T Nation

High Prolactin, Low Free T

Hi, as the title says I have high prolactin and lowish free testosterone. I’ll start with a bit of background information.

I first started getting symptoms in my late teens (around 19 and I’m currently 27), the main symptom was e.d. this gradually got worse over time and wasn’t just during sex so I don’t think it was performance anxiety. Then in my early 20’s I started to get really tired and lack energy alot of the time. My mood also suffered and I became very depressed and snapped at people very easily.

I used to workout regularly, lifting heavy weights and doing cardio. I’ve never taken any steroids and drink a moderate amount of alcohol, usually once a week or less often. I have used cannabis aswell but not consistently. I am not currently on any medication but I have tried anti depressants, which for the most part make me feel worse.

I have had multiple blood tests done in the past and they always come back with slightly elevated cortisol, high prolactin and my free testosterone isn’t that high but also isn’t severely low either.

I have posted on this forum before and I was advised to try cabergoline to see if that helped. It was difficult to find a trt specialist that knew what they were talking about and could prescribe me cabergoline, so I just gave up on the idea and tried to get on with my life. Symptoms have only gotten worse and I’m at the point I can’t cope with this any longer.

So i’ve found a trt specialist (balance my hormones) and after a phone call with one of their consultants they’ve said cabergoline is something that they can prescribe but they need to run some more up to date blood test first which is fair enough.

I went over one of my most recent blood tests with her and she pointed out that my shbg was also quiet high which I could possibly take medication for to get that lowered. My lh is a bit high and my oestradiol was a bit low. So my main questions for now are does what she says seem legitimate? And is cabergoline the best line of treatment to begin with ( I’ve had an MRI and no sign of prolactinoma)?

Most recent blood test results (as of march 2018)

Full Blood Count
Haemoglobin 166 130 - 170 g/L
Red Blood Cells 4.97 4.40 - 5.80 x1012/L
Haematocrit 0.478 0.380 - 0.500 L/L
Mean Cell Volume 96.0 81 - 98 fl
Red Cell Distribution 12.0 11.5 - 14.4 %
Mean Cell Haemoglobin H 33.4 27.0 - 33.0 pg
Platelets 184 150 - 400 x109/L
MPV 9.70 7 - 13 fl
White Blood Cells 4.4 3.0 - 10.0 x109/L
Neutrophils 2.18 2.0 - 7.5 x109/L
Lymphocytes 1.78 1.2 - 3.65 x109/L
Monocytes 0.29 0.2 - 1.0 x109/L
Eosinophils 0.08 0 - 0.4 x109/L
Basophils 0.03 0 - 0.1 x109/L
Biochemistry
Chloride 101 98 - 107 mmol/L
Glucose (Fasting) 5.7 4.1 - 5.9 mmol/L
Kidney Function
Total Protein 75.0 64 - 82 g/L
Albumin 45.7 35 - 52 g/L
Sodium 140 136 - 145 mmol/L
Potassium 4.2 3.5 - 5.1 mmol/L
Urea 5.5 2.76 - 8.07 mmol/L New range
Creatinine 93 62 - 106 umol/L
eGFR(MDRB)(Caucasian Only) 91 >60 unless evidence of CKD ml/min/1.73m2
Liver Function
Total Protein 75.0 64 - 82 g/L
Albumin 45.7 35 - 52 g/L
ALT 39 <50 IU/L
AST 24 <50 IU/L
ALP 68 <129 IU/L
GGT 11 10 - 71 IU/L
LDH 160 <250 IU/L
Total Bilirubin 10.3 <24 umol/L
Bone Screen
Test Patient Result Normal Range Units Comment
Total Protein 75.0 64 - 82 g/L
Albumin 45.7 35 - 52 g/L
Calcium 2.43 2.15 - 2.50 mmol/L
Corrected Calcium 2.32 2.12 - 2.52 mmol/L
Phosphate 0.98 0.81 - 1.45 mmol/L
ALP 68 <129 IU/L
Uric Acid 0.313 0.202 - 0.416 mmol/L
Lipids
Cholesterol H 5.06 0 - 5.0 mmol/L
HDL 1.46 1.0 - 1.5 mmol/L
Triglycerides 0.90 <1.7(Fasting) mmol/L
LDL H 3.19 <3.0 mmol/L
Chol:HDL ratio 3.47 <4.0 ratio
HDL Cholesterol ratio 28.9 >20 %
Non HDL Cholesterol 3.60 <4 mmol/L
Hormones
FSH 6.3 Men 1.5-12.4 IU/L
Follicular 3.5-12.5
Ovulation 4.7-21.5
Luteal 1.7-7.7
Postmenopause 25.8-134.8
LH 6.7 Men 1.7 - 8.6 IU/L
Follicular 2.4 - 12.6
Ovulation 14.0 - 95.6
Luteal 1.0 - 11.4
Postmenopause 7.7 - 58.5
Oestradiol 58 41 - 159 pmol/L
Testosterone 21.3 8.64 - 29 nmol/L
SHBG 48 18.3 - 54.1 nmol/L
Free Androgen Index 44.4 24 - 104 Ratio
Prolactin H 615 86 - 324 mU/L
Cortisol (Random) 565.0 6am - 10am 113 - 456 nmol/L
4pm - 8pm 58 - 278
Midnight <64
Thyroid Function
TSH 1.71 0.27 - 4.20 mIU/L
T4 Total 97.5 66 - 181 nmol/L
Free T4 16.70 12.0 - 22.0 pmol/L
Free T3 5.24 3.1 - 6.8 pmol/L
Markers
PSA (Prostate) 0.962 <4 ug/L
Immunology
Anti-Thyroidperoxidase abs 9.4 <34 kIU/L
Anti-Thyroglobulin Abs 12 <115 kU/L

Sorry to hear about this, really hate to see this stuff especially with guys in their 20s. Makes me wonder how many are out there suffering in silence.

On the surface, looks like the main issue is idiopathic prolactinemia. I say start with cabergoline.

Thanks for taking the time to read my post and reply, it made for an interesting read.

I’ll keep you updated

While I think prolactin is high and needs treatment and investigation, I also think your T status is another area of concerned. Your TT is good, but FT is subpar due in part to your high SHBG which is binding up your testosterone effectively deactivating it.

This is why you free androgen index is on the lower end. Sadly there isn’t much you can do to lower SHBG it without TRT. TRT can lower cortisol, in fact I had higher cortisol pre-TRT. TRT decrease my cortisol. It’s common to see high SHBG men with low FT and low estrogen and you’ve got both.

One could say cortisol is high because testosterone is suboptimal, low T men have more difficulty dealing with stressful situations. Having optimal testosterone can have a calming effect.

You will struggle to get TRT from a regular doctor in your healthcare system, you will need to seek a private doctor who truly specializes in hormonal treatments.

Caber is nowadays the first line treatment at it has less side effects and a longer half life. However, in constrast to bromo, caber is described to potentially increase SHBG thereby lowering free T.

Anyhow I would recommend to start caber. Very slowly work your way up to the recommended dose, limits experiencing side effects.

Thanks for the response, that’s interesting to know. What dosage would you recommend to start with? Does 0.5mg per week split into 2 doses sound ok?

Thanks for the reply. I think I’ll try the cabergoline to start with and see how things go from there. I’m going to get some fresh bloods done in the morning so I’ll let you know how I get on with those

Ok so I’ve just had my blood test results back and they’re a bit of a surprise. My prolactin is now looking ok, cortisol has come down into range but still probably looks a bit high? Shbg has come down a bit and free testosterone is up a bit. Tsh is also now a bit elevated as is free t3.

Im wondering if this could all be down to over training. Several years back when I was weight lifting I was pushing myself extremely hard, to the point I was regularly getting nose bleeds while I was lifting (in hindsight this was obviously foolish). I got to the point I was so burnt out that I had to stop lifting and give up my job. I was practically bed ridden for some time. After a couple of years I was gradually starting to feel better and got back into the gym. This seemed fine for a while but I gradually started to decline again and the same thing happened.

I took more time out of work and slowly recovered to the point I was feeling great. Energy was good, mood was good, erections were good ( I was waking up every morning with solid wood). I thought all was fixed and stupidly started hitting the gym again. About a year down the line and after gradually getting worse I had to give it up again.

About 6 months after that I decided to get another job which involves heavy lifting and shift work between 6 am and 10pm. I gradually started getting worse over time and here I am now about 6-7 months into said job.

I think weightlifting was more than just a hobby for me, it had become an obsession. I realise that I have to just give it up and forget about it. I’ve had this last week off work as holiday and I’m starting to feel slightly better mood and energy wise. I’m contemplating asking if I can go part time to try and recover a bit. Do you guys think over training could possibly have been what is causing my hormone issues? And what do you think about just taking some time out to recover and see how it goes instead of seeking medical treatment?

Here are yesterday’s blood test results

Full Blood Count
Haemoglobin 161 130 - 170 g/L
Red Blood Cells 4.93 4.40 - 5.80 x1012/L
Haematocrit 0.467 0.380 - 0.500 L/L
Mean Cell Volume 94.9 81 - 98 fl
Red Cell Distribution L 11.3 11.5 - 14.4 %
Mean Cell Haemoglobin 32.7 27.0 - 33.0 pg
MCHC 344 300 - 350 g/L
Platelets 210 150 - 400 x109/L
MPV 9.90 7 - 13 fl
White Blood Cells 4.1 3.0 - 10.0 x109/L
Neutrophils 2.08 2.0 - 7.5 x109/L
Lymphocytes 1.55 1.2 - 3.65 x109/L
Monocytes 0.28 0.2 - 1.0 x109/L
Eosinophils 0.09 0 - 0.4 x109/L
Basophils 0.05 0 - 0.1 x109/L
Biochemistry
Albumin 47.2 35 - 50 g/L
Total Protein 76.4 60 - 80 g/L
Globulin 29.2 19 - 35 g/L
HbA1c-(IFCC) 32 20 - 42 mmol/mol
hs-CRP 0.39 <5.0 mg/L
Iron 14.9 5.8 - 34.5 umol/L
Ferritin 140.0 30 - 400 ug/L
Transferrin Saturation 25.5 20 - 50 %
TIBC 58.4 45 - 72 umol/L
CK 76 39 - 308 IU/L
Kidney Function
Sodium 141 133 - 146 mmol/L
Urea 6.9 2.5 - 7.8 mmol/L
Creatinine 90 59 - 104 umol/L
eGFR(MDRB)(Caucasian Only) 87 >60 unless evidence of CKD ml/min/1.73m2
Liver Function
ALT 35 <50 IU/L
ALP 58 <130 IU/L
GGT 11 10 - 71 IU/L
Total Bilirubin 4.8 <24 umol/L
Bone Screen
Calcium 2.46 2.2 - 2.6 mmol/L
Corrected Calcium 2.32 2.12 - 2.50 mmol/L
Uric Acid 250 200 - 430 umol/L New range and units
Lipids
Cholesterol 4.65 0 - 5.0 mmol/L
HDL 1.33 >1.1 mmol/L
Triglycerides 0.98 <1.7(Fasting) mmol/L
LDL 2.87 <3.0 mmol/L
Chol:HDL ratio 3.50 <4.0 ratio
HDL Cholesterol ratio 28.6 >20 %
Non HDL Cholesterol 3.32 <4 mmol/L
Hormones
FSH 6.9 Men 1.5-12.4 IU/L
Follicular 3.5-12.5
Ovulation 4.7-21.5
Luteal 1.7-7.7
Postmenopause 25.8-134.8
LH 3.8 Men 1.7-8.6 IU/L
Follicular 2.4-12.6
Ovulation 14.0-95.6
Luteal 1.0-11.4
Postmenopause 7.7-58.5
Oestradiol 72 41 - 159 pmol/L
Testosterone 20.70 8.64 - 29 nmol/L
SHBG 41 18.3 - 54.1 nmol/L
Free-Testosterone(Calculated) 0.375 0.2 - 0.62 nmol/L
Prolactin 178 86 - 324 mU/L
DHEA-Sulphate 9.46 4.34 - 12.2 umol/L
Cortisol (8-10am) 414.0 166 - 507 nmol/L
Progesterone 0.5 Follicular 0.181 - 2.84 nmol/L
Periovulatory 0.385 - 38.1
Luteal 5.82 - 75.9
Postmenopause <0.401
Thyroid Function
TSH 2.20 0.27 - 4.20 mIU/L
Free T4 17.4 12.0 - 22.0 pmol/L
Free T3 6.33 3.1 - 6.8 pmol/L
Markers
PSA (Prostate) 0.664 <1.4 ug/L New range
Immunology
Anti-Thyroidperoxidase abs 11 <34 kIU/L
Anti-Thyroglobulin Abs 11 <115 kIU/L
Vitamins
Vitamin D (25 OH) 60 Deficient <30 nmol/L
Insufficient 30 - 50
Consider reducing dose >175
Vitamin B12 448 Deficient <145 pmol/L
Insufficient 145 - 300
Consider reducing dose >569
Serum Folate 19.50 8.83 - 60.8 nmol/L

Looks great man!!

@systemlord @highpull

What do you guys think of my latest blood test results? Where should I go from here?

It happens. I did see it and probably experienced it to some degree. At times I would be surprised with how well I did coming off of an injury or illness, or coming back after taking a week or two break.

I’m not sure I’d do anything in light of these recent results. However, you have to train. If you don’t mind, would you post your training program, everything, lifts, sets, reps, max for each, etc.? Just a typical week would be fine.

Sorry just to clarify I don’t currently lift at the moment. The last time I worked out was probably over a year ago. I just don’t have the energy for it at the moment, I’m so drained and it’s not just laziness I can assure you. However my job is somewhat strenuous.

The last time I did work out it was heavy lifting 3x per week, full body workout. No cardio as that seemed to really drain me on top of the lifting. I’d do bench press, pull ups with a backpack containing weight plates and squats or deadlifts. Bench press was about 100kg 3x5. Pull ups I’d probably put 10-15kg in the bag and do 3x5(bodyweight at the time around 85kg). Weirdly I couldn’t squat as much as I could bench, probably around 75-80kg 3x5. And deadlifts were even harder, very draining, so I didn’t do them very often or with much weight.

In contrast back in my early 20s when I was really pushing myself I was squating 110-115kg 3x10. Deadlift 105kg 3x5 and bench press around 100kg 3x5. I think I was doing cardio on top of this at the time, most likely hiit of some form. I was also consuming large amounts of cafine from pre workout supplements and drinking coffee at work.

Just to give you an idea of how drained I get. I’ve been off work since last saturday for holiday. I havent done much because I’ve got no energy and started to feel slightly better. So yesterday and the day before I went for a 45 min walk and now I’ve been in bed all day. I have no energy or motivation to do anything. Erections are non existent…

OK, that changes everything in my mind. TRT, get your numbers up and see how you respond.

Ok thanks for the response. I’ve got a phone consultation next week, I’ll let you know how it goes

Your SHBG is in a range where it is starting to affect your FT negatively, the question is when do you want your quality of life to improve, now or years from now…

You need to treat the high prolactin.

Thanks for the response, but my prolactin was well within range in my latest blood test. So I am a bit baffled now… do you think I should see if I can have it retested? or is the issue with my testosterone/ shbg in which case I need trt?

How are you doing man? I had PRL similar to yours and went on cabergoline, it helped for me.

I haven’t been on here in a while main reason being that after those test results the clinic I was dealing with wanted me to do another blood test because they need more than one test before they can prescribe trt. The results on that test were:

Testosterone 22.4 (8.64-29)
Shbg 34 (18.3-54.1)
Free test (calculated) 0.476 (0.2-0.62)

Looking at these results I didn’t want to continue with trt because free t doesn’t look too bad? And shbg has reduced by quiet a bit.

But the thing is I’m still experiencing symptoms. I’m wondering if perhaps it is all caused by overtraining. What do you think about getting a 4 point saliva test for cortisol? Is that the gold standard in testing for cortisol? Also seems like tsh is a bit high possibly from elevated rt3? Which would tie in with overtraining/stress?