T Nation

Low Test caused by a Prolactinoma


#1

Hi all:

I'm a 28 y.o. guy and I recently learned I've had a condition for many years that is killing my testosterone levels (prolactinoma). My T level is around 7 nmol/L, where normal for my age is 20 - 25. All other hormones are okay. Doc is currently undecided if TRT is necessary. She wants to wait and see.

I'm currently at 200lbs and 18% body fat. I'd like to be 12 - 15%, which means losing 10 - 15 pounds. I work out 5 - 6 days a week with either a weightlifting workout or interval workout like Insanity. I eat about 2000 - 2300 calories per day with a ratio of 40% protein, 30% carbs, 30% fat.

I've plateaued at 18% body fat whenever I've tried to cut over the years. Any advice for helping to break through?

If the doc does recommend TRT, any advice from those currently on it?


Prolactinoma (Pituitary Tumor) Causing Low T, Host of Other Issues
#2

What in the hell is she exactly "waiting and seeing"? That tumor on your pituitary ain't going to go away on its own...is she a fucking feminist that thinks testosterone is the devil? Find a new doctor--one that actually gives a shit about you


#3

I forgot to add, a pituitary tumor can also cause your gonadotropins to either be excessive or minimal (most likely)...you need to get the blood tests recommended in the Sticky...especially LH/FSH and other pituitary hormones (TSH)...


#4

Apologies for being unclear... I'm currently taking Dostinex to reduce my prolactin level and deal with the tumor. The doc wants to wait and see if the reduced prolactin will restore my natural T production.

Doc says the goal is not to get normal prolactin levels, but to restore T levels. Problem is, I've been on Dostinex for 6 months. While the prolactin is edging lower, it's still quite a bit above normal (100 vs. 1 - 15 normal range). T levels haven't improved over that period. A clinical study I read suggested T levels should recover pretty quickly (2 - 16 weeks) once Dostinex treatment was started.

I'm trying to figure out what to do in the meantime, since I'm still trying to drop body fat. Also, when do I decide enough is enough and press for TRT?


#5

Here are the values from my blood work before I started Dostinex treatment:

Testosterone: 7.4 nmol / L - Lower than ref. range of 8 - 25
Free Testosterone: 157 pmol / L
Bioavailable Test.: 4.0 nmol / L
Estradiol: 88 pmol / L

SHBG: 15 nmol / L
DHEA-S: 24.6 umol / L - Higher than the ref. range of 2.2 - 13

LH: 2 IU / L
FSH: 2 IU / L
TSH: 2.3 mIU / L
Free T3: 4.4 pmol / L
Free T4: 15.3 pmol / L

Everything is within range (to the best of my knowledge), except the Testosterone (low) and the DHEA (high). Sorry, I'm a goofy Canadian, so the results might be in different units (mol vs. g)

Any comments on the LH / FSH levels - since they are at the lower end of the range? I will cross-reference the sticky to make sure my next blood test has all the recommended hormone tests on it.


#6

LH and FSH are definitely low...this is more than likely the reason for your low testosterone...I'm not sure if you pituitary is receiving signals telling it to lower gonadotropin production due to your prolactin issues, though I suspect this is the case...

Do you have ranges for any of that other bloodwork? It would be helpful since Im not sued to the SI units.

I agree with your doctor that you need to get your prolactin under control...though it doesn't appear that your meds are helping you in that regard...you should probably press for a higher dose, or a different med (there is one called Bromo or something like that, though this is not an area I am particularly well versed in so I don't know the difference between the drugs)...6 months is a long time to fart around and feel like shit in the meantime...press your doctor to address the issue more aggressively, IMO...


#7

I'll see if I can convert some of the blood results...

I'm on the best drug for this prolactin problem that exists. Bromocriptine has all kinds of side effects and isn't anywhere as effective as Dostinex. I've been pushing the dosage of the Dostinex higher and been getting more and more depressed as a result (one of the lesser seen side effects of the drug). I'm going to see someone about that.

I agree 6 months is a long time - since this drug typically works in under 16 weeks. I'm unsure what to do about it otherwise.


#8

Here are the other reference ranges. I added in a couple more results:

Testosterone: 7.4 nmol / L (Ref. range 8 - 25)
Free Testosterone: 157 pmol / L (Ref. range 175 - 700)
Bioavailable Test.: 4.0 nmol / L (Ref. range 4.0 - 16.0)
Estradiol: 88 pmol / L (Ref. range 0 - 160)

SHBG: 15 nmol / L (Ref. range 10 - 55)
DHEA-S: 24.6 umol / L - (Ref. range 2.2 - 13)
Albumin: 47 g / L (Ref. range 33 - 48)
Cortisol: 574 nmol / L (no ref. range given...) = 208.1 ng/mL
Cholesterol: 3.91 mmol / L (Ref. range 3.2 - 4.6)

LH: 2 IU / L (Ref. range 1 - 9)
FSH: 2 IU / L (Ref. range 1 - 18)
TSH: 2.3 mIU / L (Ref. range 0.2 - 6.0)
Free T3: 4.4 pmol / L (Ref. range 2.7 - 5.7)
Free T4: 15.3 pmol / L (Ref. range 10 - 25)

Complete blood count, glucose & insulin were within normal range. I don't have any other blood results that the sticky mentions. I think this more than covers it.

I think it's entirely possible my testosterone production will return to normal if the prolactin can be dealt with, since DHEA is high, while LH and FSH are low.

Edited to correct - Prolactin inhibits GnRH, which controls production of LH & FSH.

The only wrinkle is the Dostinex - it hasn't lowered the prolactin enough at the high dosage I'm on. I had a new blood test last week, so I'll report what the updated results are later this week.


#9

How big is your adenoma? I ask because I have a non-secreting pituitary microadenoma which may have caused my hyopgonadism and am on TRT now. I'll be doing a post about my case later on so as not to hijack your thread. If the medication isn't controlling the prolactin level like it should has surgery been discussed or recommended? What were/are your prolactin levels?


#10

Yeah everything falls pretty much were I would expect for your case...you've really gotta get the prolactin issue under control before you can go further, IMO...are you sure you wouldn't be willing to try a course of Bromo? If you have maxed out your caber dose, then it may be worthwhile to consider...I wish I had more to offer, but this is a very unique case...solution is simple in theory, but not so much in practice...


#11

The macroadenoma I have is about 2.5cm x 2.5cm according to the MRI I had in August. I have another in early February, so we'll see if there's any progress.

Surgery is ineffective in 85% of cases, since the adenoma grows back in 2 - 5 years. Drug therapy is by far the recommended course of action.

My prolactin level was originally 1,875 in July. After 6 months of Dostinex at a current dosage of 2.0mg / week, I'm down to 100 (normal is under 15). Problem is, it hasn't improved in the last few months, so I'm worried the Dostinex has lost it's effectiveness.

I'd increase the Dostinex dosage more, but I'm really worried about the depression it's causing. I will have to take this drug long term (years, if not for the rest of my life). Anyone know if once the prolactin level normalizes you can cut back on the drug?

I'll ask about Bromocriptine when I talk to my Endo this week.


#12

Okay, a quick update. I got my most recent blood test results back. Prolactin is down to 50, but everything else is unchanged.

I talked to the Endo today. She wanted to cut back the Dostinex due to the depression it was causing. I told her no, because I wanted the prolactin level to get down to normal. I saw a psychiatrist earlier this morning and she was prepared to prescribe an anti-depressant to deal with the side effects.

The Endo also mentioned going on TRT with just testosterone replacement. I asked about HCG and Arimidex (thanks to this board!) and she knew about them both, but had never used them in TRT before and was not prepared to give them to me. She didn't think they were necessary.

I wasn't keen on TRT with just testosterone, so I pushed for higher Dostinex with the goal of having hormone levels recover on their own. The Endo was fine with that - less work for her.

I asked about Bromocriptine. It has a much higher rate of side effects and is not as effective as Dostinex. It has the same mode of action, so it wouldn't aleviate my current depression side effects.


#13

Don't discount the possibility that the prolactin and low T are causing your depression instead of the dostinex...I have no idea if its gotten worse or better as your dosage has increased, but low T is a major cause of depression in many...

Hope you get this under control...very unique case so I'm interested in seeing how you turn out


#14

I wasn't 100% happy before starting the treatment, but it's definitely made any depression I might have had much worse. I used to take the Dostinex every other day, and the day after I would feel horrible. It's been getting worse as the dosage has gone up too.

From the research I've read, there's a chance that my testosterone levels might not recover even after the prolactin is gone. I've been looking at using Clomid instead of TRT. Anyone have any experience with that?


#15

Clomid probably isnt a good idea if you are already depressed...it has been known to cause serious mood disturbances in men...Nolvadex is probably a better choice if you want to go the SERM route


#16

Update: I've had some more blood tests done and my prolactin level is down to just above normal at 35. However, none of the other hormones have moved.

The endocrinologist thinks that if things were to recover they would have done so by now. She wants to start me on TRT. I spoke with her before about not doing TRT alone, but with Arimidex and HCG. She didn't think it was necessary.

She wasn't worried at all about the effects of straight testosterone replacement. I mentioned things like wild fluctuations in T levels and testicular atrophy, but she wasn't worried. She said when I wanted to have kids she could provide other drugs to make it possible.

From what I've read here and elsewhere, I'm not sold on straight TRT at all. I haven't brought up Clomid or Nolvadex to her, but I'm going to when I see her later in February.

Any thoughts or experience with straight TRT? Is it something I should consider, then discontinue if I don't like the effects? Or should I just flat out refuse to consider it?


#17

These values are very low. Could be suppressed due to your high prolactin, or your prolactinoma could be pushing these downward. At any rate you appear to be secondary. Best route would be to try to bring these up with a SERM restart first and go from there. HCG monotherapy is also an option.


#18

Good to hear some agreement on what I was thinking for treatment. I definitely agree it's secondary hypogonadism. Thanks.

I know that high prolactin can supress testosterone production, but what exactly do you mean by the prolactinoma pushing my LH & FSH levels lower?

I guess the better question is: With my prolactin levels near normal, what is still keeping my hormone levels low?


#19

Another update:

I got a full copy of my recent blood test results from Jan 30. Here's some comparisons between last June and now. I converted everything to US units.

Testosterone - Range: 230 - 835 ng/dL
June 2011: 219
January 2012: 221

LH - Range: 1 - 18 IU/L
June 2011: 2
January 2012: 2

FSH - Range: 1 - 9 IU/L
June 2011: 2
January 2012: 3

Cortisol - Range: N/A ug/dL
June 2011: 20.8
January 2012: 17.9

Estradiol - Range: 0 - 43.6 pg/mL
June 2011: 23.9
January 2012: 14.1

DHEA-S - Range: 0.64 - 3.75 ng/mL
June 2011: 7.1
January 2012: 5.5

Prolactin - Range: 0 - 0.35 ug/L
June 2011: 43.1
January 2012: 0.81

My T, LH and FSH haven't moved. Cortisol, Estradiol and DHEA-S are down, but DHEA-S is still higher than range. Estradiol dropped almost in half!! My prolactin level is still above normal, but is close. My Endo said that prolactin under 2.0 should let gonad hormone production resume if it were going to.

My doctor wants me to start on Wellbutrin to help with depression. I've read that Wellbutrin stops Nolvadex from working properly, if I go that route.

Opinions? Should I use the Wellbutrin - since I might be looking to start a SERM treatment?


#20

yeah, why would she be worried. she's not the one who has to suffer through the hormone swings, the high estrogen, the stressed out adrenals, etc. etc. etc.

look, this is your life, your body, your one and only shot at this. push for a treatment plan that you agree with. your doctor is an advisor a partner - she doesn't know everything and is definitely not GOD. If you don't like what she is suggesting and you can't work with her, then go find a doctor that you can truly partner with.

you also have high TSH. you may want to test RT3 and get the 4x daily saliva test.

did you ever test D25-OH, B12, or ferritin/total iron capacity?