Not sure why you are talking about groups, seems a little weird.
I don’t agree with AIs generally, particularly when free T is out of range. High E2 is likely to be causing most issues and that stems from excessive T dose.
So why did he have these issues pre-trt when his estradiol was actually on the low side? Are you saying he did not have these sexual symptoms before getting on TRT?
His estradiol isn’t even high now.
His testosterone levels were poor pre TRT.
His Oestradiol is now double the top of range. Extremely high for oestradiol.
You’re confused as usual. His estradiol is 141 and the range goes up to 149.
Are we done here? When are you going to figure out you were way off base here? Its not a big deal, at all. But you keep making it one.
No his latest bloods show 350.
Like I said yesterday, read the entire post.
Not making it a big deal, I offered the thread starter an alternative viewpoint that my prolactin is higher yet I don’t have libido or erection issues.
Even so, this guy has had these symptoms for a long time, obviously. Or he wouldn’t be searching. He even made this thread, when his estradiol was 141.
So for the hundredth time, you sound ridiculous. This guy might not have even needed TRT if he would have been put on a dope ag
So you are wrong again.
You are right that he made not have needed TRT but no-one can diagnose a pituitary adenoma from a single mildly elevated blood level without any further questioning. It is however, highly unlikely that the pre TRT levels would indicate a pituitary adenoma.
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It’s literally the definition of hyperprolactinemia. So you must be right, and the endocrinology society is wrong lol
Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood NOT a pituitary adenoma.
This can even be caused by sex near to the point of testing, plus the numerous other reasons Charlie directed you to.
I read the word may which completely undermined the statistic presented.
There are numerous sources available which conclude that adenomas are linked to much higher prolactin levels, i.e. 10 times range. Feel free to direct me to any posts on here where adenomas were found when the poster had mildly elevated levels. Ill then point you to the plethora of ones where people found nothing when they had an MRI.
I’m embarrassed for you - you can see no other explanation other than an adenoma and aren’t even willing to consider or investigate them. That is just pure ignorance.
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I just showed you man. 50% of ALL case of prolactinemia are tumors. This includes drug induced prolactinemia and women.
You take out drug induced and women, and its near 100% chance this guy has a benign tumor. About 90% chance it is a prolactin secreting tumor.
No the article said may be, not are.
And for the last time there is no point in investigating cause no matter what you have to lower PRL, with a dopamine agonist!!!
It doesn’t matter why, there are only 3 treatments. Surgery, radiation, or DOP AG. Thats it, those are the choices.
We can rule out drug induced because he wasn’t on anything with his original labs. The TRT has made things WORSE. Much worse, and its only going to get worse unless he takes one.
The poster is on TRT and has Free T beyond range and E2 double the range. E2 is known for increasing prolactin as you were taught yesterday.
These should be addressed as the primary issue, basically in accordance with his doctor advice.
How have you ruled out drug induced? He his on testosterone and his levels have tripled.
One test pre TRT does not give you an authoritative baseline
None of that matters, just look at the pre-TRT labs. Also the fact he had pubescent gyno, glaring red flag.
He should find a new doctor, obviously.
It matters massively. his TRT regime should be fixed.
Dude there is no fixing anything until he gets that tumor to stop secreting prolactin.
After that yes, he could fix his TRT. But if he is a young guy he should see if the dop ag fixes the the low t. It might.
Abstract
OBJECTIVE:
To attempt to determine clinical or hormonal characteristics that could help distinguish benign idiopathic low testosterone (ILT) from pituitary tumor.
METHODS:
On retrospective review of medical records of patients encountered by Johns Hopkins endocrine staff between 1985 and July 1995, 64 patients who fulfilled our enrollment criteria–27 men with ILT and 37 patients with imaging-proven pituitary tumor–were identified. Men 21 years of age or older needed to have had serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin levels measured before hormonal replacement therapy or pituitary tumor extirpation (or both) and a high-quality imaging scan (computed tomography or magnetic resonance imaging) done and interpreted by the Johns Hopkins radiology staff.
RESULTS:
In comparison with men who had ILT, men with pituitary tumors had similar serum testosterone levels and significantly higher serum levels of LH, FSH, and prolactin. In addition, significantly more men with pituitary tumors had visual field abnormalities, headaches, and symptoms of hypothyroidism in comparison with the men with ILT. In contrast, the group with ILT complained significantly more of impotence, erectile dysfunction, and depression than did the group with pituitary tumors. The age at initial assessment was comparable in both study groups.
CONCLUSION:
Although age at initial manifestation did not predict the presence of pituitary tumor, the group of men with tumors were more likely than those with ILT to have serum testosterone levels <150 ng/dL, higher serum gonadotropin and prolactin levels, and visual field abnormalities and less likely to have sexual dysfunction. Therefore, on the basis of our data, we recommend that men with these findings should be referred for a magnetic resonance image to exclude the presence of a tumor.
Central hypogonadism: distinguishing idiopathic low testosterone from pituitary tumors.
Again, one blood test does not accurately determine prolactin levels. It is too easily affected by other factors.
How can the dop ag fix his low T if he is still on TRT - have you recommended he stops (i.e. fix his regime)?
The only thing I said is he should get on a dopamine agonist stat. I stand by that, obviously.
The reason a dopamine agonist can fix his low t is because it shrinks the size of the adenoma, and prolactin (which is suppressive) is not secreted, or at least not nearly as much.
When you have a pituitary tumor, thats why you have low T, because you have tumor. So if you can fix the root of the problem, the HPTA can bounce back.