When is Prolactin too high and what are benefits of lowering it

My Prolactin is a bit high at 448 and the UK range is 86-324 mU/L. One doc said to me its not a problem another said I should take Cabergoline to lower it at 0.25mg twice a week. I wondered what is the benefit to lowering it to what level for us on TRT. I was told its normal to have high Prolactin on TRT?. Do we feel any better if it is lower, I did read that high Prolactin can increase fat round the middle, I must say I find it hard to shift the love handles , whether we can blame that on Prolactin I dont know and how high does it have to be to cause fat. I also wonder if it someway interferes with the efficiency of T etc. In other words whats wrong with having slightly elevated Prolactin.?

 

Be careful when messing with Cabergoline. It can crash your prolactin and has negative effects on dopamine in the long term.

I would not say that your levels are too high

 

What’s your free testosterone E2 and SHBG levels

 

What’s your free testosterone E2 and SHBG levels

SHBG is 40 and Estrogen (Not the sensitive one as we dont have it in UK) is mid range and Free T is 70% up range

 

Be careful when messing with Cabergoline. It can crash your prolactin and has negative effects on dopamine in the long term.

I would not say that your levels are too high

okay thanks, I thought the idea of lowering Prolactin was by doing so Dopamine was increased, ie Prolactin lowers Dopamine?

 

OK, I looked at the comments and some I take issue with. Prolactin is not an adult man's friend.
Prolactin actions:
1) acts synergistically with LH to stimulate testosterone secretion from testicles by increasing the number of LH receptors in the testis;
2) influences adrenal androgen formation;
3) enhances testosterone uptake by prostatic cells;
4) alters intra-prostatic androgen metabolism
5) increases uPA to dissolve ECM (extracellular matrix) and facilitate spread of CA
6) enhances angiogenesis
7) decreases libido
8) decreases cognitive function

But the caveat here is that I am a HemOnc and my focus has been prostate cancer and prostate diseases for the last 40 years. So in my context, I like keeping prolactin levels low, very low (e.g., < 10 ng/ml). With TRT, the T ⇢ E2 and the estrogen will increase PRL (prolactin). So I want my adult men to have great cognition, any chance at good libido, and not stimulate PCa (prostate cancer). I have used a lot of cabergoline (Dostinex®) in my medical practice and have found (by checking fasting PRL levels) that often as little as 0.125 mg twice a week (biw) will lower PRL < 10. I also do not want my patients who are on TRT to develop gynecomastia and suppressing estrogen with an aromatase inhibitor and prolactin with cabergoline prevents/solves that problem. So when I use TRT, I monitor PSA to ensure no serial ↑ indicating that an occult PCa has been awoken; I use an AI like anastrozole (Arimidex®) at 0.5 mg biw and titrate the dose based on estradiol (E2) levels, ensure the PRL level is optimal (for my patients < 10) and use cabergoline, but start with 1/2 tab or 0.25 mg biw and lower or raise pending fasting PRL level; I check the DHT level since that is a potent hormone that stimulates prostate growth, which I do not want; and of course, I check the free testosterone which is far more important than total testosterone. I would consider using HCG to preserve the size of the gonads, but in my patient population that is usually not an issue.

 

okay thanks, I thought the idea of lowering Prolactin was by doing so Dopamine was increased, ie Prolactin lowers Dopamine?

Sexual function and depressive symptoms in men with hypoprolactinaemia secondary to overtreatment of prolactin excess: A pilot study - PubMed

The results obtained indicate that men with dopamine agonist-induced hypoprolactinaemia are characterised by impaired sexual functioning and reduced wellbeing. These disturbances are a consequence of subnormal prolactin levels and do not seem to reflect adverse effects of dopamine agonists.

pubmed.ncbi.nlm.nih.gov

 

Sexual function and depressive symptoms in men with hypoprolactinaemia secondary to overtreatment of prolactin excess: A pilot study - PubMed

The results obtained indicate that men with dopamine agonist-induced hypoprolactinaemia are characterised by impaired sexual functioning and reduced wellbeing. These disturbances are a consequence of subnormal prolactin levels and do not seem to reflect adverse effects of dopamine agonists.

pubmed.ncbi.nlm.nih.gov

thanks for the paper, my understanding of this its the problems occured when Prolactin was driven too low , ie below 3 when normal is much higher. What am looking at is reducing my Prolactin which is over range to within range so presumably that should be okay?

 

OK, I looked at the comments and some I take issue with. Prolactin is not an adult man's friend.
Prolactin actions:
1) acts synergistically with LH to stimulate testosterone secretion from testicles by increasing the number of LH receptors in the testis;
2) influences adrenal androgen formation;
3) enhances testosterone uptake by prostatic cells;
4) alters intra-prostatic androgen metabolism
5) increases uPA to dissolve ECM (extracellular matrix) and facilitate spread of CA
6) enhances angiogenesis
7) decreases libido
8) decreases cognitive function

But the caveat here is that I am a HemOnc and my focus has been prostate cancer and prostate diseases for the last 40 years. So in my context, I like keeping prolactin levels low, very low (e.g., < 10 ng/ml). With TRT, the T ⇢ E2 and the estrogen will increase PRL (prolactin). So I want my adult men to have great cognition, any chance at good libido, and not stimulate PCa (prostate cancer). I have used a lot of cabergoline (Dostinex®) in my medical practice and have found (by checking fasting PRL levels) that often as little as 0.125 mg twice a week (biw) will lower PRL < 10. I also do not want my patients who are on TRT to develop gynecomastia and suppressing estrogen with an aromatase inhibitor and prolactin with cabergoline prevents/solves that problem. So when I use TRT, I monitor PSA to ensure no serial ↑ indicating that an occult PCa has been awoken; I use an AI like anastrozole (Arimidex®) at 0.5 mg biw and titrate the dose based on estradiol (E2) levels, ensure the PRL level is optimal (for my patients < 10) and use cabergoline, but start with 1/2 tab or 0.25 mg biw and lower or raise pending fasting PRL level; I check the DHT level since that is a potent hormone that stimulates prostate growth, which I do not want; and of course, I check the free testosterone which is far more important than total testosterone. I would consider using HCG to preserve the size of the gonads, but in my patient population that is usually not an issue.

thanks for useful info, can I ask you how low do you like Prolactin to be ie just under 10 or? Also re DHT you mentioned you check that, can I ask you what level of DHT is okay and if it needs lowering how do you lower it, eg Finasteride. I have problems with BPH and hairloss , my DHT varies from around 50% to 88% up range depending on what dose of T I am on, I use Gels which raise DHT more , unfortunately I dont do so well on injections, currently I am on a combo of both. I had Rezum for my BPH but its worse again if I raise my T to give 75% up range FT. So a trade off, for optimal FT my BPH gets worse and hairloss worse. I keep reading up on Finasteride but so far have not made the leap to use it as concerned about sides and post Fin syndrome etc. Not sure if its real or not some say it only happens if one is not taking T?

 

...
But the caveat here is that I am a HemOnc and my focus has been prostate cancer and prostate diseases for the last 40 years. So in my context, I like keeping prolactin levels low, very low (e.g., < 10 ng/ml). With TRT, the T ⇢ E2 and the estrogen will increase PRL (prolactin). So I want my adult men to have great cognition, any chance at good libido, and not stimulate PCa (prostate cancer). I have used a lot of cabergoline (Dostinex®) in my medical practice and have found (by checking fasting PRL levels) that often as little as 0.125 mg twice a week (biw) will lower PRL < 10. I also do not want my patients who are on TRT to develop gynecomastia and suppressing estrogen with an aromatase inhibitor and prolactin with cabergoline prevents/solves that problem. So when I use TRT, I monitor PSA to ensure no serial ↑ indicating that an occult PCa has been awoken; I use an AI like anastrozole (Arimidex®) at 0.5 mg biw and titrate the dose based on estradiol (E2) levels, ensure the PRL level is optimal (for my patients < 10) and use cabergoline, but start with 1/2 tab or 0.25 mg biw and lower or raise pending fasting PRL level; I check the DHT level since that is a potent hormone that stimulates prostate growth, which I do not want; and of course, I check the free testosterone which is far more important than total testosterone. I would consider using HCG to preserve the size of the gonads, but in my patient population that is usually not an issue.

How much testosterone are these patients getting and in what form? In the general TRT population we see a lot of effort to treat symptoms that ostensibly stem from excess testosterone administration. At least with injection protocols it's been uncommon to see attempts to limit daily absorption to the physiological production range.

 

thanks for the paper, my understanding of this its the problems occured when Prolactin was driven too low , ie below 3 when normal is much higher. What am looking at is reducing my Prolactin which is over range to within range so presumably that should be okay?

Yep, just be careful that you don't tank

 

OK, I looked at the comments and some I take issue with. Prolactin is not an adult man's friend.
Prolactin actions:
1) acts synergistically with LH to stimulate testosterone secretion from testicles by increasing the number of LH receptors in the testis;
2) influences adrenal androgen formation;
3) enhances testosterone uptake by prostatic cells;
4) alters intra-prostatic androgen metabolism
5) increases uPA to dissolve ECM (extracellular matrix) and facilitate spread of CA
6) enhances angiogenesis
7) decreases libido
8) decreases cognitive function

But the caveat here is that I am a HemOnc and my focus has been prostate cancer and prostate diseases for the last 40 years. So in my context, I like keeping prolactin levels low, very low (e.g., < 10 ng/ml). With TRT, the T ⇢ E2 and the estrogen will increase PRL (prolactin). So I want my adult men to have great cognition, any chance at good libido, and not stimulate PCa (prostate cancer). I have used a lot of cabergoline (Dostinex®) in my medical practice and have found (by checking fasting PRL levels) that often as little as 0.125 mg twice a week (biw) will lower PRL < 10. I also do not want my patients who are on TRT to develop gynecomastia and suppressing estrogen with an aromatase inhibitor and prolactin with cabergoline prevents/solves that problem. So when I use TRT, I monitor PSA to ensure no serial ↑ indicating that an occult PCa has been awoken; I use an AI like anastrozole (Arimidex®) at 0.5 mg biw and titrate the dose based on estradiol (E2) levels, ensure the PRL level is optimal (for my patients < 10) and use cabergoline, but start with 1/2 tab or 0.25 mg biw and lower or raise pending fasting PRL level; I check the DHT level since that is a potent hormone that stimulates prostate growth, which I do not want; and of course, I check the free testosterone which is far more important than total testosterone. I would consider using HCG to preserve the size of the gonads, but in my patient population that is usually not an issue.

Thanks for your input. I'm starting .125mg Cabergoline today(will administer bi-weekly) to help drive my 17+ prolactin level down to where you suggest is more optimal for libido that being <10.

Was doing daily sub-q injections of 8mg. test.C/P +330iu's hCG eod over the last 8 weeks or so and didn't seem to do well. Little energy and lack of good sleep at night, libido only lukewarm.

Now a change to 100mg. total test.E(split bi-weekly) + 50mg weekly Nandrolone for some joint pain relief and to help calm 3 herniated discs in lower back. So far, after 2 weeks, joint pain is easing and lower back pain is also better. Sleep is the same struggle but with more elevated e2(70 range) that is expected. Began taking .125mg Arimidex this morning to lower e2 a bit and hopefully Caber will help lower my prolactin levels down. Orgasms and erection quality hasn't been too good lately...hoping to change that around. Also, checked my PSA a couple of days ago...and am happy with 0.82.

Have to admit that the Nandrolone, even at the small amount of 50mg. per week I'm taking is having a positive effect on my workouts. Overall strength is up and physique appears more athletic. All good for now.

 

Regular caber use can cause heart issues apparently. At least with larger dosages.

What I've personally found is lowering prolactin helps you drop water weight and improves energy levels and libido a bit. If you drop it too low it also seems to affect erections negatively and causes all sorts of issues. A single 0.5 tab can nuke your prolactin by 50-80% so you've gotta be careful. I've crashed it many times.

 

I found Caber to cause extreme fatigue. I didn't get any of the magical benefits you read about on the internet. I wouldn't recommend it for anyone with prolactin levels below 35. It is normal to see spikes to 35. If your levels are in the 100s you may benefit from it. If your levels are in the 100s you need an MRI of your pituitary.

 

I was told its normal to have high Prolactin on TRT?

There’s is no medical science backing up your doctors claim that men on TRT have high prolactin or did he learn this in medical school.

This is nonsense and is just an excuse so he doesn’t have to provide medical care.

In other words whats wrong with having slightly elevated Prolactin.?

High prolactin can cause ED.

 

My Prolactin is a bit high at 448 and the UK range is 86-324 mU/L. One doc said to me its not a problem another said I should take Cabergoline to lower it at 0.25mg twice a week. I wondered what is the benefit to lowering it to what level for us on TRT. I was told its normal to have high Prolactin on TRT?. Do we feel any better if it is lower, I did read that high Prolactin can increase fat round the middle, I must say I find it hard to shift the love handles , whether we can blame that on Prolactin I dont know and how high does it have to be to cause fat. I also wonder if it someway interferes with the efficiency of T etc. In other words whats wrong with having slightly elevated Prolactin.?

My levels are a bit higher than yours and I'm about to start some caber so will let you know if I have any benefits.

 

My levels are a bit higher than yours and I'm about to start some caber so will let you know if I have any benefits.

Great thanks, I look forward to hearing how it goes

 

I found Caber to cause extreme fatigue. I didn't get any of the magical benefits you read about on the internet. I wouldn't recommend it for anyone with prolactin levels below 35. It is normal to see spikes to 35. If your levels are in the 100s you may benefit from it. If your levels are in the 100s you need an MRI of your pituitary.

How low did your Prolactin go on Caber, were you under range?

 

Prolactin went from 24 to .5 on Caber.

 

Prolactin went from 24 to .5 on Caber.

How much of a weekly dosage of Caber did you take for those results?