Blood Work - Elevated Prolactin

[Syphon22]

Hi all, I first want to say this is a great site with tons of info on here...keep up the great work!
Anyways.I decided to get some blood tests done on my own since it cost a fortune to get at my Dr. to order them. I did have a previous test done with them that checked my Test levels and they were low but got the normal analysis of they are okay because they are in range, which was on the low end of the range. They did not check the Prolactin or any other hormone levels that I have below. So, by reading on here and doing some more research, I decide to take my own health in my hands and got Blood results.
One concern is my High Prolactin, which could be the direct results of my lower Testosterone, and Estradiol levels?
-age
40
-height
67"
-waist
31"
-weight
162lbs
-describe body and facial hair
Normal
-describe where you carry fat and how changed
Have some around mid section and lower back. Exercise regularly for the past 5years; been trying to put on muscle, therefore body fat has been a little high to bulk up. BF =14%
-health conditions, symptoms [history]
Can't sleep through the night . High stress levels at times, Been through a recent divorce. headaches, orgasm not the best, decreased sex drive, and not being able to get, or keep an erection sometimes.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
none have recently ordered some research peptides tadalafil
-lab results with ranges
see below



-describe training [some ruin their hormones by over training]
Train for about 90-120 minutes 5 days a week. This includes free weights ,and cardio sessions.
-testes ache, ever, with a fever?
no pain or aches
-how have morning wood and nocturnal erections changed
Only when I have to wake up and have to urinate sometimes, otherwise nonexistent.
LabResults:



I have some new one coming in from Defy that I just got on December 22nd but they are waiting on my estradiol sensitive to come in before he shares them with me, however the results are similar to these shared, which was done in the end of October 2016. High prolactin and low test was the topic.
My question is does Defy (Dr. Saya) usually treat high prolactin with Cabergoline and trt? Does he try to restart my natural production with say clomid or HCG restart, or is it only cabergoline to start with and retest blood levels in 4-6 weeks and see if trt is needed. I guess I am just trying to make sure I am in good hands and since I have been through several Dr now that don't want to treat me.
Thanks

 

[Dr Justin Saya MD]

Syphon22- Have you had a pituitary MRI ordered by any of your previous physicians?

If so, please forward to be included in your chart. If not, I will need to order one for you with that prolactin level. Cabergoline would be the medical treatment of choice for the prolactin itself, but the bigger picture would be determining if you have a pituitary prolactinoma (MRI scan). Concurrent TRT with cabergoline would be a topic of discussion during consult.

 

[CoastWatcher]

Welcome to Excelmale. As you can see from his response, your case is in excellent hands with Defy and Dr. Saya. We hope you'll be an active member here and wish you all the best as you sort out your challenges.

 

[Syphon22]

Thanks for the quick reply Dr. Saya! And, yes, I have had an Mri scan and I did forward my results to your office. By the way you come highly recommended! I have an appointment with you on the 31st of the this month,so I am very much looking forward to discussing my results, history, and treatment with a knowledgeable Dr. as yourself. Here is a summary of my findings...Images were performed without and with intravenous gadolinium contrast.

FINDINGS:
PITUITARY: Normal for age. No mass seen. No evidence of pituitary
infarction CONCLUSION: No MR evidence of pituitary mass

 

[Syphon22]

Thanks @CoastWatcher for the welcome! I look forward to being a member. This site is absolutely amazing in terms of knowledge and history for men's health. Every man should and hopefully finds this site!

Thanks much

 

[Dr Justin Saya MD]

Thanks for the quick reply Dr. Saya! And, yes, I have had an Mri scan and I did forward my results to your office. By the way you come highly recommended! I have an appointment with you on the 31st of the this month,so I am very much looking forward to discussing my results, history, and treatment with a knowledgeable Dr. as yourself. Here is a summary of my findings...Images were performed without and with intravenous gadolinium contrast.

FINDINGS:
PITUITARY: Normal for age. No mass seen. No evidence of pituitary
infarction CONCLUSION: No MR evidence of pituitary mass

Very good. We will have an informative and productive chat.

I'll be interested in any trend in previous prolactin levels (if checked prior). If not, it would be informative (though not required) if you had a repeat prolactin checked between now and our consult. Certain factors can impact prolactin levels transiently and may skew results. Prolactin should be drawn fasting (at least 8 hours, preferably 12), no ejaculation X 48hrs prior (at least 24hrs prior), certain meds/supplements can also raise prolactin as well and should be discontinued for a few days prior to labs (unless they are absolutely necessary). Hypothyroidism can cause elevated prolactin, but your thyroid labs look okay. Look forward to our chat and Happy New Year!

 

[Vince Carter]

I was going to state the same as Dr Saya in regard to prepping for your next Prolactin test, very good advice to retest given that it was so very high.

 

[Syphon22]

Ok, so I met With Dr Saya, and by the way it is so nice to talk with a competent Dr. We came to the conclusion and treatment of Caborgoline at .5mg 2 times a week and Clomid therapy every day at 25mg for 8 weeks for a kickstart hopefully. 25mg every day was decided since my TT, E2 and FT was really low. Then, retest levels and go from there. Today is day 1 and I will keep you guys posted on my levels and how I am feeling. I am going to definitely get a blood test at around 4-5 weeks to test my Prolactin levels and will also include TT, FT, E2, LH, FSH, SHBG to see where I am at.

 

[CoastWatcher]

Thanks for the update. Please let us know how this unfolds.

 

[Syphon22]

Recent labs 12-22-16

Here are my labs from Defy on 12-22-16

 

[Syphon22]

Update Blood test on 2-23-2017

Hey guys!,
Here is an update of 4 weeks on Clomid and Cabor. I wasn't suppose to get any blood test until the 8 week mark,however, I couldn't wait and I wanted to see what my levels were. Well they surprised me! And with only 4 weeks under my belt, I am very optimistic. I didn't do a full panel of bloods this round because I will be doing those in 8 weeks (End of March) My prolactin really came down and I have responded well to the Caborgoline. I am going to call Defy in the morning and see what they want to do with my Estrogen as it is really high. I can tell too, I haven't been feeling the greatest mood wise and seem to be grumpy and moody often. No lumps or sensitivity in my nipples as of yet,but I don't want to wait with this high of estrogen to see if I develop any gyno symptoms.

Thanks all!

 

[Syphon22]

Another side note that I have noticed is the weight gain. I have gained 10 pounds in 4 weeks since starting this!

 

[CoastWatcher]

I understand you've had a few surprises, but there is no reason to think they can't be worked out. Keep us posted!

 

[Vince Carter]

Looks good and that you'll need some Estrogen management but you've def responded to the Clomid.

 

[Syphon22]

Okay, so the weight gain and hunger pain is getting out of control. I crave crappy food all the time! I am up almost 15 lbs now. My main diet is clean and calories are actually lower than before I started taking clomid and I maintained my weight. Also, sleep is crappy. Do you think this could be a cortisol thing? How do I combat it? I just got my labs drawn so waiting on results of my e2 since it was high in the 80s. Then I will schedule a consult with Defy for my intiali follow up since starting. I know it will take a bit to dial things in,but man, I dont know how much more weight I can put on! lol Things that have changed for the bad are mood, sleep, weight gain and the fact that I am dead tired at mid day. But, that is probably because I am not sleeping. My TT FT LH have responded really well with the clomid however, I do not feel all that great like I thought I would. Any thoughts?

 

[Vince Carter]

You're not going to feel good until you get that Estrogen under control but Clomid therapy's aren't my thing and I don't know how they fit in an AI, if at all, in that kind of treatment. I've been there with E super high like that and it's like super PMS, bitchy and crabby all the time...not a good place to be.

 

[CoastWatcher]

I do recall seeing posts from Dr. Saya and Melissa, Defy's PA, where they said that getting a grip, and keeping a firm grip, on estradiol is a key element in the success of a Clomid protocol. Which means they've seen this before. You still have every reason to be hopeful.

 

[Syphon22]

I hope so, the .5mg twice a week isn't doing anything for me. I am also on Dim,but thinking it is worthless. I did get my labs back and my E2 is stil in the 80s.

 

[CoastWatcher]

I hope so, the .5mg twice a week isn't doing anything for me. I am also on Dim,but thinking it is worthless.

When did you start the AI?

 

[Syphon22]

I started on the 9th of March. I am supposed to receive a call tomorrow on what to do next. I cant get in to see Defy until the 11th. That will be with the PA