TRT in Canada if borderline Testosterone and Prolactin?

[LookingForAnswers]

I’m in Canada (late 50’s) and as I have many of the low-T symptoms (fatigue, poor motivation, no drive, flat mood). I went to WellnessHaus to get a bloodwork requisition and hopefully start TRT. Here are my labs

Prolactin: 20 µg/L (20 ng/mL)
Total T: 20.7 nmol/L (~596 ng/dL).
Free T: 391 pmol/L (~11.3 ng/dL).

I was told that the prolactin was “high” (18+ is considered high) and I should talk to my GP about an MRI. But from what I’ve read, most doctors here don’t even think MRI until prolactin is much much higher. I asked if getting my prolactin down or if I convinced my GP to request an MRI that said I don’t have a tumour would be enough, they then said they usually won’t prescribe unless total T is under 11 nmol/L (~317 ng/dL). That to me sounds like the levels a conservative GP would use, not an optimization clinic.

My gut feeling is because I’m borderline low testosterone they may have considered prescribing TRT with my symptoms, but they are hiding behind the “high” prolactin” for maybe liability reasons?
I’d really like to hear from anyone who was in the same range (T around 550–600 ng/dL, prolactin slightly high… or even one and not the other) and still got TRT in Canada — which clinic helped you? Or even U.S. guys with similar numbers who got approved, just so I know it’s possible.

 

[Seagal]

High prolactin can cause your symptoms!
Your testosterone is not borderline.

Do you take any medications?

 

[LookingForAnswers]

High prolactin can cause your symptoms!
Your testosterone is not borderline.

Do you take any medications?

Thanks for your reply. No medications. I am surprised if 20 causes significant symptoms considering 18 is considered high normal. I have RBC, WBC below normal range and my doctor just shrugs. My platelets are 80 while normal is 150-400 and my doctor says your probably won’t notice any problems unless you are under 50. So I find it odd that anyone thinks prolactin that is 10% outside the range is concerning.

As far as testosterone levels, I should have clarified…. Yes it’s probably normal based on health Canada official ranges, but borderline for a clinic that attempts to optimize energy and libido. I have heard many think men should be 30-35 to feel closer to their peak. The odd thing is 3 years ago I had it tested (long before I’d heard of TRT) and my level was at 12. I have less energy, exercise less, and sleep a lot less (was getting 5.5h on average back then but it is under 4.5h a night these days - just can’t get back to sleep after I wake up). All these things, I thought, affected testosterone negatively. So I’m surprised the number now is as high as 20. The only thing I’ve done is eat a keto ish diet, with a lot more red meat. But I haven’t read anything about a carnivore diet affecting Testosterone.

 

[Seagal]

You are right about your prolactin being only slightly above range. Also opinions vary about T optimization.
Imo the information about your nutrition might be crucial. I recommend you try cyclic keto including 1-2 days per week where you eat 'normal' reloading on carbs. Did you get a test for fT3 and fT4?

There are few members here on carnivore diet who can give additional advice. @FunkOdyssey

 

[Cataceous]

Prolactin works against dopamine, so it can contribute to the symptoms you describe. According to Dr. Saya, and also in my experience, in some men even prolactin over 10 ng/mL can cause issues. Perhaps it depends on the level that's appropriate for the individual's physiology. There's a simple test for it: run a trial with micro-doses of cabergoline. This could be something like 50-100 µg twice a week. Knock prolactin down to about 5 ng/mL and see if it makes a difference.