T Nation

Prolactinemia on TRT and Dostinex No Libido

I have been diagnosed with Prolactinoma.
I am on Dostinex 2mg biweekly and Depo Test 2,5ml a week for 7 months.
My libido and sex drive has not returned to normal but mood has improved and am loosing excess weight.
Could anybody advise next step.
Oestradiol < 61 Range 95-223 pmol/l
FSH 3.2 Range 1.3-19.3 IU/L
LH 2.8 Range 1.2-8.6 UI/L
TSH 1.42 Range 0.35-3.5 mIU/L
Free T4 8.9 Range 7.6-16.1 pmL/L
Free T3 5.7 Range 3.5-5.4 pmL/M
Total Test 4.6 Range 6.9-23.6 nmol/l
Free Test 88.0 Range 170-660 pmol/m
SHBG 31.4 Range 13.3-89.5 nmol/m
DihidroTest 1.03 Range 1.13-4.13 nmol/no

hope this helps.
no desire for sex even porn doesn’t do it for me.

You are low in every sense of the word, low E, low LH, low FSH, low TT and low FT. However your SHBG levels is midrange which bodes well for you and will be a factor in how well you respond to TRT. We see guys all day long with SHBG levels either too high or too low and this can make TRT challenging, for you twice weekly injections will produce good results.

Beware most doctors have cookie cutter protocols that are designed for everyone, unfortunately everyone is different with varying levels of SHBG and nothing affects how often one should inject more than SHBG. Your doctor should have you injecting T 50mg twice weekly because injecting once weekly creates peaks and lows, towards the end of the week your levels are lower than they were at the start.

We also see guys who have undiagnosed thyroid issues and for TRT to work your thyroid hormones must be optimal. You may have hyperthyroidism as your fT3 is above range and your doctor is failing you. High fT3 can mimic low T symptoms such as weakness, and fatigue. For TRT work your thyroid have optimal thyroid hormones, fT4 and fT3 should be midrange. This might be why TRT isn’t working!

Nobody injects 2.5mL of anything as it’s just too much T for anyone to handle. Example I inject from a vial 10mL 100mg and I inject (.2mL) 20mg every other day do to my lower SHBG. If your dose is too high or too low you will feel little benefit. Where are you labs post-TRT?

Hyperthyroidism symptoms:

weakness and fatigue.
difficulty sleeping.
increased sensitivity to heat or cold.
weight loss or gain.
dry or puffy skin.
dry, irritated, puffy, or bulging eyes.
hair loss.
hand tremors.

Thank you for the prompt reply.
What blood work do you recommend I have done?
What could be the cause of my sex drive issues ?
The depo Test is a very thick oily substance which my doc told me will slow release into my system But i will try your method…I use 22guage needles.

There’s no need to harpoon yourself, most guys use 27 gauge insulin syringes and inject in the shoulders. My doctor started me out on 19 gauge syringes, the smallest you would want to go is 25 gauge. Your estrogen is low and your FT is low, just one of these being low is enough to cause sexual dysfunction and lower libido.

Jst know most doctors are ignoring E2 levels and aren’t monitoring them at all and guys on TRT are wondering why their sex drive and erections are missing, unless your E2 levels fall within a narrow window of 73.42 - 110.13 pmol/L neither will occur and you may not feel well.

You may need a small dose AI to help control E2.

Hi SystemLord

I have been to see my doc and blood was taken which i will post as soon as a get it.
The 25Gauge needles are shorter but i followed your advice and injected my shoulder.

What AI and dosage would you recommend AND is there a superior alternative to the Depo Testosterone brand i am using?



You need to find out where your E2 lands 4-6 weeks after beginning TRT, based on that reading you can either reduce T dosage to better control E2 or add an small AI dosage. You want to use as little AI as possible and T-cyp is all the same. I’m attempting to aim for the 650 range without an AI by injecting more often.