T Nation

Getting The Doc Run-Around

uh, absolutely NOTHING! all my levels were “low” but not low enough to justify “disease”. so everything had to be cash. gh was like 17 dollars an IU, hcg was 70dollars for what i could get for 30dollars online, etc. fuck that.

A doc here, who hates docs (a long story.)
Normal Prolactin is 2-12 in men, slightly elevated is usually due to meds (most often psych meds which decrease dopamine), but also can drop due to hypothyroidism, stress, and strenuous excercise. Very high levels are much more suspicious of pituitary adenoma, a benign tumor which cranks out Prolactin. You do need an MRI to rule that out, they can sit there for years, undetected.

 However, if your level is just a little high, its probably the fluctuating T levels combined with the stress. Your doc should know this, but docs operate out of fear, that is order the MRI to cover his ass that you don't have a tumor. 

 In the long run, I am sad to say that most people have to essentially become their own doctors, learn what their body needs, and use docs (regular or Internet) to simply write the scripts they need. It shouldn't be this way, but it is. 

[quote]Dr.PowerClean wrote:
A doc here, who hates docs (a long story.)
Normal Prolactin is 2-12 in men, slightly elevated is usually due to meds (most often psych meds which decrease dopamine), but also can drop due to hypothyroidism, stress, and strenuous excercise. Very high levels are much more suspicious of pituitary adenoma, a benign tumor which cranks out Prolactin. You do need an MRI to rule that out, they can sit there for years, undetected.

 However, if your level is just a little high, its probably the fluctuating T levels combined with the stress. Your doc should know this, but docs operate out of fear, that is order the MRI to cover his ass that you don't have a tumor. 

 In the long run, I am sad to say that most people have to essentially become their own doctors, learn what their body needs, and use docs (regular or Internet) to simply write the scripts they need. It shouldn't be this way, but it is. [/quote]

thanks for the info… I did have the mri done and there was no tumor. he put me on .5mg of dosinex a week. In 3 weeks he wants me to do a prolactin test followup and in 6 weeks a followup with him.

I am now taking the dosinex and also decided to continue self-medicating with the 125mg of test a week. How will this counteract the dosinex and ultimately prolactin levels?

I have heard a bunch of testimonials of people with high prolactin and who take dosinex and it only eleveated their testosterone slightly. Ultimately i want the doc to prescribe the testosterone injections, but cannot wait around weeks and months for him to treat my slightly elevated prolactin level which is 23.

Any advice drpowerclean?

I sent you a long post and it disappeared when I hit submit. WTF
Anyway, first of all I’m glad you’re MRI’s fine and your level is only 23. Folks with bad hyperprolactinemia have levels over 1000.

Next, the Dostinex should work, and I expect your level in three weeks to be in the normal range. Now, Dostinex is a dopamine agonist (increases it), and docs like it because its safer than the previous drug (Parlodel), but any drug that works on the Dopamine receptors in your brain is tricky.

The combined effect of increasing dopamine and decreasing prolactin should result in a natural, although mild, rise in testosterone. That, however, is the normal effect in someone not doing HRT. In your case, I doubt it would bump it up much, especially right away. Thus, I find myself in the odd place of agreeing with your intinctive desire to coninue self-medicating with weekly T. (Was it cyp? should be.) 

The tricky part comes with your next T level. You clearly will need to be more than a week out from your shot, or your level might come in too high due to the above Dostinex effect. If so, you’re screwed as far as that doc giving you HRT. Maybe some guys out there have experience in passing drug tests can tell you exactly how best to make sure you come into that T level test with a normal level.

Another key thing, IMO, is to get TWO normal Prolactin levels and then get off that drug. Another fear-driven doctor behavior is to keep patients on meds forever.

I still am not 100% sure why you got the high level, but if it was what I thought before, once it’s down, it should stay down. That’s important too…for many reasons.
Good luck and I’ll keep up with you. Doc

[quote]Dr.PowerClean wrote:
I sent you a long post and it disappeared when I hit submit. WTF
Anyway, first of all I’m glad you’re MRI’s fine and your level is only 23. Folks with bad hyperprolactinemia have levels over 1000.

Next, the Dostinex should work, and I expect your level in three weeks to be in the normal range. Now, Dostinex is a dopamine agonist (increases it), and docs like it because its safer than the previous drug (Parlodel), but any drug that works on the Dopamine receptors in your brain is tricky.

The combined effect of increasing dopamine and decreasing prolactin should result in a natural, although mild, rise in testosterone. That, however, is the normal effect in someone not doing HRT. In your case, I doubt it would bump it up much, especially right away. Thus, I find myself in the odd place of agreeing with your intinctive desire to coninue self-medicating with weekly T. (Was it cyp? should be.) 

The tricky part comes with your next T level. You clearly will need to be more than a week out from your shot, or your level might come in too high due to the above Dostinex effect. If so, you’re screwed as far as that doc giving you HRT. Maybe some guys out there have experience in passing drug tests can tell you exactly how best to make sure you come into that T level test with a normal level.

Another key thing, IMO, is to get TWO normal Prolactin levels and then get off that drug. Another fear-driven doctor behavior is to keep patients on meds forever.

I still am not 100% sure why you got the high level, but if it was what I thought before, once it’s down, it should stay down. That’s important too…for many reasons.
Good luck and I’ll keep up with you. Doc[/quote]

finally a non-robotic doctor. :slight_smile:

I self-medicate with enanthate due to its longer lasting esthers. My original high prolactin level was most likely due to prior self-medicating that the doctor knew about (I told him). So he had me discontinue everything for 2-3 weeks and get rechecked… prolactin still high, so mri ordered. My lab followup for prolactin level is in 2 weeks.

If I find out testosterone test was also ordered (just called nurse), I will not inject again until the lab test. then continue after testing and 6 week followup with doc should hopefully yield lowered prolactin levels along with still low testosterone levels. Then hopefully he will prescribe the testosterone.

I will keep you posted doc, but if you see anything wrong with this agenda, please let me know.

just found out that they will not be testing testosterone level. According to the doc, once the prolactin level is back to normal, it can take several weeks for testosterone level to rise. :slight_smile: Meaning even more time to wait for that 50 point test level increase!

So docpowerclean… if I self medicate with 125mg/wk testosterone, how will that affect my prolactin test in 2 weeks from now. I am taking .5mg dostinex once a week… so by then, I will have done 3 weeks of dostinex plus 125mg/wk testosterone…

I do have refills on the dostinex… can I up my dosage of dostinex to counter act the exogenous testosterone I am taking or will that exogenous testosterone have no bearing on the testing anyways?

Sounds like your plan is dialed in.

[quote]Dr.PowerClean wrote:
Sounds like your plan is dialed in.[/quote]

so if i am taking 125mg/wk of testosterone and .5mg of dostinex, should my prolactin still come down in 2 weeks?

Your Prolactin will be lower, but I doubt it will be all the way down to normal. Dostinex typically takes 4 weeks to get prolactin normalized.

[quote]Dr.PowerClean wrote:
Your Prolactin will be lower, but I doubt it will be all the way down to normal. Dostinex typically takes 4 weeks to get prolactin normalized.[/quote]

typically will prolactin then remain balanced or wlll you continue dostinex indefinitely ? what is your opinion on the risk to heart-valves shown earlier in the thread ?

Good questions, giving my brain a workout. In the above situation, the presumption is the elevated Prolactin was related to T use, but possibly other factors involved. I’m not a BALCO doc, so I had to do a lot of internet reading. Clearly, some steroids (Tren, Deca, others) elevate Prolactin more than others, and should obviously be avoided. Good articles on steroidology.com. There may be one anabolic, even one specific form of T that would be the least offensive for someone who reacts with high Prolactin.

The reason I raise this issue is that the goal for anyone in this situation find a way to stay Prolactin-normal without long term use of Dostinex. I believe it would be VERY RISKY to stay on Dostinex beyond six months, the literature-good unbiased clinical studies-shows that up to 25% of patients taking Dostinex beyond six months get cardiac valve regurgitation (leaking). Now, to be fair, these patients were taking DAILY Dostinex for Parkinson’s, so the likelihood of valve disease would naturally go down significantly with once/twice a week dosing.

Still, if it was my heart, I wouldn’t risk it with long term use. Now, interestingly, if someone is stuck with high Prolactin, there are two other things I came across. First, Vitamin B-6, 200mg three times a day, can actually make a good dent in the levels. Secondly, if someone needs a Prolactin lowering drug long term, the Restless Legs drugs Requip and Mirapex can work, and have no significant risk of heart damage.

If there's one thing I learned in twenty years of psychiatry, there is absolutely no perfectly safe drug that operates on the Central Nervous System. We went through one "wonder drug" after another, and almost without fail, five or ten years later, they find some horrible unknown side effect. Prozac-causes teenagers to be suicidal. Zyprexa-causes Diabetes. Paxil-weight gain and addiction. And on and on. 

Remember, try to use CNS meds prudently and get off of them as soon as you can.  Doc

[quote]Dr.PowerClean wrote:
Good questions, giving my brain a workout. In the above situation, the presumption is the elevated Prolactin was related to T use, but possibly other factors involved. I’m not a BALCO doc, so I had to do a lot of internet reading. Clearly, some steroids (Tren, Deca, others) elevate Prolactin more than others, and should obviously be avoided. Good articles on steroidology.com. There may be one anabolic, even one specific form of T that would be the least offensive for someone who reacts with high Prolactin.

The reason I raise this issue is that the goal for anyone in this situation find a way to stay Prolactin-normal without long term use of Dostinex. I believe it would be VERY RISKY to stay on Dostinex beyond six months, the literature-good unbiased clinical studies-shows that up to 25% of patients taking Dostinex beyond six months get cardiac valve regurgitation (leaking). Now, to be fair, these patients were taking DAILY Dostinex for Parkinson’s, so the likelihood of valve disease would naturally go down significantly with once/twice a week dosing.

Still, if it was my heart, I wouldn’t risk it with long term use. Now, interestingly, if someone is stuck with high Prolactin, there are two other things I came across. First, Vitamin B-6, 200mg three times a day, can actually make a good dent in the levels. Secondly, if someone needs a Prolactin lowering drug long term, the Restless Legs drugs Requip and Mirapex can work, and have no significant risk of heart damage.

If there's one thing I learned in twenty years of psychiatry, there is absolutely no perfectly safe drug that operates on the Central Nervous System. We went through one "wonder drug" after another, and almost without fail, five or ten years later, they find some horrible unknown side effect. Prozac-causes teenagers to be suicidal. Zyprexa-causes Diabetes. Paxil-weight gain and addiction. And on and on. 

Remember, try to use CNS meds prudently and get off of them as soon as you can.  Doc[/quote]

thanks for the free advice doc!

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Yeah, I can vouch for it being safe at least for three-four years on dozens of my patients with RLS.
-“M.D. to whole T-Nation”. Sounds flattering but I’ll pass. Need to keep time available for my cleans.

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See today’s post on my thread-Am I Crazy???