T Nation

41yr Old, Diagnosed with Low T = 122, High Prolactin


#1

I’m about to start TRT at a local clinic. Got initial bloodwork and found TT at 122, but they found that prolactin was unusually high. They will not start TRT until I’m cleared by an endo regarding the high prolactin, which it will be about 4 weeks until I can get a consultation. So, I thought on posting here to share my situation and hopefully get some opinions. I’m sorta scared about potential pituitary problems. I’ve never had any chronic illness or major health issue. I’ve had a good diet and training most of my life. Diet and exercise stopped working and workouts recovery started to go downhill, along with libido so I looked into TRT. I always thought my symptoms were type 2 diabetes, since my regular doctor never ran hormone tests. Year after year they would tell me “get more exercise”.

I already have family, so not looking to optimize fertility. But it’s my understanding that preserving testicle size is important as they produce other needed hormones.

-age: 41
-height: 5’ 5"
-waist: 33
-weight: 170 lbs., BF is 25% according to bodyfat scale.
-Ethnicity: Filipino/Asian
-describe body and facial hair: armpits, lower legs, some arm hair, pubic hair
-describe where you carry fat and how changed: Was lean growing up, but as an adult since around age 30 carry fat in the lower abdomen, love handles, and chest.
-health conditions, symptoms: Pre-diabetic (but usually handled this with diet and exercise), Slightly high cholesterol but not enough to get on statins or other medication. Low T symtoms are mental fog, less motivation, less libido, weaker and fewer erections, hard to make progress in the gym compared to 2-3 years ago.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: None
-lab results with ranges: See below
-describe diet: Clean with cheat days every 3-4 days. Usually do slight calorie deficit (as goals mainly are fat loss and preserve as much strength as possible). Increase calories every now and then just to feel better and socialize.
-describe training: Power lifts, Olympic lifts, C2 Rowing for cardio. 4-5x a week.
-testes ache, ever, with a fever? They used to ache a couple years ago, but now they don’t (in the past year). No fever.
-how have morning wood and nocturnal erections changed: Yes, rarely get morning wood or nocturnal. Maybe 2x a month.

– Labs –

Aug 2016 (LabCorp):
PSA: 0.7 ng/mL (0.0 - 4.0)
Testosterone, Serum: 122 ng/dL (348 - 1197)
FSH: 5.1 mIU/mL (1.5 - 12.4)
Prolactin: 38.4 ng/mL (4.0 - 15.2)
Estradiol: < 6.0 pg/mL (7.6 - 42.6)
Hemoglobin: 14.6 g/dL (12.6 - 17.7)

Edit: I think thyroid is fine, as I’ve taken measurements for 3 days in the morning and throughout the day. 97.7 F upon waking, then average 98.6 during the day. Diet consists of seaweed snacks with iodized salt.


#2

High prolactin usually indicates a pituitary tumor. It can be treated with cabergoline. Endo will probably send you out for an MRI to confirm. T may come back on its own after you treat your high prolactin.


#3

That’s interesting. I’ve been reading up a bit about those treatments. Would I still be able to do TRT at the same time as being medicated for pituitary tumor? Or would they make me wait? (I hope not, because I’d like to be able to experience the benefits of higher T levels sooner).


#4

Prolactin depresses your HPTA and is probably causing your low T. I’d wait and see if your HPTA recovers, or consider doing an HPTA restart (read the sticky). Restarts have a higher chance of working when there was a reason that your T was low. Your situation applies.


#5

TRT has not impact on your prolactin issue and vice versa.

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

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Your case suggests primary hypogonadism with prolactin dampening the then expected LH/FSH increase.

FSH and LH should be tested together. If FSH is strong and LH low, this opens up the possibility that there is a FSH secreting testicular cancer. Do not want to miss such diagnostic opportunities. Another way to catch that is to start TRT which shuts off pituitary LH/FSH and then if FSH does not go to zero, a cancer is suspected.

TRT:
50mg T cyp/eth self injected twice a week
0.5 mg anastrozole at time of injection, wait one week to start
hCG 250iu SC EOD
ALWAYS do labs halfway between injections

Above should improve insulin sensitivity and cholesterol. Exercise will burn triglycerides.

Prolactin is released at time of orgasms and hugging puppies and babies. Allow 48 hours for lab work.

Prolactin secreting adinoma can be shrunk and managed, not cured, with 0.5mg/week Dostinex/cabergoline. MRI can visualized adinoma, but if not seen, may be just too small. A cabergoline trial can be useful. Prolactin lowers suppresses HPTA can can lead to mood/depression issues.

Labs:
TT
FT
E2
prolactin
CBC
fasting cholesterol
fasting glucose
A1C
AST/ALT
Vit-D25 or just take 5000iu Vit-D3 per day
AM cortisol - affects energy levels


#6

Side note to ease your concerns. A pituitary tumor would put your levels in the 100s. Its not likely a tumor or growth


#7

thank you all. That is very good information and gives me some things to think about and prepare to ask the endo. Good to know that the cutoff for suspecting a tumor is 100. The endo won’t be able to see me for over a month.

Interesting thing about the orgasm and puppies. Now that I think about it, I did jerk off the night before the blood was drawn. That would still raise it to 58? Blood was drawn around 11am the next day.


#8

General blood work from May 2016 (most recent one I have):

CBC:
white blood cell: 7.7 (3.8-10.8 Thousand/uL)
red blood cell: 5.38 (4.20 - 5.80 Million/uL)
Hemoglobin: 15.0 (13.2-17.1 g/dL)
Hematocrit: 48.0 (38.5-50 %)
MCV: 89.3 (80.0 - 100.0 fL)
MCH: 27.9 (27.0 - 33.0 pg)
MCHC: 31.3 (32.0 - 36.0 g/dL)

Cholesterol, Total: 238 (125 - 200 mg/dL)
HDL: 39 (> or = 40 mg/dL)
Triglycerides: 107 (< 150 mg/dL)
LDL: 178 (< 130 mg/dL)

Glucose: 100 (65-99 mg/dL)
A1c: 5.9 (< 5.7)

AST: 36 (10-40)
ALT: 79 (9-46 U/L). This was retested later and found to be lower at 61, attributed to recent heavy workout.


#9

What’s with the glucose and A1c?


#10

This is pre-diabetese according to the docs. At the time this was taken I had not been to the gym for like 4-5 months and eating out a lot (travelling a lot for work). This lab was taken just a month after I got back on the ground and got back to my usual workouts and meal prep. Usually this gets better when I’m consistently working out. It has gone in and out of the pre-diabetic range for years now, and I’ve been managing it (trying to) with diet and exercise. Some years it’s fine, some years it’s in “pre-diabetic” range. Until now, I’ve only gotten blood work maybe once every 1 or 2 years.


#11

Rather than fight a constant uphill battle against insulin resistance and all the shitty side effects, you may want to entertain the thought of starting on Metformin.


#12

Since the glucose and hc1 aren’t in actual diabetic range, and I wasn’t having symptoms, they didn’t recommend medication nor did I feel like I needed to. Figured I need to exercise and eat better anyways.


#13

Your body is inefficient at using insulin. So you pump out more insulin than the average person consuming the same food. That extra insulin causes a worsening of the resistance and a bad cycle is set up. Much of this can be controlled by diet and lifestyle changes, but if your not careful you can wind up on exogenous insulin. Metformin actually has lots of positive effects. Many people with normal glucose and a1c take it to help with carb management. Just my two cents.


#14

Hmmm. I’ll have to look into that one after the whole low T and Pituitary concerns are cleared. Who knows what the labs will look like later. But, it does look like an interesting option!


#15

Do a search, there’s a few stories on here of pituitary tumors with prolactin under 100.


#16

Read the part about “not likely”. As in not common at those levels according to most reading material.

The doc is going to order a pituitary MRI either way. You don’t need an Endo for that. Your GP should order it up to save the wait.


#17

The TRT clinic I am at needs an endo to sign off before I can do anything else. If I go to my GP now, she will be like “why do you need TRT?” and starts to be a mess from that point I think.


#18

Low T may cause insulin resistance. So, when you correct your testosterone levels, your insulin sensivity will improve.


#19

I finally got my MRI done and results were normal. Pituitary was normal as were the rest of the structures, brain, sinus cavity, etc.

I have not seen the endo yet, but I found a TRT clinic that would take my case regardless of my prolactin level. Have not started any T treatment yet (hopefully next week). I got my primary care provider to do the MRI and get more blood tests while waiting for endo:

Sep 8, 2016, 8:30am - Quest:

TSH - 1.23 mIU/L (0.40-4.50)
T4, Free - 1.2 ng/dL (0.8-1.8)
Iron, total: 164 mcg/dL (50-180)
Ferritin: 249 ng/mL (20-380)
LH: 1.9 mIU/mL (1.5-9.3)
Testosterone, Total: 161 ng/dL (250-827)
Cortisol, AM: 7.0 mcg/dL (4.0-22.0)

Question: Am I primary or secondary hypogonadism?


#20

Even with your prolactin issues, that does not preclude TRT.

AM cortisol is too low, very sub-optimal.

  • is stress a major factor in your life?
    Topical 2% progesterone cream, google KAL progesterone, will help as progesterone–>cortisol happens in the adrenal glands. You wife can try it too to address estrogen dominance that happens as progesterone levels drop starting mid-30’s.

Get on 500mg metformin, it costs $40 a year at Walmart. The idea is to address the problem now, not wait until it gets worse. Metformin also has some very good health benefits.

TRT will help resolve cholesterol.

Keep an eye on AST/ALT and avoid training prior to labs.