I am a 21 year old man.
I had erectile dysfunction and terribly low libido for 5 years. (no more morning erections :(, half-soliod erections)
I recently decided to go to a urologist to check what is wrong.
He ordered testosterone and prolactin dosing.
Prolactin 21.67ng/mL (normal<18 in men) but shouldn't it be around 8 at my age?
Total Testosterone: 521 (normal between 100something-1000something) but shouldn't it be around 670-700 at my age?
Therefore I have 2 questions:
1- Do I have a hyperprolactinemia? If so, is a microadenoma of the pituitary possible? (remember it's been 5 years now)
2- Are such levels of prolactin and testosterone in a 21 year old men responsible for all these symptoms?
I would go see an endocrinologist. Specifically, I would go see a neuro-endocrinologist. I would try to get in to a pituitary center. You may not get in at this stage since you only have one abnormal test and no *support* that you may or may not have a lesion (elevated prolactin can be caused by thyroid issues as well as many many other things, but a pituitary issue needs to be ruled out).
Your lab does not have age adjusted testosterone (not sure that is done) - but there are other tests like bio-available testosterone, sex binding hormone, estrogen, LH, FSH, DHEA sulfate that should be done to see how you are as well so the doc has only basically touched the surface.
Just the prolactin can cause a myriad of symptoms. I would see an appropriate doctor. Do let us know what happens.
Thank you for your kind reply.
In fact, I am a med student so I truly know my endocrinology well.
What puzzles me is that my urologist says my troubles are only psychogenic! (hey! 5 years man!) But he mentioned that he's generally used to see men with very high prolactin levels so I'd better go check with an endocrinologist.
According to many sources, prolactin >20ng/mL in a man is dubbed hyperprolactinemia, mild prolactinemia. Prolactin lowers testosterone secretion but my levels of PRL are not that high (but may have cause a small reduction in T levels from 650_ to 521?)
Moreover, IF i do have HPRL, it can't be due to a macroadenoma. (very high levels), I don't take medications. I have no liver and renal insufficiency.
hmmmmm what's left? hyperstrogenemia? (where will this come from?) primary hypothyroidism? (hmmm I have no flagrant syndrome) microadenoma? (5 years on and it's still at 21.67ng/mL?)
I'm quite stunned.
Pituitary *things* can be quite subtle - and complex. I had full lactation in both breasts and prolactin level just a few points above normal. They found a 5-6mm pituitary tumor (on the left) and they just said, well, this cannot be so, and when I pleaded for at least relief from pain (lactation is very painful plus the other symptoms were rather nasty as well) they finally gave me some parlodel for a short time. They said I certainly did NOT have a prolactinoma uh uh no way but I kept having weird symptoms. In the end, I kept progressing (this is a progressive sort of thing, and lots of things are hidden) until they finally figured I had Cushing's disease. Surgery revealed the initial tumor found was the Cushing's lesion and another one on the right was a prolactinoma.
Not everyone has every symptom, and other issues or even good health can make or mask issues. I had many other concurrent issues which made my diagnosis complex.
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