New member: Prolactinoma

[Libra88]

Greetings everyone. I am a 28 y/o male who is dealing with a prolactinoma that has caused my testosterone to go below normal (around 271) and prolactin too high (around 231) Long story short, the tumor has shrunken a bit since starting cabergoline( for 2years now) and brought my prolactin down to 20ng, just above the maximum for prolactin in males. I aslo started TRT 2 months ago. I spoke with Dr. Saya over the phone about my situation which I really do appreciate and am now on a protocol of taking 75mg test cyp.(2x a week IM), 400 units of HCG (2x a week) and .125mg of anastrozole (3x a week). He also recommended that I up my dose of cabergoline to bring it even lower which I added .25mg to my .5mg(2x a week) protocol so I just added half a pill to one of the days. Just got my lab results back:

(started TRT Feb. 21st and got this bloodwork around mid-April)

Total T: 690
free T: 24pg
estradoil: 11.7pg
SHBG: 23.4nmol
prolactin: 40.4ng

I wish I could speak with Dr. Saya but he booked until late May, so I got an appointment with Dr. Calkins? (sorry for mispelling) for May10th. I am very concerned about my prolactin and estradoil levels and do not want to wait until then to change my protocol, but need help from this forum or even Nelson Vergel or Dr. Saya if they are reading this. I appreciate you all for taking the time to read this post and I hope I get an answer from the Excel Male family. Thanks in advance!

Syed Jamal Mirzada

 

[CoastWatcher]

Greetings everyone. I am a 28 y/o male who is dealing with a prolactinoma that has caused my testosterone to go below normal (around 271) and prolactin too high (around 231) Long story short, the tumor has shrunken a bit since starting cabergoline( for 2years now) and brought my prolactin down to 20ng, just above the maximum for prolactin in males. I aslo started TRT 2 months ago. I spoke with Dr. Saya over the phone about my situation which I really do appreciate and am now on a protocol of taking 75mg test cyp.(2x a week IM), 400 units of HCG (2x a week) and .125mg of anastrozole (3x a week). He also recommended that I up my dose of cabergoline to bring it even lower which I added .25mg to my .5mg(2x a week) protocol so I just added half a pill to one of the days. Just got my lab results back:

(started TRT Feb. 21st and got this bloodwork around mid-April)

Total T: 690
free T: 24pg
estradoil: 11.7pg
SHBG: 23.4nmol
prolactin: 40.4ng

I wish I could speak with Dr. Saya but he booked until late May, so I got an appointment with Dr. Calkins? (sorry for mispelling) for May10th. I am very concerned about my prolactin and estradoil levels and do not want to wait until then to change my protocol, but need help from this forum or even Nelson Vergel or Dr. Saya if they are reading this. I appreciate you all for taking the time to read this post and I hope I get an answer from the Excel Male family. Thanks in advance!

Syed Jamal Mirzada

Welcome to Excelmale.

I understand your anxiety, but it would be foolish in the extreme to begin tinkering with your protocol - on your own, based on advice from strangers - when you have an appointment with the medical staff at Defy in less than a month. Since you have spoken to Dr. Saya, why don't you email Defy? The message will be routed to the appropriate person.

How much time had passed between increasing the cabergoline and the blood draw that resulted in these labs?

 

[Libra88]

Thanks for the quick reply...I upped the dose of cabergoline when I started TRT, so its been 2 months. I understand the appointment is close, but I feel like horrible and don't know an alternative. I will take your recommendation of emailing them thanks again. So do you believe my estradoil is getting to low?

 

[Vince Carter]

I take it you had an MRI and the Pituitary was "normal"

 

[Libra88]

I have had 2 MRI's since I found out about the tumor 2 years ago. It started as a 14mm adenoma and is now about 10mm so basically it has shrunk 2mm per year since starting cabergoline.

 

[CoastWatcher]

Thanks for the quick reply...I upped the dose of cabergoline when I started TRT, so its been 2 months. I understand the appointment is close, but I feel like horrible and don't know an alternative. I will take your recommendation of emailing them thanks again. So do you believe my estradoil is getting to low?

Assuming those were Defy tests (please post reference ranges for tests in the future since labs establish their own ranges), and that e2 is a sensitive, LC, MS/MS, result, it would seem your estradiol is very low.

 

[Libra88]

Yes they are done with Defy

Total T 690 (348-1197)
Free T 24.0 (9.3-26.5)
estradoil 11.7 (8.0-35.0)
SHBG 23.4 (16.5-55.9)
prolactin 40.4 (4.0-15.2)

 

[CoastWatcher]

Yes they are done with Defy

Total T 690 (348-1197)
Free T 24.0 (9.3-26.5)
estradoil 11.7 (8.0-35.0)
SHBG 23.4 (16.5-55.9)
prolactin 40.4 (4.0-15.2)

I'd be very surprised if you weren't having problems with that low estradiol value.

 

[Libra88]

Yes I agree, that is why I was thinking of reducing the anastrozale to 2x a week as opposed to 3x a week.

 

[CoastWatcher]

Yes I agree, that is why I was thinking of reducing the anastrozale to 2x a week as opposed to 3x a week.

That's probably reasonable. It's still a good idea to check in with Defy since you've spoken to Dr. Saya.

 

[Vince Carter]

Yes I agree, that is why I was thinking of reducing the anastrozale to 2x a week as opposed to 3x a week.

I would say that that is reasonable, pulling an 11 E2 is not good.

 

[Libra88]

Also I haven't really felt any different from 2 months of TRT other that bloating and a little bit of b.o. I would like to know considering if everything else is balanced, could raising my estradoil to 20-25 help me feel better and help the testosterone give me a better effect on me overall?

 

[Vince Carter]

the typical recommended E2 is level is 21-30. 11 is too low and will cause you problems. In the scheme of E2 it would be better, a bit, to be too high than too low. You're only two months in, expectations have to be lowered as this is a long journey not a quick fix.

 

[Libra88]

I understand, I just spend alot of time researching about time of TRT working in different areas of your body, I just thought by 2 months I should be starting to get better at least gradually...

 

[CoastWatcher]

I understand, I just spend alot of time researching about time of TRT working in different areas of your body, I just thought by 2 months I should be starting to get better at least gradually...

You have every reason to be hopeful, but two months is not long at all in this game. You've yet to have a full consultation with Defy...patience is the key to eventually reaching a goal.

 

[Dr Justin Saya MD]

Hi Libra88-

I'd dial back slightly on anastrozole to 0.125mg BIW and increase the cabergoline to 0.5mg TIW until your consult.

 

[Dr Justin Saya MD]

As a side note, your E2 is lower than we like, but with the somewhat low SHBG you will have a higher free estradiol (same as a higher free testosterone) at any given total E2 level.

Translation...the E2 is a bit low, but not as low as it appears on the surface. Hope that makes sense.

 

[Libra88]

Thank you for responding Dr. Saya. I understand the whole low shbg means their is more free test or estradoil. So now I will take anastrozole .125 2x a week and up the dose of cabergoline another half a pill. Can ED be caused by prolactin being a little bit above normal ranges? Also I still feel lethargic, could be from my cortisol I am assuming?

 

[Dr Justin Saya MD]

Thank you for responding Dr. Saya. I understand the whole low shbg means their is more free test or estradoil. So now I will take anastrozole .125 2x a week and up the dose of cabergoline another half a pill. Can ED be caused by prolactin being a little bit above normal ranges? Also I still feel lethargic, could be from my cortisol I am assuming?

Yes the prolactin level can certainly cause ED, as can lower E2.

Fatigue/lethargy has many possibilities including prolactin, E2, cortisol, thyroid, sleep, etc.