T Nation

How to Treat High Prolactin Caused by TRT?

Hi everyone!

New here, first post.

Before my question, background info:

42 years old.
Big into weightlifting for several years when younger, never used steroids or any other substances.
In 2002, sustained back trauma, injured two discs.
From 2002 until April 2016, could not lift. Had two back surgeries, took every kind of painkiller known to man to cope with pain.
I eventually chose to wean myself off pain meds entirely, and began to gradually get back into walking, stretching, light exercise. Began weightlifting again in April.

I suffered chronic fatigue, joint pain, NO sexual function, NO libido, insomnia for years.
I suggested to my docs to check my testosterone due to my symptoms, which THEY thought were “unrelated to testosterone levels”.
After much cajoling, they agreed to test me.

Surprise, surprise, my levels were incredibly low!

In March, my labs were:

PSA 1.9
SHBG 10 (reference range 10-50)
Total Test 100 (reference range 72-813)
Free Test 43.5 (reference range 46-224)
Estradiol 13 (reference range ><= 29)
TSH 1.4 (reference range 0.47-4.68)
Prolactin 13.1 (reference range 2.6-13.1)

Upon MY insistence, docs agreed to let me try Androgel.
I started with one pump per shoulder, noticed no benefits.
Two weeks later went up to 2 pumps per shoulder.
Still, no noticeable benefit.
Next, up to 4 pumps per shoulder, for another few weeks. Still no benefits.

Test level was rechecked, it had only gone up to 160.
Free test went up to 101.7 (ref range of 46-224).

Doc said, “Well, your free test went up, and that’s all that matters”.
I should add that I go to the VA for treatment, and despite there being a number of fantastic and caring practitioners there, the endocrine department seems incompetent in regard to understanding up-to-date protocols for hormone replacement therapy.

Once again, it was up to me to press the issue.

I asked to have injections. “OK, every two weeks you can come in for one,” they said.

No way!

I convinced them to have the nurse show me how to give the injection to myself WEEKLY.
From there, the doc prescribed .375ml of Test Cypionate once weekly.
I did that for one month.
Levels were rechecked–

Total test 206 (reference range 72-813)
PSA 1.9 (reference range 0.0-2.5)

They didnt bother to check Estradiol, Free test, FSH, LH or anything else, because they said “It doesnt really matter; we only care about the testosterone levels”.
Can you believe it?!

Once again, I was experiencing no benefits.
I asked to PLEASE let me increase the dose.
They said I could go up to .5ml

Well, after months of no benefits from Androgel and the tiny dose of Test, I said Forget This, and gave myself the entire dose in the vial, which was slightly more than 1ml (maybe like 1.1ml)

INCREDIBLE difference!!!

I FINALLY could get erections after YEARS of nothing, no more fatigue, no more chronic pain and achiness…It was a miracle!

One month later, my labs were done again.

This time they were ONLY gonna check total test…ugh…
I asked them to check my Estradiol, because I was concerned my Estrogen might be high, since I have leaned out EVERYWHERE, except I either have kept the fat around my chest/nipple area, or have gained fat there.

They checked my prolactin, PSA, total testosterone, and estradiol.
The estradiol results haven"t come back yet, but my other results were:

Total Test 658 (reference range 72-813)
Prolactin 23.2 WAY HIGH (reference range 2.6-13.1)
PSA 2.1 (reference range 0.0-2.5)

Here are my questions–

I feel AMAZING on the dose I am taking (little over 1ml). Anecdotally speaking, is this dose safe to take?
Without knowing my exact Estradiol levels (but assuming they’re high,) should I be taking an Aromatase Inhibitor?
Should I be taking something to get my prolactin level down? I have no lactation or nipple soreness.

My cousin is a doctor–very knowledgeable and accommodating. She has prescribed me meds before after having seen me. However, she is NOT a specialist in hormone replacement therapy.

The VA docs are neanderthals about TRT! Basically, they told me if my Estradiol level comes back high, they want me to either go way down on my Test dose (yeah right!) or come off of it COMPLETELY.

My life has been a nightmare before hormone replacement! I do NOT wanna stop taking test.

If I have some kind of info to show my cousin in regard to adding different meds in CONJUNCTION with the test, that will HELP my labs, then I wanna go that route.

Ideally, she could prescribe something for me, then I could go back to the VA and get labs AGAIN, then say, “weird…looks like the Test is working just fine after all”.

So, advice?
What other meds might help?

I am an intelligent/ informed person. I ALWAYS take meds as prescribed, but these docs at the VA treating me like an idiot because I wanted to take testosterone have really ticked me off.

Thanks for reading guys.
I have dealt with no sexual function and bad health for nearly 14 YEARS, and now the docs wanna take my restored health away, and I am just dreading that.


It sounds like you have it made. SO long as you can afford to supplement what the VA will pay for. Assuming your cousin will write the prescriptions.

GO here About the T Replacement Category

Read everything, do everything, including looking into your thyroid issues. Take that Iodine unless you are a seafood eater who uses table salt that has iodine. And take your temperatures morning noon and night and see if that is effecting things

After you read it all, you will know what is the best treatment protocol. Then you can push the VA docs and have your cousin fill in the holes

Please give your test dose in mg’s not ml’s.

You have to list the Test in mg. 1ml of T cyp that is 100mg/ml is very different from 200mg/ml.

You need an AI to keep the E2 in check. The high prolactin may be from a benign prolactin secreting tumor. You need an mri and a Med to reduce those levels.

My test vial says Depo Testosterone/Testosterone Cypionate 200mg per ml.

I have no doubt my cousin would prescribe any needed HCG or arimdex, etc.
But, I have no insurance-- all my meds are free from the VA, but if I want anything else, I have to pay out of pocket.


Hopefully I can afford extra meds.

Thanks guys!!!

Ok so you’re taking 200mg/week. That’s a lot for TRT. Two things are pretty certain. Your E2 will be very high on that dose. Likely 35 or higher. Your blood may thicken and cause a real health issue.

Try arimidex 0.5mg twice weekly then run labs in 4 weeks and adjust.

Hcg is a good idea. Try 250iu’s EOD or E3D.

Just got my Estradiol results back;

It was 49.

Well, I’m gonna shoot my cousin an email and see about getting a script for arimidex or anastrazole.

I DID read the stickies/links that were provided regarding T-replacement.
Thanks again guys!


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Ouch! That’s way too high.

I would reduce the T cyp and try 0.5mg or Adex twice weekly. Then retest in 4 weeks

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The meds are shockingly cheap. But full blood testing is not. If you get the VA to do your blood work you are n there

49 that will help you get in touch with your feminine side fortunately is easily fixed.

Taking over 200mg a week is one hell of a lot. You might want to spring for another blood test, you can get one that only costs $66 that will help you get your TRT and Adex right. Im going to guess you may be taking a solid 25% more than you should. But only a test will tell the tale, we are all different


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See these stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

So do metabolize T in a hyper fashion and need higher doses.

TRT does not increase prolactin, something else is going on. Prolactin can be released during orgasm and cuddling puppies and babies - so watch what you are doing and provide 48 hours buffer time.

Low thyroid function can rob your energy and not getting enough iodine can do that. Check overall thyroid function by checking oral body temperatures AM and mid-afternoon as per the thyroid basics sticky.

Not absorbing transdermal T is a symptom of low thyroid function.

Did you experience any head trauma? That can damage the pituitary.

You never had proper diagnostics. Should have checked LH/FSH before any TRT.
Doctors are the problem. If your testes were small and pulled up tight before TRT, that would be from low LH. On TRT that will probably happen unless you inject hCG.

Inject twice a week and always do labs half way between injections so differences in lab results are not lab timing artifacts.

So it will only cost me $13 per month for anastrozole pills.
But seems like some guys are injecting a liquid version?
Are pills less effective, or bad because they are metabolized by the liver?

Guys don’t inject a liquid version of anastrazole. Guys get or create the liquid version themselves and take it orally because it allows for more accurate or microdosing versus the pills which become difficult to cut/dose under 1/4 mg.

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Ok, thanks for the clarification!

Got my cousin to prescribe me the anastrozole, will take 2x p/wk.

Question about my test vial-- it says ONE USE ONLY. Can’t I just take 1/2 my dose with a syringe, put the cap back on, and put it in the fridge til my next injection?
I’d like to do it twice per week, instead of one big dose.
Will putting the vial in the fridge cause it to not be sterile?

Yes you can refrigerate it. Just bring it to room temp and shake the vial before drawing.

Thanks! Much appreciated!

I don’t know if it’s just a placebo effect, but I FEEL like the anastrazole is already having a noticeable effect… I’m not all puffy and bloated, I don’t feel sluggish… Hopefully this is a sign of good things to come!

Not a placebo. AI’s work quickly. Enjoy. It’s all good as long as you control E2.

Does this test show prolactin?