The answer from the MRI came, it showed no abnormality. So it’s not a pituitary tumor that’s causing my hyperprolactinemia. So what could the reason/reasons be?
My nipples have recently (the past months) become itchy and sensitive, and according to my doctor I’ve gynecomastia (he taught it was caused by aromatase, what do you think?). Can prolactin directly induce gynecomastia, or only indirectly through elevating estrogen and lower androgen? I still haven’t checked my estrogen yet, but I will do it soon, I will call them tomorrow.
Can elevated estrogen have caused my hyperprolactinemia in the first place? (I find it hard to believe since if estrogen dominance can elevate prolactin to the extent of causing hyperprolactinemia, every female should suffer from hyperprolactinemia which isn’t the case. However perhaps it’s different when it occur in men, it might trigger another chain reaction of stress hormones but I’m only speculating here.)
My cortisol and ACTH is elevated too, and stress hormones do elevate prolactin. But perhaps it’s the other way around in my case; lack of androgen and to much prolactin and estrogen in the first place might have caused a stressful impact on my body, since puberty, either directly or indirectly. I see no reason for them to be elevated so I wounder what’s wrong here.
My LH is elevated too, hyperprolactinemia typically suppress LH and thus cause secondary hypgonadism. Elevated LH indicate primary hypogonadism. This make me wounder if my elevated prolactin is the actual cause/source of the problem or only a symptom of the problem down the chain reaction…
My TSH is elevated too, does my thyroid have problems? Can the thyroid be the main cause and cause hyperprolactinemia?
I’ve varicocele, which I’ve had since childhood, can it have caused primary hypogonadism and caused estrogen dominance during puberty? My total testosterone look fine though, is a high totalt testosterone even possible if primary hypogonadism was the cause? Since my SHBG is high too; the SHBG might store testosterone produced slowly under a long period of time, and that could explain a high value of totalt testosterone despite primary hypogonadism? (Just a thought, I have no idea)
What should I do? I feel like the doctors I’ve met so far don’t know more than I do, which bothers me. Should I focus on lowering my prolactin first? If my estrogen is very elevated (which I strongly believe), should I focus on lowering estrogen before lowering prolactin? If my hyperprolactinemia is induced by estrogen it make sense to lower estrogen in order to lower prolactin, but it might be the other way around.
If primary hypogonadism were the main issue, and it’s the lack of androgens that’s causing estrogen dominance and hyperprolactinemia, replacing my androgens extrenous would be the best treatment (TRT).
I will check estradiol, and I’ll see if I can get them to test bioavaible testo and DHT too. Is there anything else that’s missing? What tests should I take to check liver status?