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High Prolactin, High SHBG, Normal Test. Prescribed a SNRI

Hi,

Came across the forum whilst researching my symptoms of low libido, lethargy, lack of motivation, and depression. I initially put it down to just getting older but then read about declining testosterone levels and decided to investigate. I have seen that there is a wealth of knowledge on this forum and was hoping I might get some assistance and direction.

Age: 42
Height: 177cm
Weight: 77kg
Waist: 33cm Hips: 39cm
Job: sedentary
Activity: resistance training 3-4 times peer week, daily 20m walks
Non-smoker
Alcohol: 2-3 units a days whilst on holiday but nothing otherwise
General health/medication: not on any medication and general health is fine

I have had a blood test and whilst my testosterone levels look ok I do have elevated SHBG and prolactin. From my limited knowledge, I don’t think my liver or thyroid levels are so bad to be causing the SHBG or prolactin to increase but I could be wrong.

Results:

Kidneys - was dehydrated and had done a heavy leg session night before test
Urea 6.4 nmol/L (2.5-7.8)
*Creatinine 104 umol/L (59-104)
EFGR 66 (>60)

Liver
ALP 68 IU/L (<130)
ALT 27.2 IU/L (<50)
CGT 31 IU/L (10-71)

Thyroid - I have started to consume diary on a regular basis to increase my iodine
TSH 2.15 mIU/L (0.27 -4.2)
Free T3 4.51 pmol/L (3.1-6.8)
Free Thyroxine 18.4 pmol/L (12-22)

Proteins - have started boron 12mg to tackle elevated SHBG
Albumin 42.3 g/L (35-50)
*SHBG 59.7 nmol/L (18.3-54.1)

Hormones
FSH 5.76 IU/L (1.5-12.4)
*LH 8.74 IU/L (1.7-8.6)
Oestradiol 98.3 pmol/L (41-159) - 98.3 pmol/L = 26.7 pg/mL
Test 18.4 nmol/L (8.64-29) - 18.4 nmol/L = 531 ng/dl
Free test 0.263 nmol/L (0.2-0.62)
*Prolactin 715 mU/L (86-324) 715 mU/L = 33.6 ng/mL

I have spoken to my GP (I’m U.K. based) and he was completely unconcerned about the prolactin. He did question me about my low libido and depression and proceeded to prescribe 37.5mg of Venlafaxine (Effexor).

My questions for you gentlemen:

  1. Are my prolactin levels elevated enough to cause the above symptoms? Also, what levels would be regarded as ‘optimal’?
  2. Have any of you gentlemen been prescribed 37.5mg of Venlafaxine/Effexor and if so how was your libido?
  3. Am I right to be worried about my Doctor? From my limited internet research, I fail to see how a SNRI would help with my low libido and, whilst rare, could even further elevate my prolactin.
  4. I’ve read that prolactin and dopamine have an inverse relationship and so was wondering could that potentially mean my feelings of depression and lack of direction are stemming from low dopamine levels? If that’s reasonable then I’m curious why the doctor would prescribe a SNRI and not a dopamine agonist (Cabergoline) or a NDRI (Wellbutrin) - if this assumption is correct then I will be asking my GP this on my next visit. But I’m all ears to any opinions/guesses.
  5. Whilst my total testosterone levels look ok I am concerned about my free levels. I’ve put this down to my SHBG and will re-test after I’ve been on the boron for a month or so. If my free levels don’t increase what else can I try and what kind of ‘optimal’ free testosterone levels should i be aiming for?
  6. Should I be concerned about my LH level?

Thank you for taking the time to read all of the above. I hope I provided enough information. But please do let me know if you need more.

Sam.

First thing, Effexor is a m-fer to get off of if you ever decide to. It’s bad and takes a while to do. Wellbutrin on the other hand is great with relatively little side effects and if you ever want to get off of it it’s easy to do without much if any withdrawal symptoms. The only real side effect is mild anxiety due to the fact you actually have more energy (similar to anxiety after drinking coffee). I just came off wellbutrin after 5 years and it was easy.

My prolactin levels are similar and as long as you don’t have a tumor then it’s not the end of the world. You’d need a pituitary MRI to know that.

Your doc probably has no clue about hormones but for anything they don’t understand they’ll usually give an anti-depressant for. I wouldn’t take Effexor ever.

Your testosterone level looks like shit. My grandfather has similar free T. I’m sure similar libido as well. I had a total T of 600 when getting on trt and my libido went from nonexistent to kid during puberty. It’s been a life changer for me.

Your thyroid doesn’t look good. Google “stop the thyroid madness” and read up on it. That site has a good way of explaining things especially if you don’t know anything about thyroid.

Your SHBG is high but not super crazy high. I’ve had respected endos tell me not to worry too much about SHBG then you have some forum members who think it’s the end-all-be-all so who knows. It really doesn’t matter either way until if and when you start TRT.

Your doctor have no clue about your situation and is defaulting to SNRI, most doctors do not want to dig deep enough to find the causes of your health problems and prefer to threat the symptoms, this is no good as the health problems are allowed to get worse.

You’re also looking at primary hypogonadism with the above range LH and low Free T, you’re not really producing that much testosterone. The UK doctors in the NHS have a blind spot for anything related to sex hormones and are not very knowledgeable.

Your prolactin needs to be treated and your very low Free T is unacceptable and you need TRT.

Your doctor is an idiot!

This is dead on balls accurate.

hey bro u have identical levels to me would be interested to reading your RT3 and thyroid antibodies too. following your journey - i am considering trt … also.

i can tell you from personal experience trying to alter shbg with boron, nettle, high carbs, whatever everyone tells you may work for a little and bit but reverts back. it is a losing game.
i read every single topic on shbg on here and no one has ever said that they have long-term reduced shbg with ANY lifestyle or dietary changes.

i tried for a long long time. i fully belief you cannot alter shbg long term it is in our genetics unless of course you are ILL & DISEASED or on a 0 carb diet or something stupid.

from reading this forum and others trt is the only way to reduce shbg…but then who cares anyway to reduce shbg when you can just inject more tastosterone anyway!

i like to read things like this!

good luck with you
bikerg

Don’t take the Effexor. Stay away from all SSRI and SNRI they will kill your libido and can give you ED. There are many other drugs for depression anxiety panic attacks. But you should start with a good therapist to find out why you are depressed.

OTC stuff to drop SHGB does not work. If you go on TRT and do 1 shot per week you will cut 10 points of your SHGB in 6 weeks and it will continue to drop slowly for about 2 years. Well at least mine did. I started with a 38 pre TRT now on TRT for just over 6 years I have tested as low as 24 but have been 29 now for the last 3 years.

My favorite drugs for mild depression is a shot of good whiskey around bedtime. Next would be Wellbutrin XR150’s and the strongest if the other two don’t work Buspar. None of these have bad sexual side effects. In fact Wellbutrin will double your orgasm intensity. Got to love that side effect.

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Hi bro. You have very similar testosterone levels like mine.
They are not horrible(around 500-600), but they are far from optimal as well.

Even though you are 12 years older than me, we should have like 1000-1400 total T to feel well and free T above this crappy scale(depending also on the method testing). A really good dr like dr Keith Nichols will reccomend testosterone optimization to you.

And stay away from all SNRI and SSRI and tell the doctor that prescribes them to you to stick them up in his ass! I’m very serious about this, good to tell him that. Who knows how many people he has fucked up?

On the prolactin - I also had elevated prolactin, but mine was like 370. It is good to make a pituitary NMR to check for pituitary adenoma. Most likely with a prolactin secreting adenoma it will be much higher, but still need to check that

Hi mate,

I’m from the UK too and had been put on antidepressants 4 years ago.

But the problem for me is they seemed to be masking the symptoms and everything would just come back after a few months.

I pushed my gp to check my hormones for 2 years and finally they did. I had low t but they literally tried to throw even more antidepressant meds at me, give me more counciling and a prescription for Viagra.

After reading on here I just bit the bullet and went private and was put straight on trt by a specialist. Its cost me about £300 in total £195 consultation, £35 for 12 ampoules of sustanon, £20 for hundreds of needles and sharps bin etc and £50 petrol.

I had my first jab yesterday.

Long story short I pushed the NHS for 2 years to check hormones, basically got fobbed off for being on the low end of the normal range.

Posted on here and booked private and was done in a week.

Hope you get better mate but I had a long drawn out miserable two years with my GP.

A private doctor was hopefully well worth the money, I’ll find out in a few months when my meds start working properly.

Kind regards,

Stephen

Firstly, thank you all for your advice and for sharing your experiences.

Hi, do you experience any negative symptoms from your prolactin or do you feel the trt helps negate them? Also, did you ever try any OTC supplements like vitamin B6 (p5p) or medication like caber and did it help?

Thanks, I will do.

Hi, thank you for alerting me to the primary hypogonadism. I will certainly investigate into that.

Unfortunately, that’s definitely the impression I got. When I asked about side effects from the SNRI he just kind of mumbled “nothing much”!

Hi, sorry but I only had the above thyroid tests done. But I will look into doing more on my next blood test.

God, that’s depressing! I’ve only just started my journey with the boron. How long have you been trying to reduce your SHBG?

Hi, I had actually asked my GP if he could refer me to my local mental health team and so was very surprised he was keen to prescribe. But I certainly won’t be taking the Venlafaxine he’s given.

That’s very interesting to know, thanks.

Hi, was that 370 ng/mL or 370 mU/L? How did you tackle the prolactin?

That’s sad to read. I know the NHS can be great and we’re fortunate to have it but it is sad to constantly read/hear about doctors not really wanting to find out the underlying issue and quickly giving pills to mask the actual issues.

Best of luck and I hope it helps!

Its mIU/L, I started taking cabergoline

Thanks a lot mate, I kind of feel like I can feel the sustanon kicking in a bit.

It could be placebo since I only had my first dose just over 24 hours ago, however I kind of feel like I’ve got a generally happy store of energy building up.

I know one or two of the esters are fast acting but maybe 24 hours is a bit fast.

But like I said it might just be the fact that now I know it wasn’t all in my head and a weight has been lifted.

Yeah the NHS is amazing for virtually everything. I mean I sliced my arm deep with a pane of glass two days ago and got stitched up and bandaged for free (well I pay my taxes but you get what I mean) probably would have cost a few hundred quid else where.

Anyway I hope you get to the bottom of your issues and start feeling good again.

The only point I wanted to make was if you hit roadblocks and can afford it consider a private consult.

I don’t know whether we can name doctor’s on here but I went to the Leger Clinic in Doncaster.

Thanks again and good luck, I hope you get to the bottom of it.

Sam, sorry to hear of these issues.

Run down the high prolactin, pituitary microadenoma should be excluded. If you have one, at least monitored.

TRT is for you. Double your total testosterone, triple your free testosterone. Experience the increased energy, libido, motivation, even look better. You will be stronger, have more and better sex, improve relationships and have energy. You’ll then find that you are not depressed any longer.

Good luck.

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@sam42
I don’t think I have any negative effects from the high prolactin. According to the list of side effects it seems they are all physical. Gyno and ED. I did try PHP (active form of b6) for a while but I got tired of it and just stopped doing it.

.

Doctors are taught in medical school that “in-range is normal”, only for TRT this is NOT the case.

The problem is doctors do not understand young men are supposed to be closer to the top of the ranges and old men on the bottom, most doctors are completely ignorant and just don’t care to educate themselves on the subject of normal testosterone for a given age because they specialize in other areas of medicine.