T Nation

Freeing Up Testosterone from High Prolactin & High SHBG (Normal TT & E2)


#1

Oh, where to begin. First of all, thank you to everyone that has shared and contributed their stories and advice on this forum. Now I need your help in understanding what to do next.

With low-normal Total Test, I’m hoping that getting Prolactin and SHBG in check will improve my Free Test.

ME: 31 year old, non-drinker/smoker, physically active (crossfit/mountaineer), healthy eating, male with typical “low t” symptoms, including a massively depleted libido, low energy, sadness/negative moodiness, lack of muscle development, poor sleep, etc.

…went to Men’s Clinic…

LEVELS:
Had my levels run, most things look in range except for SHBG and Prolactin, which are both high and can negatively affect Free T.

  • Hemoglobin A1c - 5.3 (4.8-5.6)

  • Testosterone, Serum - 536 (348-1197)

  • SHBG - 54.5 (16.5-55.9)

  • Prolactin - 17.2 (4-15.2)

  • Tsh - 2.33 (.45-4.50)

  • LH - 6.5 (1.7-8.6)

  • E2 - 18 (7.6-42.6)

  • Prostate - .4 (0.0-4.0)

  • Free Test (calculated) ~ 9 ng/dl

HIGH SHBG: As many of you know, the more SHBG you have, the more of your total test is bound up, leaving less of it free to do the good stuff. And since two thirds of circulating testosterone is bound to SHBG, having high SHBG means you have less Free T to use. :frowning:

HIGH PROLACTIN: Makes sense with the tenderness I experience in my nipples.

Prolactin is produced in pituitary gland. One of the reasons for high prolactin is prolactin-producing adenomas (also called “prolactinomas”), which are benign (non-cancerous) tumors.

Low thyroid function is another cause of raised prolactin levels. However, my thyroid levels are normal, so it must be something else.

POTENTIAL SOLUTIONS:

For high Prolactin, the most commonly used medicines are cabergoline and bromocriptine. OTA/Herbal remedies include Ashwagandha, Mucuna Pruriens, B6, Zinc and Vitamin E.

For high SHBG, it is not typically treated directly through prescription means. OTA/Herbal remedies include Boron, Magnesium and Vitamin D.

NEXT STEPS:

  • Doc recommended getting a pituitary MRI to determine if cause of high prolactin is a tumor. Scheduled an appointment for next week with an Endo to discuss.

  • Consider the possibility and side effects of taking Cabergoline vs Herbal Remedies like Mucuna Pruriens.

QUESTIONS:

Am I missing anything here?

Feeling a lot of helplessness and self-pity over not being able to fix this. If Cabergoline is prescribed, should that help lower SHBG as well or should I also try some of the herbal remedies to lower SHBG more directly? In other words, is high Prolactin linked to high SHBG? Saw this somewhere, but don’t quite understand if it is correlation or causation: > “Testosterone is dopaminergic. High SHBG = Low Free Testosterone . Low Free Testosterone = Lower Dopamine. Lower Dopamine = Higher Prolactin.”

For anyone that has used Dostinex/Cabergoline, should correcting Prolactin levels be enough alone to send Free Test levels in a positive direction or does that have more to do with SHBG?

Thanks!


#2

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

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • thyroid basics - check oral body temperatures

TSH should be closer to 1.0 and TSH=2.33 is a problem. Perhaps because you have not been using iodized salt. Please post timeline of iodized salt use/non-use and timeline of fatigue.

Feeling colder easier now?
Outer eyebrows sparse?

Labs:
TSH
fT3
fT4 - please not T3, T4
rT3
fasting cholesterol - can be too low, 180 optimal, <160 associated with increased all-cause mortality

Also explain stress as a factor in your life. With low T and thyroid issues, blasting though Xfit with adrenalin could cause adrenal fatigue with rT3 blocking fT3. fT3 regulated antimitochondrial activity which makes ATP as part of your body’s temperature control loop.


#3

Cabergoline 0.5mg/week in divided doses will lower prolactin and will help you recover T. This will shrink pituitary adinoma and cannot be done prior to MRI.

Prolactin labs can be falsely higher from recent orgasm or hugging babies or puppies.


#4

KSman, you always say this and I know its true, it just cracks me up every time I see it


#5

Better to have sex and puppies than a pituitary adinoma!


#6

Hi and thanks for sharing that information.

The doc at the clinic was not concerned with 2.33 as a thyroid level, as the sticky points out that most docs are not. I do add salt regularly, and the salt I cook with is non-iodized Mediterranean Sea Salt. When I see the Endocrinologist on Monday, I will definitely push and insist on a more comprehensive thyroid panel. I’ll check and monitor body temp over the next couple days and report back - good idea.

No pets, no babies, no orgasm before the tests…win some, you lose some.


#7

12/1: morning is 96.0, afternoon 97.5, evening 96.6.
12/2: morning is 95.6, afternoon 97.7, evening 96.4.
12/3: morning is 95.9, afternoon 97.3, evening 96.9.


#8

I’ve always over-analyzed situations and considered myself more of an introvert (up in my head). After college, I went into the military as a bomb tech and the stress of the job/lack of flexibility/military life/long physically demanding hours was taking a major toll on me. My sleep worsened and I became depressed.

I came to Crossfit since it was directly applicable to my job and my body never really responded to traditional hypertrophy bodybuilding (I didn’t gain muscle). Many can probably relate to watching friends with better genes/hormones develop their physiques and strength, who didn’t eat healthy, didn’t sleep well, drank, etc. Depressing. Crossfit allowed me to focus more on mental strength and endurance and has given me the functional strength needed to continue climbing/mountaineering.


#9

Went to the Endo…not good.

Started off saying that she isn’t a big fan of the whole idea of “optimizing levels,” said she subscribes to the medical theory of “do no harm.”

Since my Prolactin is only slightly outside of the normal range, she doesn’t think it is representative of a tumor where levels of 75+ are typically seen. She said she wouldn’t recommend getting an MRI.

Since my TSH is 2.33, she said that it is “well within the normal range,” and said that I should go to Naturopathic clinic if I want someone who will pay attention to the advice found in online forums and websites. My Low T Clinic doc wasn’t bothered by this number either; at least not as much as he was my high Prolactin and high SHBG.

I kept going back to my symptoms, and she only reluctantly agreed to test for T4, T3 and Free T4, but said that rT3 and Free T3 are not appropriate for my situation.

At a loss for what to do next here. Spending all of this money and getting nowhere…feeling lost as to where to go.


#10

I’ve heard of B6 for reducing Prolactin. Not sure how well it really works, but its worth a shot and you won’t need a script to buy some.


#11

Why are you missing the point that you are iodine deficient and fixing that should be your first option. See the sticky. You need iodine supplements and need to watch for changes in mood/energy and body temperatures. You do not need a doc for that or any Rx meds.

You can order your own lab work in most USA States.


#12

I swapped the sea salt for old school iodized salt and added a multivitamin that has a low dose of iodine in it. Will track temps over next 3 days. Thanks for pointing out the obvious, KSman.

On another note, I found someone who seems like a great doc - she is 3 hours away, but after the first visit she only requests face to face visits every year. She has a great contract with a lab where she can run the most comprehensive labs on everything for only $100, like 4k worth of stuff. That, and she also seems well versed on the holistic importance of getting everything balanced, saying that she wants to explore why my prolactin is so high, run advanced thyroid panels, etc.

Looking forward to the next time I can make a trip down to get the ball rolling.


#13

Ok, started TRT!

80mg Test Cyp x2/wk = 160mg/week
Arimidex at .25mg x2/wk = .5mg/week
HCG - waiting on compounding pharmacy - forget dose doc is recommending - should know dose within a week.

I have nolvadex on hand if nipple issue persists. Hoping I stabilize.

I’m assuming it will take a while to stabilize. Day 1 felt great during the day but felt like heart was racing and couldn’t sleep at night. Assuming that is due to the fact that I already have somewhat normal test levels so with addition, test and e2 probably spiked. Not sure if it was paranoia, but felt like my left nipple was itchy, so I took arimidex same day even though doc recommended day after.


#14

You are on your way.
Glad that you found a good doctor.

If you manage E2=22pg/ml there will be no need for Nolvadex.

Consider the stickies your user’s manual.

More than 250iu hCG SC EOD is expensive and excessive.
When you start TRT, LH/FSH–>zero within a day or two. So you can start hCG at any time.

If you are an anastrozole over-responder you will need ~0.6mg anastrozole per week, otherwise you will need ~ 1.6mg/week. Suggest that you take anastrozole at time of injections.

Iodine replenishment needs more than the maintenance amounts you are now taking.
Would not expect any pronounced energy or temperature gains.

Vitamin also needs to have selenium!
Men should not take supplemental iron, check vitamin.


#15

Vitamin checks out here, so thanks for the confirmation.

Things have taken an odd turn: Since injecting 80mg on Saturday, I’ve been feeling my left chest tighten slightly. This concerns me obviously because of any potential heart issues, but also with the complication of the fact that my previous issue with gyno, albeit minor, was also on my left side, so not sure if it is just a reaction at the tissue level that for whatever reason I am feeling more deeply, or if it actually a heart problem. I would describe it as a mild left chest tightening that can be felt more directly by taking a big breath, and no increased soreness by touching.

This, and I’m having trouble sleeping, like the chest tightening, and also my mind just has more energy. I slept only like 5 hours both nights and don’t feel tired (weird), but anxiety is probably not making things better.

Took my BP with at home monitor and it was slightly elevated @ 142/83. I have always been much better than this…

I called the doc, and was suggested to go to Urgent Clinic to get things checked out, and now I’m at another loss for what to do.

Is it my adrenals, have I uncovered some sort of heart issue, is it my hematocrit, is it just shock since my natty test levels are being enhanced by the exogenous since natty was still active (first injection), is it E2 related (high or low?)…I saw on another thread with someone experiencing similar sides the OP “cured” his problems by finding out that he was allergic to the carrier oil the Watson Test was delivered in, and when switched all symptoms went away…Should I ask the doc about this?..ugh.


#16

If you press or massage chest tissue and they are tender, its not your heart.

There really is no association if T, TRT and heart problems, but I would add that E2 needs to be manages as higher E2 is bad for arteries, brain, breast tissues, fat and prostate.

Doc was taking to his lawyer, he kept is hands clean.

Try SC injections, shallow and note any inflammation that might suggest an oil compatibility issue.


#17

There is no tenderness. There is however a more noticeable presence of the tightening when I take a deep breath. So weird.

Great advice about the SC injection. Will update after next convo with doc.


#18

I would not have started TRT without more root cause analysis. I’m a few years younger than you and have very similar things going on. Prolactin was about 25-30, TSH 2.1. My body temps were good though.

I started with Defy (highly recommended, you aren’t going to have luck with random doctors) and just started taking cabergoline + clomid + anastrozole for an 8 week trial. Also ran iodine replenishment + selenium for a while prior to this because I was sure I was deficient, and take maintenance doses now.

Thyroid should be looked into much more imo. fT3, fT4, rT3, thyroglobulin antibodies, thyroid peroxidase antibodies. Your body temps are low. Do you have the classic hypothyroid symptoms?

Kidney problems can also cause high prolactin, but I’m no expert on that.


#19

Good advice - Since I only took one dose, I’m going to hold off on getting any more until i figure this thing out. I will wait a week or so and have a more comprehensive panel run by a ND that seems pretty experienced with all of this. I started the T because I have been prescribed it in the past and felt a lot better, but was in military and it could not be properly managed so I had to PCT off.

Glad you found a place willing to work with you. Caber will def work to lower your prolactin so will be interesting to see how you feel. With that combo, it may be hard to ascribe what is causing what though. I’m unfamiliar with that protocol. I thought Clomid was usually done as a mono-therapy, or with test. Why are you taking an AI? What were your E2 levels?

My body temps have been getting better but I’m still overly sensitive to the cold.

My best guess on what is happening with me is an increase in RBC and therefore viscosity. My hematocrit was a healthy 45% so the surge could have sent it up to the low 50s, which would cause the heart to have to pump noticeably harder. I’ve read that a _hematocrit of over 50/52 percent should be evaluated._Some guys on TRT have to get a therapeutic phlebotomy every month or so to help with this exact problem.


#20

How long should I wait within reason for my system to return to baseline? Is 10 days enough?