Clean MRI, High Prolactin, Low T. Options and Risks?

Pharma / TRT Testosterone Replacement
1

31
5’ 8"
-32" waist
-170 lbs

  • +/- 25% BF (skinfold and bio impedance)
    -Body and facial hair pretty much average (have a beard, and have chest hair)

  • I carry my fat as spare tire, especially in the back. Muffin top if you will. My wife used to love my big muscular ass and glutes, those have now diminished significantly.

  • Started lifting when I was 16 and lifted consistently some years, and slacked off others. Was consistent with lifting and diet 2005-2007 and did a cycle of EQ and and Cyp? when I was 21. Kept my gains and felt fine post cycle. Used Nolva and Dostinex. I dont have the exact cycle as it was kept in an encrypted email server that is now defunct.

-Had surgery for a deviated septum Nov of 2007 and basically stopped lifting and eating right at that point. Got fat, up to 185 in 2009. Started slowly realizing that something wasn’t right in 2011. Was eating better and hitting the gym and it helped but not nearly as much as I felt it should have. I lost my vibrancy, energy, confidence, and mental sharpness that I used to have. I chalked it up to just getting older, after all, I’m not in my early 20’s anymore.
What really got me thinking about possible hormonal issues was a Joe Rogan podcast with Dr. Mark Gordon who talked about traumatic brain injury which made me think about a possible concussion from watersports in 2007. I also had a motorcycle crash in 2008 and slipped and hit the back of my head (almost knocked out, was talking gibberish for a few seconds) in 2010(?)
I had shoulder surgery in 2013 and another septoplasty June 2015

I had been diagnosed with varicoceles in 2004-2005 but were told they are nothing to worry about, but I went an saw a urologist as my testicles, and especially my left (more severe varicocele) would ache from time to time, and especially after orgasm (sometimes felt like I had gotten kicked in the balls after orgasm). While there I also described symptoms that I felt were getting worse and worse. Talked about feeling like a shadow of my former self. Low energy, low libido, infrequent morning wood, softer erections, loss of muscle mass, brain fog, less confident, much harder to lose fat and make gains in the gym, low motivation, etc.

Uro order T test (just straight T) early 2014. Did the test in the AM and it came back 248 (or close) out of 249-836 ng/dL. Doc didnt think it was bad enough to do anything about.

Went and saw another Urologist who ordered some labs, and referred me to an endocrinologist. All my labs to date are below.

My prolactin is really high so Dr. ordered an MRI which came back clean (at least nothing they can see). Pituitary is a bit twisted but apparently nothing too out of the ordinary.

Dr. then put me on clomid, which I hated. Made me a grumpy bitch. Doc also tested my semen and they got a gold star. Doc said his fertility patients would kill for swimmers like mine. (not a lot of help when ya don’t feel like using them). He also referred me to a pituitary specialist (female) who immediately said she didn’t think low T had anything to do with my symptoms based on my overall muscle mass, muscular neck, and body hair (this actually suprised and upset me. I dont WANT it to be low T and I know its complicated. I also dont want to be on TRT but just cause I’m not a withered, hairless lady man doesnt mean I dont have an issue. Especially since she doesnt know my baseline. To her I look normal. I didnt used to. I looked great and felt great. Now I look “normal” and feel shitty. I’m not interested in that, I want optimal.)

At this point endocrine Doc said we can try dostinex or go to TRT.
With dostinex I’m concerned about the heart valve scarring issue.

I know this has been kind of a long, choppy post but to sum it up,

  • At 31 I’d strongly prefer not be on TRT for the rest of my life especially since my testicles still work (just arent very well right now)

  • My prolactin is pretty high, and my T is low

  • MRI doesnt show a prolactinoma, or damage but I have had some head injuries

  • I’ve read up on this in both the stickies here and other sites but it feels like a big jumble in my head right now. I would love feedback/thoughts from the community.
    I’m glad this place exists, it helps just getting everything out on “paper”

Thanks!! and Thanks to KSman for being a part.

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They can’t see the source of the prolactin, but there is no doubt where its coming from.
0.5mg/week Dostinex/cabergoline should fix this, then you can see where your HPTA goes when the repressive effects of prolactin are gone.

You should get that varicocele fixed. Sex should be rewarding.

Please read:

In the one sticky in this forum, the 2nd post contains links to informative topic.

  • advice for new guys, explains a lot
  • things that damage your hormones
  • finding a TRT doc - it ain’t easy!
  • thyroid basics explained.

Your TSH should be closer to 1.0
T3, T4, fT3, fT4 should be closer to mid range or a bit higher
The lab ranges for these things are useless
You can have problems from not using iodized salt and/or vitamins that list iodine+selenium
Many here have thyroid issues

Thyroid problems:
feeling cold
sparse outer eyebrows
generalized hair thinning
fat gain and inability to loose fat

TRT does not cause hair loss. It can speed it up in those that have the genetic disposition for male pattern baldness. If you don’t have it, you will not get it.

You can check your overall thyroid function by checking oral body temperatures:

  • when you first wake up, should be 97.7-97.8, higher is OK, 93.7 is a problem
  • also check for 98.6 mid-afternoon
  • your wife can check herself too

Labs: - fill in the blanks
TT
FT
E2
prolactin
LH/FSH
TSH
fT3
fT4
DHEA-S
AM cortisol
CBC with hematocrit
fasting cholesterol
fasting glucose

You need to manage your healthcare. Doctors are into disease management.Good to see your persistence.

Vit-D3 also affects your metabolic rate and general health. Most need 5,000iu to get near optimal levels. RDA for Vit-D3 does prevent bent legs in children, not much else.

3

Emailed my doc and he approved, without hesitation the following labs:

TT
FT
E2
prolactin
LH/FSH
TSH
fT3
fT4
Reverse T3
DHEA-S
AM cortisol
CBC with hematocrit
fasting cholesterol
fasting glucose
Progesterone
Pregnenolone
Vitamin D, 25-OH Total
Vitamin D, 25-OH D3
Ferritin
VITAMIN B12
Iron, Total Binding Capacity
Iron, Binding Capacity
Magnesium, RBC
Hs-CRP

I should be able to go in tomorrow morning and once the results are in, I will post them.

Thanks for your feedback KSman!

4

Ping me in the KSman is here thread later.

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So I have the scripts, but didnt go give blood yet. I have to do some research because I dont know if I should take a break from lifting for a few days beforehand and also if I should make sure I’m consistent with my supplementation to see how my values are when I’m supplementing or if I should see how they are with no supplements

6

The main effect of lifting on blood work is the effect of sore muscles creating elevated AST/ALT. Perhaps you should test that and make sure that muscles are well recovered.

Have AST/ALT added to your labs.
My error in suggested labs.

If you are going to be using supplements long term, you want labs to represent your use of those supplements.

7

Ksman, you probably already know this, but you are an absolutely invaluable resource, not just for the “forum” but for peoples lives. Truly. Thanks so much for that.

You’ve confirmed what I was thinking about testing while taking supplements. I’m taking them, so I might as well see if they are working/I’m at optimal levels.

Thanks again!!

8

@KSman, I finally got the labs done and have most of the results. Unfortunately the lady taking blood missed 9 data points so I went back this morning to give blood for those. The missing tests are:
Progesterone
Pregnenolone
Vitamin D
Ferritin
Vitamin B12
Reverse T3
Magnesium RBC’s

The results that I do have are here:



Looking at my labs over the past few years it looks like Total T is moving up slowly although prolactin also rose (weird…)

9

Here is a comprehensive chart with all my tests and results. I went back through my records and put everything on here. There were a few things missing that I hadn’t posted before, and now its organized by test and by time so you can see any trends.

10

So this is getting fun. Looking at further posts here, my TSH appears to be too high and I’m assuming @KSman will recommend IR (already ordered idoral from amazon and my multi has +200% RDA Selenium)

Also, I get to go back AGAIN to give more blood. Dr. just called and they got lab results for CBC and my hematocrit came back as 75 (range is like 32-52). No, I’m not an EPO doping cyclist. Dr thinks its lab error and I hope it is otherwise my heart is pumping sludge and I’ve got multiple problems. Yay.

11

I think that you have a prolactin secreting adinoma that simply does not show up a a mass on the MRI [yet].
Ask for a Dostinex/cabergoline trial, 0.5mg/week in two divided doses. If prolactin goes down there is your treatment and diagnosis.

Aspirin would be helpful for HTC.

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I actually take 250-500mg Aspirin 1-3x a week for frequent headaches, so I’m surprised that hematocrit is that high (if it really is). Perhaps dehydration played a role. I normally drink +/- 1 gallon a day but hadn’t for a few days before the test.

I’ve also been trying to really pay attention to how I feel an I noticed that I crave salt and milk…

13

TSH=3.11 is way too high.
fT4 is slightly below mid range, but decent.
T3 is below midrange.
fT3 is the primary active agent and should have been tested.
I can’t see that you have posted your body temperatures.

LH is not horrible, but FSH is and that may be the better representation of your average LH status.

Prolactin is high and is known to be a HPTA represent.

FT is very low and very low relative to TT.
This indicates that T+SHBG is not been cleared or there is higher SHBG levels.
We would then suspect that SHBG is high because of high E2.
But E2 is low, E2 is not the cause of higher SHBG.
Maybe this is a result of high prolactin levels.

If you do TRT, cholesterol may improve.
But prolactin will not be significantly corrected by TRT.
However, TRT can improve dopamine sometimes and that can be expected to improve prolactin a bit.

Adrenals:
DHEA is quite high.
Cortisol is strong, but need to know time of day for lab work.

Action items:
Report body temperatures
Get fT3 and rT3
Get Rx for Dostinex/cabergoline 0.5mg/week as two doses per week
Time of day for cortisol lab

Recommendations and guiding concerns:
You need to fix what is going on or get on TRT.
Both thyroid and prolactin can cause low T.
At age 31, you should try to resolve thyroid and prolactin issues and see what happens

Do you consider all of the points that I make in my posts? Review?

14

@KSman,
Absolutely I consider your points and posts. I’ve spent hours (as have many in sure) reading the stickies and different posts.
Hence, I ordered idoral as soon as I saw TSH at 3. I know you recommend 1 for TSH level.

The most recent labs were done fasting and the draw happened at approx 8:45
The cortisol was blood, not saliva.

I emailed Dr. To add rT3 and fT3 since I have to redo CBC anyway and also requested your suggested caber protocol.

I am at the store right now to pick up a thermometer. I have one but can’t find it. (Stupid reason to delay taking temps).

Regarding cholesterol my diet is quite high in fats (1Tbsp coconut oil, 1Tbsp Kerrygold butter in coffee every morning). I also drink quite a bit of milk and consume more butter on different things throughout the day) Also eat bacon, use bacon grease and butter to cook.

As always, very much appreciate all your help KSman!

15

Also, reverse T3 was one of the ones that the lab missed. Dr. Has results but I can’t see them yet. He just told me rT3 is: 16.6 (range is 9.2-24.1)

Took my temp just now (3x) average was 97

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Updated labs:

Also temps so far:

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a. We have the normal ranges for rT3.

b .We have lots of people with thyroid issues and lower body temperatures.

So some with normal rT3 will have b.
I do not know how variations in higher normal rT3 affect body temperatures, so may be a contributing factor.

You need to supplement Vit-D3, should be in 60-80 range.

Progesterone is ample for cortisol support.

Ferritin could be a little bit higher.

You drink a lot of water, but glucose=84 says no concern with diabetes. Got to connect the dots.

Please update when you have iodine loading for 7-10 days.
Some notice some mental clarity effects sooner.