
Urea 9.4 (2.5-7.8)
Gfr >60 (60-99)

The doctor said creatinine and urea were probably high from supplements, I think I was using creatine at the time.

I’ve tried a high dose of iodine as suggested by ksman and this didn’t ease any of my symptoms. I’ve also checked morning and afternoon body temps which were ok but I will do them again.

The doctors/endo won’t help me out because they say prolactin isnt high enough to be a prolactinoma and I look fit and healthy.

Any help is much appreciated!

Edit: I was wondering if overtraining could be the cause as the doctor said prolactin can act like a stress hormone and excessive excersise could increase prolactin. Especially as cortisol was high as well.

What does it mean body temps are ok? You have a very serious problem with doctors in your country, how a doctor can determine that prolactin isn’t high enough simply by looking fit and healthy is absurd! I lot of maybes and probably without much investigating which has more to do with your state healthcare system being a bad joke.

The reality is budget, state healthcare system are horribly underfunded and the reality is you need to go private or things will not change. Labs cost money and you’re missing all thyroid hormone testing, they are prioritizing who really needs treatment.

Cortisol levels are high, prolactin is high, , vit D is low, TSH is high, and they believe you’re fine. Dear lord these doctors sound completely incompetent and uncaring. You need to keep at it until you find a doctor that will listen.

I can’t remember the temps exactly but morning was over 97.7 and afternoon was over 98.6 but I shall be checking them again tomorrow.

Yeah I realise underfunding the NHS in my country is a problem which is why I’m on here trying to get some advice! I’m going to go back to the doctors soon he said he could refer me to the endo again if i wanted, but I don’t know what to ask when I’m there? Demand an MRI to check for pituitary tumor? Ask if I can try caber? I don’t know where to start.

I’d love to go private but I can’t justify the cost at the moment.

Also I’ve tried a vitamin d supplement before but they make me feel really sleepy

@KSman any ideas where I should go from here?

I’ve tried a high dose of iodine in the past which didn’t ease my symptoms. My body temps this morning was 97.5 f which is a bit low? Will check again mid afternoon.

I’m thinking of asking for some more blood tests to get some more recent levels, what should I ask to be tested for?

Appreciate any help

97.5 when waking up is perfect. temps in early mid afternoon should be close to 98.6

edit. you can test TSH, free t3 and free t4. reverse t3.

Ok, just did my afternoon temp though which is also 97.5 although I am a bit late today. It was taken at 4:30 pm

Anyone else have any ideas?

@KSman could you offer your insight on my first edit at the top of my original post?

  • TSH should be nearer to 1.0, could be increased by rT3
  • T4 below mid-range, maybe needing a bit more iodine
  • fT4 is good
  • fT3 is good

Body temps last showed low, you need a series of readings as we should be setting a course based on one result.

With mid-range fT3 we need consider that low temperatures may be from stress induced rT3 and adrenal fatigue. High cortisol can be from stress, but when the adrenals start giving up cortisol can drop low creating another big problem. All discussed in the thyroid sticky.

Prolactin suggests a pituitary adinoma, often confirmed by a MRI. Easy to shrink and maintain with 0.5mg/week Dostinex/cabergoline. Adinoma typically leads to lower LH/FSH and yours does not. So a very odd situation.

No need for TRT at this time.

Focus is the thyroid stress issues and you need to investigate on your as docs will laugh at that.

Thanks for the reply, so I shall retest my body temps over several days and if they’re still low I will try the iodine replenishment and retest temps after.

As for cortisol over the last few years of several blood tests it always seems to be elevated a bit so surely if it was from stress it would have dropped very low by now? Maybe I naturally have higher cortisol levels?

The prolactin situation does seem odd. As stated I will hopefully be getting an MRI but it is a very long wait. Do you still recommend cabergoline for the prolactin even if there is no pituitary issue? I was surprised the hormone specialist recommended HCG to treat it, i still don’t really understand his reasoning behind that.

hCG has nothing to do with prolactin or the possible adinoma.

There is only a slight need for more iodine based on the lab results. You seem to be missing the need for selenium, please understand that issue.

If Vit-D3 made you feel off, perhaps it was restoring some parts of your metabolism that was stressing because your metabolism is generally weak. Think about the weak link in the chain.

Read about over training in the thyroid basics sticky and consider reading Wilson’s book on adrenal fatigue.

You do not start caber treatment now because there is a need to see what the suspected adinoma looks like on the MRI - before caber makes it shrink.

Ok thanks, I have 100mcg selenium tablets I can take with iodine.

I did think that about the vit d and I tried to continue taking it for as long as I could but it just made me feel so much more tired I couldn’t take it anymore.

I shall read about over training in the sticky thanks.

I have done my body temps again over the last few days they are as follows:

Mon am: 97.5
Pm: 97
Tues am:97
‎Weds am:97.4
Thurs am: 97.5
Fri am:97.2
Pm: 99.1

Mon evening I decided to take 200mcg of selenium then Tues and today I took 100mcg of selenium. I’ve also been having a cup of cranberry juice daily to get an extra bit of iodine.

Also most evenings and also this afternoon I’ve been feeling like I’m high on caffeine/ my adrenaline is pumping.

I will continue taking body temps and update you. What do you make of these temps @KSman ?

some reading about THC and hypopituitarism/high PRL

Thanks, I actually read some research which indicated that thc actually reduces prolactin, chronically rather than acute usage .

After reading the bottom article it looks like they claim the cannabis use suppressed his thyroid which is known to increase prolactin. Where as my ft3 and ft4 are good.

have you just started smoking pot or returned to that? Of course everyone is diffrent at the molecular level.

Just recently returned to weed approx. 4-5 months ago. Before that I hadn’t smoked it for about 5 years.

Just an update I feel like my mood/energy, erections and libido have all improved some what but still not what they should be .

Also starting to get some morning wood, not every morning but some mornings.