T Nation

Prolactin Keeps Raising While on TRT

As per title, my prolactin keeps going higher and higher while on TRT and it’s not estradiol related. The new blood test registered a new record of 57.5 ng/mL.
I guess I would have to do an MRI, but with the COVID-19 mess now it will be quite complicated.
I’ll jump on cabergoline to bring it down for now, as my libido is non existent basically, but I’m curious to know what’s the mechanism behind it. All the medical literature I’ve seen is linking it to an increase in E2, but 6 weeks ago was 40 with an E2 of 16 pg/mL, so that’s not the case here.

Holy moly, that is a very high prolactin. As soon as you can get an MRI, please do it. Maybe you could at least get an online appointment with a doctor to see what you can do in the mean time?

I saw my doctor 2 days ago. But in any case I had it at 40/45 in the last year and he told me not to touch it if it doesn’t give me symptoms.
He says he sends you for an MRI when it goes above 100.

I’m gonna take cabergoline for now, but I was curious on why TRT pushes it so high, with apparently no connection with E2 levels.

Same here, MRI came back fine and no E2 issues but high prolactin.

Thanks for the report. What’s your doctor saying about it?

My GP didnt know what it did it males.

The Endo had no issues with the high prolactin following the clean MRI and didn’t want any follow up.

I don’t think it is doing me any harm, jut makes my nipples sensitive.

Understood.
It’s a libido killer in my case and I don’t feel confident keeping it so high.
Did your endo explain what’s the mechanism at play here, since you don’t have a tumor?

No he was very condensending and didnt think I should have been on TRT, yet wasnt willing to have any debate about it whasoever. He basically scoughed at the high prolcatin levels and told me clenching could cause the high levels. He was a bit of a prick to be honest.

Typical doctor behaviour.

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@highpull what are your thoughts on that?
Did you have any of your patients that experienced it?

Yes, but all have microadenomas. It will jump around and I believe that to be independent of TRT. A few need cabergoline. I’ll order the MRI, but send to neurology for co-management if an adenoma is present.

In your case, I would have insisted on an MRI.

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I suddenly got high prolactin about a year and a half ago. Reading this thread made me go take a look at my past labs. In my case, coincidentally (or otherwise), my prolactin spiked when my e2 was at its historical highest. Incidentally, I just recently asked my doc if prolactin had any benefits for males, and he said, “No”.

Like you I am very sensitive to elevated prolactin, so I am a low dose of caber (0.125mg/week)…half of a half of a one half mg pill.

Isn’t the treatment for microadenomas a dopamine agonist anyway? Or do they do surgery for it these days?

How would you explain @lenono’s case?

Yes and yes. I want a baseline MRI in case the response to medical management changes or other symptoms present.

I cannot. Medications? Hyopthyroidism? Hx of head trauma? Stress? Kidney, liver issues?

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Depends how big it is and whether it is being suppressed by dopamine agonist

My TSH is on the high side but still within range (3.6 mlU/L range 0.27 - 4.20). I have been for a TSH stimulation test but results were judged to ba acceptable. I take no other medication or have any other health issues that I’m aware of.

My prolctin last checked was about 1200 mU/L (range 86 - 324)

OK. That would eliminate them as a cause then.

On a prolactin test with a reference range of 3-15. At what point do you start seeing the prolactin causing problems/symptoms?

I have 17 in prolactin but I am taking kratom everyday which I believe can cause higher prolactin levels.

Good question and I do not know the answer. The typical prolactinemia patient I see has levels in the 20s and signs and symptoms of low testosterone. Giving them testosterone removes those symptoms. This is regardless of whether or not there is a micoradenoma.

This is relatively high TSH that can be likely a symptom of undiagnosed hypothyroidism. Usually anything above 2 is suspicious