Hi all, haven’t posted here for a while. Since I’ve started TRT almost 8 months ago, i’ve been having continuous sex drive issues. I have recently started Levothyroxine treatment and had gotten up to a dosage of 100mcg, still trying to figure out where my sweet spot is. In terms of TRT everything seems to be fine, my dosage is 50MG EOD, since I cannot do a E2 sensitive test (it’s not available where I live) I’ve made do with the non-sensitive test with a reading of 80 (have tried arimidex and it’s made me feel much worse). However I haven’t had any BP issues or water retention with this reading. The only thing that’s been bugging me is I’ve never been able to recover my sex drive since starting TRT.
Prolactin: 700 (Normal range <320 ) or 35 nmol/L
Should I ask for Dostinex? or would that complicate things even further?
Thanks!
If KSman still posted one thing he’d tell you to do is run a full thyroid panel. TSH, fT3, fT4. If your thyroid levels aren’t under control you’re going to continue to have issues regardless of what you do with TRT.
I would follow the protocol Kaman posted to the tee. Perform the tests he says to have done. It looks like your e2 may be too high, but it’s unclear from your post. Elevated e2 levels will certainly cause problems.
Also, your prolactin is way too high. Something major is wrong here. Is it possible your dose of Al was too high? Again, read the stickies for beginners, read about thyroid basics and protocol for injection.
Your levels are way off for someone only doing 50mg EOD. My guess is you should only do twice per week. KSman says you should supplement with Al at time of injection. You should also be supplementing with HCG.
Well, looking it up online tells me that I’d need levels of 150 nmol/l and higher to be worried about a tumor. Since I’m only 35 nmol/l I think i’m safe right?
Probably safe. But you do have hypogonadism meaning your pituitary not working right and high prolactin. A prolactinoma is possible.
So I think to play it safe you can get.
I didn’t even have high prolactin and my Dr took anyway since he thought I had secondary hypogonadism
Ok so I just checked my TSH today and it came back at 1, which is awesome. I do feel some improvements, my prolactin did come back a little lower but still very high, from a 35ng/ml to a 34ng/ml.
Now I’ve never had this high of a prolactin since starting TRT, it only has crept up after taking Levothyroxine, which then it use to be like 15-16ng/ml high-normal, could it be a side effect of the drug? What would be the appropriate course of action? I’m still waiting to see a doctor about it but my hopes are pretty low since I’m yet to meet a doctor that has not complicated things further without any results, thanks.
Why are you on TRT? Aside from no libido, what negative side effects or symptoms have you experienced?
Do you have any idea what your prolactin levels were before starting TRT?
It’s good that your TSH is around 1 but without a thyroid panel we don’t know how your thyroid is functioning. TSH is a test of pituitary hormones.
I don’t know where you live or your available funding, but you maybe able to order your own testing online. The Stop the Thyroid Madness website has links to different online companies that allow you to order your own testing.
I’m only passing along this information. I’m sorry I don’t have an answer for you.
I don’t think your thyroid is the problem and I don’t know of any connection between levothyroxine and prolactin, but since you brought it up I want to have my prolactin checked.
Based on what you said, your e2 has spiked on TRT. I realize this is a non-sensitive test, but 80 is way above the upper range. It should be roughly between 20 and 50. I get the impression you have a great deal of aromatization.
I don’t know who is managing your protocol or how, but it seems like you need to be on a small dose of AI. I’m not an expert but without other testing, that’s what appears to be going on.
Lastly, how are your T levels on TRT? You haven’t posted any results.
My T levels are around 1100 ng/dl, I do aromatize alot even though I’m only 12% body fat. Will taking an AI be able to cut my prolactin in half, or will I have to take dostinex? The reason why I’m on TRT is I was severely/suicidally depressed. I was fatigued, had low sex drive, couldn’t even leave my bed. My T levels came back at 160 ng/dl consistently and at 20 years old that is not normal at all. So I took a leap of faith (with nothing to lose tbh) and here I am
I feel your pain. At what point did you identify a thyroid problem? Do you have Hashimoto’s thyroiditis or just hypothyroidism? 100mcg of levothyroxine is a decently large dose.
As I think I’ve said before, if your thyroid is underperforming, your T levels will suffer. So, I am wondering if that’s why your T levels were so low. Either way, I would expect you to have the symptoms you described with TT levels that low.
How much arimidex were you taking? You have to get your e2 down GRADUALLY. You should probably take a small dose of AI on days when you inject. Every time you inject your body senses the increased testosterone and it’s going to convert lot of it to e2.
Low libido or poor sexual response can definitively be due to the elevated e2.
I am not qualified to say anything about whether lowering the e2 will lower your prolactin. But, if your hypogonadism is secondary, that is, if it’s a pituitary issue, I would suspect the pituitary gland is the problem. If you have primary hypogonadism, then we’re at square one.
I wouldn’t wait to address your elevated e2. You have committed to TRT. You’re in it for the long haul. You have to find a way to dial in your therapy. I think your TT levels are a little too high but that’s just my opinion. Either way you need a small dose of AI or you’re going to continue to feel how you do now.
I really appreciate the reply. I’ve had a higher thyroid since my first blood test a year ago (came back at a 5.6 with a ref range max of 4.2) so i must of had a thyroid issue for a long time ago. I was diagnosed with subclinical hypothyroidism (normal T4 and T3, very high TSH). About the E2 issue, I got my hands on some proviron, but for some reason whenever I reduce my water retention by taking Adex, my joints feel horrible popping/snapping everytime i move something, the dosages of Adex I took where very small (0.0625-0.125) and that was enough to make me feel shitty. I also suffer from severe anxiety, so I’m hyper aware of things in my body, so it could be all in my head and if that’s the case I’ve got bigger issues. I use to suffer from severe panic disorder before starting TRT where I’d have panic attacks 3-4 times a day, TRT crushed my panic disorder. Going from very low testosterone to high testosterone has changed the game for me, social and mental strength have increased 10 fold so I guess that’s a huge benefit for me.
Shit, man. That’s rough. It’s a shitty situation but you gotta try something new until you figure out the right plan for you. Adex sounds like the wrong medication for you if that small of a dose causes such horrible side effects.
I read that hypothyroidism may cause high prolactin. Also, medications used for depression (SSRIs and tricyclics) may cause it. High prolactin in men will kill libido and sexual response.
I don’t believe you posted your thyroid labs. TSH is a pituitary hormone and by itself it doesn’t tell us anything about thyroid function. What are your fT3, fT4, and fT3 levels? Did your doctor give you any explanation for your thyroid condition? Have you been checked for thyroid antibodies? Have you ruled out an iodine deficiency?
I really cannot make sense of your panic disorder. You seem to say TRT crushed your panic disorder but you still have high anxiety? Your previously low T could explain why you had panic attacks. If you’re not on any medications to manage it, have you considered it?
Have you experienced headaches or changes in vision? I think it’s doubtful that you have a tumor. But you have had such severe symptoms that I would want to get to the root of the problem.
Yeah, I was on SSRI’s and anti-anxiety but that proved very ineffective and actually when my libido got much worse, though when I checked my prolactin; it was high-normal and the Endo who I was seeing at the time didn’t think it was necessary to take Dostinex for it. I have been checked for anti-bodies (TPO and TG) and both results came back great. I’m yet to meet a doctor that can actually help me, most don’t even know the basics that I learned from reading, it’s terrible. Yeah I still have very high anxiety even though my panic disorder’s gone, I haven’t tested RT3 yet but my latest FT4 was 19 (12-22) Ferritin 67 SHBG 8.23 (12-30) FT3 I remember was high-normal (can’t find the blood test results)
Wierd thing is, I used to get very often migraines (used to take meds EOD for it) and when I got on TRT, these migraines completely disappeared. As for vision changes, I’ve always had a weaker left eye but nothing specifically new, perhaps my vision is a bit blurrier.