+ 1 High PRL from TRT?
I'm doing 75mg of TE 2x weekly, totaling 150mg, no AI, no HCG. Two months on this protocol.
Pulled bloods last week, checked for hormones, lipids, liver, CBC.
I didn't check for PRL for a while (before starting TRT two years ago) so I included it just for curiosity, really.
Results as follows:
tT >13.50 ng/ml
E2 56 pg/ml (7-43)
DHT 78 ng/dl (40-100)
SHBG 45 nmol/l
PRL 54 ng/ml (!)
Test is above therapeutic range and will lower the dose. SHBG is on the high side, estradiol assay isn't that accurate so might be normal or just a lil above the top. I'm not experiencing any estro issues.
The PRL is what concerns me here. I have no idea where that comes from. Symptoms specific to elevated PRL are nipple leakage (clear fluid), crushed libido, and cognitive/depressive symptoms typical of low dopamine (anhedonia, poor motivation, etc).
TRT never gave me much of relief, and I do suspect this might have something to do with it.
I did a pituitary MRI before TRT and did find a small adenoma, which happens to be non-secreting, and not expanding, so I really doubt it's related.
Your thoughts?
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Bump, anyone?
Area-1255The only way TRT would raise Prolactin is if you are having Estrogen issues, when the E2 rises Prolactin rises. Its also possible you have a neurological issue, specifically with the hypothalamus, maybe you are either genetically or chemically susceptible to Dopamine deficiencies.
Could also be something as simple as not getting enough Zinc, B6 and Tyrosine in your diet.
--> https://www.ncbi.nlm.nih.gov/pubmed/2753470
--> https://www.ncbi.nlm.nih.gov/pubmed/263321
--> https://www.ncbi.nlm.nih.gov/pubmed/11291999
Given the clusterfuck of neuropsychiatric symptoms I deal with on a daily basis I sense hypothalamic dysfunction is the straightest answer. I supplement with B complex daily and I take care not to overdose B6. Diet is plenty of tyrosine and aminos.
ZInc is a strange one for me, I tested borderline at 54 a couple of yrs ago, I only supplement with 7.5mg Zn citrate daily because more than that gives it goes to worsen my hypogonadal symptoms.
When I wasn't supplementing with Zn at all at least TRT gave me improved muscular responses, hardness, strenght. Add Zn, and that was lost.
I believe this is due to the fact I must have intracellurar 5-AR deficiency, my beard got really sparse after I developed low T and even pushing test into ultraphysiological range didn't change a thing, unless I dialed down SHBG by crushing E2, that made me feel even more worse so nowadays I use low-dose winstrol (5mg/die) and that does the trick for me.
I sense the PRL elevation comes from two years of shitpoor doc-prescribed TRT that went to down-regulate AR and 5-AR expression because of chronically high SHBG shifting the balance toward estrogen dominance.
That means my system responds more readily to estrogen than does to androgens, hence the high PRL.
I hope with time, by keeping SHBG low and E2 in check, I will be able to reverse this condition.
Ever get your thyroid checked? High prolactin can be a sign of hypothyroidism.
I am actually on thyroid meds, T4 plus T3, got everything in check.
Do you have a TRT doc? Taking caber to lower prolactin or adding proviron to lower SHBG and increase free test would be the quickest options but I would say ask a doctor to make sure there are no underlying conditions before adding any drugs.
Testosterone is dopaminergic. High SHBG = Low Free Testosterone . Low Free Testosterone = Lower Dopamine. Lower Dopamine = Higher Prolactin.
I used to but I'm on my own now. I can still see him though, but I'd need to wait for months, even if he's a private endo.
Testosterone is indeed dopaminergic as androgens upregulate D2 receptors in the brain.
Total test is above the charts so is unlikely that free T is low, though a problem with DHT (which has highest binding affinity) might exist. However, if I try to dial SHBG down I might get excessive aromatization. I don't want to deploy an AI as I don't feel good on them, plus they mess with my lipids.
Caber is kind of "heavy artillery" here and might offer a quick solution, but I want to understand what is going on.
I don't know where the high SHBG is coming from either. Perhaps E2 stimulated it first, then as free T reduced it normalized.
I believe it might be helpful to lower test dosage down to 50mg biweekly, then add a synthetic DHT to balance things.
That PRL levels is what you get on antypsychotics, not hypothyroidism. Pregnant women might display that level but underlying mechanism are different, in gestation you get progesterone and estradiol acting synergically at the pituitary lactotroph cells. It really looks like things are pretty nasty at a neurochemical level, provided the adenoma isn't involved, which is a remote possibility anyway.
The estrogen from aromatization too isn't enough to raise PRL that high.
My next question would have been if you are taking any Rx meds lol
http://www.ncbi.nlm.nih.gov/pubmed/11048906
"PRL is elevated moderately by olanzapine (mean change, 1-4 ng/mL), intermediately by haloperidol (mean change, approximately 17 ng/mL), and strongly by risperidone (mean change, 45-80 ng/mL)"
Not even haldol could raise it that high. Anyway, no, I'm not taking any meds, just the hormones mentioned.
Yeah I think I read that study, not sure where else to go with this. I'm just scratching the surface and you seem to have a solid grasp on the science of it so I would have to keep digging. In the meantime, go talk to a real doctor, I just play one on TV ;-)