When is Prolactin Too High and What are the 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.?

 

@Cataceous what are your levels of prolactin. And what made you get them tested?

My last test a couple years ago had it at 4 ng/mL. It had been as high as 11 ng/mL at one point. I had also driven it as low as 1.5 with the aforementioned micro-dosing of cabergoline. I was testing levels because of continued issues with libido and sexual function. I think higher prolactin was a contributing factor, not the only one; the prolactin itself could have been a symptom of something else, such as estrogen imbalance or HPTA shutdown.

 

So what are your levels prolactin and amount of cabergoline are you using?

My most recent prolactin (PRL) level was 2.9 (normal < 15.2) on a dose of cabergoline 0.25 mg twice a week (biw). I also was on anastrozole (Arimidex®) 0.5 mg biw with an E2 of < 5.0. Recognize that I am an old timer, soon to be 81 years old, and surviving a usual fatal disease diagnosed in 2018. I assume that most of you are half my age or close to that. How you invest your time in your health at your age and younger yields huge dividends when you are older. It is the folly of youth that discounts such advice. Most of you are smart enough to research the peer-reviewed literature. But it is how you track your health, selecting a real physician who is into prevention of disease and resolution of any abnormalities, what you eat, how you exercise and finding work that equates with being a "labor" of love providing fulfillment to your life, that are all vital concepts.

 

My most recent prolactin (PRL) level was 2.9 (normal < 15.2) on a dose of cabergoline 0.25 mg twice a week (biw). I also was on anastrozole (Arimidex®) 0.5 mg biw with an E2 of < 5.0. Recognize that I am an old timer, soon to be 81 years old, and surviving a usual fatal disease diagnosed in 2018. I assume that most of you are half my age or close to that. How you invest your time in your health at your age and younger yields huge dividends when you are older. It is the folly of youth that discounts such advice. Most of you are smart enough to research the peer-reviewed literature. But it is how you track your health, selecting a real physician who is into prevention of disease and resolution of any abnormalities, what you eat, how you exercise and finding work that equates with being a "labor" of love providing fulfillment to your life, that are all vital concepts.

Sorry, I thought your question was addressed to me and then realized just now that it was not.
But commenting on Cataceous's input, I do not think I would have bothered advising a patient with a prolactin of 11 to start cabergoline. Lab tests such as prolactin are subject to major variation and a level of 11 is not high enough to concern me. I also wonder if the level was obtained fasting or not. Those testing prolactin should know the issues involved with optimizing the accuracy of any lab test. A crucial test that is often obtained incorrectly is blood glucose. Labs always stress the need for fasting. However, a 2-hour post-prandial blood glucose (2hr PPBG) informs the MD & patient far better as to the possibility of glucose intolerance and its association with pre-diabetes and diabetes. Some biological systems need to be assessed under stress. Many lab tests are influenced by circadian rhythms. Others of great importance such as PSA are affected by ejaculation prior to testing (within 48 hours of testing). Therefore, if you have an "abnormal" test, look into factors that might be operative that could cause a false positive reading.

Last comment is for Cataceous. I wonder about the choice of your user name. Are you aware that an important herbal product is Crataegus? This is the botanical name for Hawthorn, an important natural product that can improve cardiac health. Or, are you into dinosaurs and modifying crataceous?

 

...
But commenting on Cataceous's input, I do not think I would have bothered advising a patient with a prolactin of 11 to start cabergoline. Lab tests such as prolactin are subject to major variation and a level of 11 is not high enough to concern me. I also wonder if the level was obtained fasting or not. Those testing prolactin should know the issues involved with optimizing the accuracy of any lab test. ...

Dr. Saya has said that when there are continuing issues without other obvious causes he is willing to treat prolactin >10 ng/mL with a trial of cabergoline. In my case it may well have been attacking a symptom without addressing the underlying problem—leading to improvement but not resolution. My prolactin tests were done in a fasted state, and without sexual activity in the preceding 24 hours.

While I would like to be half your age again, I must settle for 3/4 at the moment. There is a large age range in ExcelMale members, though admittedly you are one of the older ones.

...
Last comment is for Cataceous. I wonder about the choice of your user name. Are you aware that an important herbal product is Crataegus? This is the botanical name for Hawthorn, an important natural product that can improve cardiac health. Or, are you into dinosaurs and modifying crataceous?

I've heard of Crataegus in passing, but no, it wasn't the inspiration for my user name. An interest in the Cretaceous period is a reasonable hypothesis, as is another involving a portmanteau and bodacious felines.

 

My most recent prolactin (PRL) level was 2.9 (normal < 15.2) on a dose of cabergoline 0.25 mg twice a week (biw). I also was on anastrozole (Arimidex®) 0.5 mg biw with an E2 of < 5.0. Recognize that I am an old timer, soon to be 81 years old, and surviving a usual fatal disease diagnosed in 2018. I assume that most of you are half my age or close to that. How you invest your time in your health at your age and younger yields huge dividends when you are older. It is the folly of youth that discounts such advice. Most of you are smart enough to research the peer-reviewed literature. But it is how you track your health, selecting a real physician who is into prevention of disease and resolution of any abnormalities, what you eat, how you exercise and finding work that equates with being a "labor" of love providing fulfillment to your life, that are all vital concepts.

So u keep ur E2 less than 5 to keep the disease u have from returning, or to keep it at bay?

do u mind if I ask what disease it is that u have/ had?

how do u feel with an E2 that low?

i think u said ur an oncology doctor, if I’m not mistaken. I had a couple cancer questions for u. Are u not able to receive private messages just yet? I didn’t see the option when clicking on ur profile

 

Dr. Saya has said that when there are continuing issues without other obvious causes he is willing to treat prolactin >10 ng/mL with a trial of cabergoline. In my case it may well have been attacking a symptom without addressing the underlying problem—leading to improvement but not resolution. My prolactin tests were done in a fasted state, and without sexual activity in the preceding 24 hours.

While I would like to be half your age again, I must settle for 3/4 at the moment. There is a large age range in ExcelMale members, though admittedly you are one of the older ones.


I've heard of Crataegus in passing, but no, it wasn't the inspiration for my user name. An interest in the Cretaceous period is a reasonable hypothesis, as is another involving a portmanteau and bodacious felines.

I've never had any issues with prolactin or for that matter even had it tested. Even after sex I'm able to work out with no rest in between. It makes me wonder how many men actually have issues with prolactin, but if you treat it and your libido increases, then your know it's working.

 

The dose of cabergoline (Dostinex®) you cite above is quite reasonable. Most men on TRT (testosterone replacement therapy) will have an increase in prolactin unless they are monitored for estrogen increase that is routinely related to aromatization of T to estradiol. It is called aromatization because the enzyme is an aromatase. Therefore, for men on TRT, I also advise a low dose of either anastrozole (Arimidex®) or exemestane (Aromasin®) and I check to ensure the estradiol (E2) is within normal limits. I have not seen any adverse side-effects (AES) when using such low dose cabergoline, and very rarely does any patient complain about side effects from the aromatase inhibitor. Of course, and most importantly, men on TRT should monitor PSA. I have had a half dozen patients develop prostate cancer while on TRT with two having evidence of metastatic disease from prostate to bone.

interesting info, you say have had patients on TRT get prostate cancer, is that cause or correlation.?. I thought the latest data was those with low T are more prone to prostate cancer?. Also re prolactin , at what level do you think its a risk for the prostate, ie what level of prolactin in optimal. Lstly, I dont hink I have high E but I do have elevated prolactin?

 

An interest in the Cretaceous period is a reasonable hypothesis, as is another involving a portmanteau and bodacious felines.

Ever the mystery...

 

my prolactin was in range. Started taking 0.25 mg caber once a week and felt more energy and my libido was way higher. After a month on this dose my prolactin tested: 3.31 range :3.46-19.40. I feel pretty good and still have a high libido. But since my prolactin is under the reference range, what should I do? Take 0.25 every two weeks?Would that work taking the caber every 2 weeks? That would bring it in the lower range probably?!?

 

interesting info, you say have had patients on TRT get prostate cancer, is that cause or correlation.?. I thought the latest data was those with low T are more prone to prostate cancer?. Also re prolactin , at what level do you think its a risk for the prostate, ie what level of prolactin in optimal. Lstly, I dont hink I have high E but I do have elevated prolactin?

I thought the same re latest data and watched numerous videos claiming the same as well...

 

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.

When you say you prescribe your clients with caber do you recommend they take .25mg twice weekly? I'm currently taking .25mg once weekly for a little over a month, I had bloodwork done about 2 months ago and my prolactin was sky high and felt terrible 24.56ng/ml. I've felt better since taking the caber but not 100%. I'm going to be having bloodwork done again in the next week. Would you recommend I take .25mg caber twice weekly? I'm also on 120mg test e weekly and I've been taking 12.5-15mg aromasin my e2 before taking aromasin was 88.