Prolactinoma Tumor & T Issues?

Pharma / TRT Testosterone Replacement
1

Hey everyone. I’ve lurked this site for awhile reading about TRT and related issues but it’s time to post and hopefully get some advice from people who know what they’re talking about.

I’m a 28 year old male. About 2.5 years ago, my sex drive and ability to get/maintain an erection decreased somewhat, to about 75% of normal. At the time I went and saw a couple different doctors and got the following tests:

10/08/12:

Testosterone, Total: 234.0 ng/dl, 210-1274 This was taken in the afternoon around 5 pm, so had to retake in the morning.

11/12/12:
LH: 5.4 mIU/ml, 0.8-7.6
DHEA-Sulfate: 370.0 ug/dl, 80-560
Testosterone, Total: 365.0 ng/dl, 210-1274
Sex Hormone Binding Glob: 24.5 nmol/L, 7.2-100
Free Testonsterone Index: 51.7%, 14.8-94.8
Androstenedione: 0.755 ng/mL, 0.330-1.340
Estrogens, Total: 91 pg/mL, 40-115

1/21/13:

Comprehensive Metabolic Panel w/GFR:
All Normal except: BUN 21 mg/dl, range: 10-20

CBC:
All normal except: RDW, 15.3%, range: 10.8-14.8%

Prolactin: 16.2 ng/ml, range: 2.5-17.0
FSH: 5.6 mIU/ml, 0.7-11.1
LH: 4.5 mIU/ml, 0.8-7.6
Cortisol: 23.1 ug/dl, 6-24 ug/dl
Progesterone: 0.8 ng/ml, 0.27-0.90
T3, Free: 3.31 pg/ml, 1.80-4.20
Free T4: 1.19 ng/dl, 0.80-1.80
Estradiol: 24 pg/mL, <57 pg/mL
DHEA-Sulfate: 323.0 ug/dl, 80-560
Sex Hormone Binding Glob: 27.8 nmol/L, 7.2-100
Testosterone, Total: 519 ng/dL 250-1100
Testosterone, Free: 82.1 pg/mL, 46.0-224.0
Testosterone, Bioavail: 186.6 ng/dL, 110.0-575.0
SHBG: 26 nmol/L, 10-50 --What is difference from four rows up?
Albumin: 5.0 g/dL, 3.6-5.1
Vitamin D, 25 Hydroxy: 35 NG/ML, Optimal 30-100

6/1/13:
Prolactin: 12.1 ng/ml, 2.5-17.0
Testosterone, Total: 393.0 ng/dl, 210-1274

I took these tests to multiple doctors, and everyone said I was normal, nothing to worry about. Multiple doctors told me I just needed more confidence (smh). The closest I got to anything was a urologist saying I had chronic pelvic pain syndrome/pelvic floor dysfunction. At the time I’d had two hip surgeries and had some pelvic floor/tailbone/SI joint pain. He said my testosterone was lower due to poor blood flow to the testes due to pelvic floor muscle spasms.

For the next two years or so I stayed at about 75% as far as libido goes (75% was workable albeit shitty). About a year ago I had another hip surgery (with a good surgeon) that really helped my hip and pelvic pain, and my pelvic floor is now doing better than ever, which I thought would help my T levels. However, a couple months ago I went from 75% to 0% pretty rapidly. Now have little interest in sex, hard time achieving an erection, headaches, light headedness, softer body even as I was working out more, etc… Went to a new doctor and got the following tests:

7/11/2015:
CBC - All normal except: HCT, 41.0%, 41.4-51.0%
PSA, 3rd Gen: 0.58 ng/ml, <4.0
Prolactin: 45.6 ng/ml, 2.5-17.0
FSH: 6.9 mIU/ml, 0.7-11.1
LH: 5.4 mIU/ml, 0.8-7.6
Testosterone, Total: 243.0 ng/dL, 210-1274

7/25/2015:
Creatinine: 1.0 mg/dl, 0.5-1.3
eGFR: 89, >60
TSH: 1.58 uIU/ml, 0.40-4.40
T3, Free: 2.7 PG/ML, 2.3-4.2
Free T4: 1.11 ng/dl, 0.80-1.80
Anti-TPO Antibody: <1 IU/ML, <9

After the test showing Prolacting at 45 I had an MRI showing a 3x4 mm microadenoma. I’ve been on Cabergoline .5 mg 2x/week for about a month now and don’t feel any different. This Friday I’m going back to the doctor to check on things. In the mean time i’ve taken the following tests but won’t have the results until Friday:

-ACTH
-IGF-1
-Cortosyn Stim Test
-Dexamethasone Suppresion Test
-Visual Field Exam shows no defects (told me right after the test)
-I got my Testosterone and Prolactin rechecked monday and will see results this friday.

A month ago when he put me on Cabo he offered me TRT but I declined hoping my T levels would increase as my prolactin dropped. However after a month on Cabo I feel no different, so I was hoping I could get some guidance on where to go from here. I’d think that my T levels are low due to the elevated prolactin and not due to any dysfunction in the testes, but my LH/FSH numbers don’t look very low at all. So does the normal LH/FSH indicate I also have a problem in my testes and Clomid would be ineffective, or can I have normal LH/FSH and still gain some benefit from Clomid? If not, is my only other option TRT?

If I go with TRT, I know I’ll have to monitor Estradiol, which I haven’t had tested. Are there any other tests I should have run? Or should I continue to wait and see a few more months to see if my T levels will improve on their own? And this is all assuming that the Cabo is working and lowering my PRL levels…I’d really appreciate any advice anyone has, especially anyone that’s dealt with a Pituitary issue? Or any recommended TRT doctors in NW Ohio/Ann Arbor area. Thanks so much,

2

There is a lot of slack in “norma”, that is why we like to see the numbers.

Yes, you are showing signs if primary hypogonadism. Docs checked for vascular abnormalities in your testes? Often correctable.

Odd to have higher LH and prolactin at the same time.

Your thyroid numbers are not great.
Did you stop using iodized salt?

Please read these stickies:

  • advice for new guys - note first paragraph
  • thyroid basics - check your oral body temperatures
  • finding a TRT doc
3

So I have any update with more tests for the tumor and test levels:

ACTH: 48 pg/ml, 7-69
IGF-1: 188 ng/ml, 84-313
Dexamethasone Suppresion Test and Cortosyn Stim Test were good
No visual field defects

8/24/15 (After being on Caber .5 mg 2x/wk for a month)
Prolactin: Undetectable
Testosterone, Total: 276 ng/dl, 210-1274

So, my PRL went down so I changed the dose of cabergoline to .25 mg 2x/wk going foreward. However, my testosterone didn’t really improve, so I started Clomid 25 mg/day. Got tested again after being on Clomid for about two weeks:

9/14/2015
Prolactin: Undetectable
FSH: 10.3 mIU/ml, 0.7-11.1
LH: 9.3 mIU/ml, 0.8-7.6
Testosterone: 451 ng/dl, 210-1274
Estradiol: 44 pg/ml, <10-52

KSMan, I have also been charting my temps. When I started a couple weeks ago after your post I was waking at around 97.6 and getting to around 98.3 in the afternoon. I’ve been pounding iodoral and now am waking around 97.9 or 98.0, and getting up to around 98.5 in the afternoon. I don’t believe my primary issue is my thyroid, as I think things just got messed up when the tumor started, however I’ll keep taking iodoral until my temps get just right.

My prolactin is still undetectable so my Cabo dose is going down to .25 mg/wk. My testosterone went up after being on Clomid from 273 - 451, but none of my symptoms improved. Now i’m in that dreaded zone where the doctor says I’m all cured, everything looks good, but I still feel like shit and have all the ED/libido symptoms. SMH. My E2 was somewhat high so I did get him to prescribe an AI.

-He prescribed Letrozole, 2.5 mg/day, which is way too much I believe. I was thinking of doing a quarter tab, .625mg, 2x/wk?
-KSMan if you read this, based on these tests would you still recommend getting my testes checked for vascular abnormalities? By that are you talking about a variocle? And I’m assuming my best bet would be a urologist for that?
-Can I expect my Test to keep improving from the Clomid, or is two weeks about as high as it is going to get on that dose? Should I raise the dose? My eyes are already dry as a bone on 25 mg/day, but I could increase it I guess.
-I’d love any other recommendations or suggestions. Like I said my doctor isn’t much help now but he does seem open to giving me pretty much whatever I ask for. I’d like to avoid HRT as I’m pretty young, but if it comes to that then that’s what I’ll have to do, as my symptoms now suck. Thanks.

4

Your strong LH from clomid seems to rule out varicocele if LH/FSH were low prior. But you can still go through doing this.

Your E2 is so high, because your clomid dose is too high, driving high T–>E2 inside the testes, and anastrozole cannot control T–>E2 inside the testes. You may need to take 12.5 mg. You should know that from the stickies.

When you take a SERM and LH/FSH increase, it takes time for form and function changes to follow. Give things time.

Do not stop any SERM suddenly, taper out.

Letro can be very harsh. Try to take .625 a week in divided doses. May need to dissolve in vodka and dispense by the drop.

Do you feel bad in clomid? Some guys do, Nolvadex does not do that.

HTC was low re your T levels.
Do you have food allergies/sensitivities or other digestive issues?
An occult blood test can detect a GI bleed, its a simple poop smear on a test card.

Don’t do IR iodine dosing indefinitely.

5

I’ve gone some updated labs that I purchased privately before my next doctor in a couple weeks:

9/30/15:

TSH: 3.300 uIU/mL, 0.450-4.500
Thyroxine (T4): 9.1 ug/dL, 4.5-12.0
T3 Uptake: 30 %, 24-39
Free Thyroxine Index: 2.7, 1.2-4.9

Testosterone, Serum: 1139 ng/dL, 348-1197
Free Testosterone (Direct): 32.2 pg/mL, 9.3-26.5

DHEA-Sulfate: 356.7 ug/dL, 138.5-475.2

Estradiol: 27.0 pg/mL, 7.6-42.6

PSA, Serum: 1.1 ng/mL, 0.0-4.0

Vitamin D, 25-Hydroxy: 42.0 ng/mL, 30.0-100.0
Vitamin B12: 340 pg/mL, 211-946

-My test levels look awesome, but my symptoms have not improved at all. Still no sex drive and difficulty with erections. Hopefully I can chalk this up to side effects of the Clomid and I’ll feel better as I taper off the Clomid.
-I’ve been taking 12.5 mg Clomid ED, and an eighth tab Letrozole (.3125 mg) MWF. I’m going to lower the Clomid to 12.5 mg EOD, and the Letro to .2 mg or so MWF. I’ll have to dissolve that in alohol.
-I’m not worried about the TSH right now, because I’ve been taking Iodine and a raise in TSH is to be expected?
-I’ll hit the Vitamin D and B12 to try to double both values.

Be back to the doctor in a couple weeks and get test/e2 levels measured again.

6

I agree, TSH probably jacked up by IR. When do you go to maintenance dosing.

Do not know what to do with these:
T3 Uptake: 30 %, 24-39
Free Thyroxine Index: 2.7, 1.2-4.9
Now that fT3 and fT4 labs are available, the above really are antiquated and should be avoided.

As you lower clomid dose, you need to reduce AI as you are attempting. So finding a balance is not easy or direct.
Can you switch to Nolvadex?

7

KSman, thank you for all the help.

I figured they weren’t going to be that useful, but the thyroid tests were included in the blood test package that I bought, so I put them up just in case.

[quote]KSman wrote:

Can you switch to Nolvadex?
[/quote]

My current plan was to taper off the clomid, and if my test crashed again to try Nolva instead. I’ll be at the doctor in a week and a half or so and could probably switch to Nolva, but what advantages will it give me? At the dose of Clomid i’m taking the only side effect I have now, if it is a side effect of Clomid at all, is low (basically nonexistent) sex drive. Nolva would likely have the same effect, correct?

8

Nolvadex has no advantage for a guy who knows that he does not have clomid sides.
If Clomid restart fails, no reason to expect more from Nolvadex unless the attempt is better designed and executed.
It would be interesting nevertheless to see if Nolvadex provided a different libido experience.

Have you seen this: https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_for_trt_guys_with_application_to_gear_and_pct