Aa
A
A
A
Close
Men's Health Community
13.5k Members
Avatar universal

Man - 21 - High prolactin levels?

Hello
I am a 21 year old man.
I had erectile dysfunction and terribly low libido for 5 years. (no more morning erections :(, half-solid erections)
I recently decided to go to a urologist to check what is wrong.
He ordered testosterone and prolactin dosing.
Results:
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 man responsible for all these symptoms?

Thank you and happy new year
25 Responses
Avatar universal
Hello,
     First of all, you should get the answers to your questions from a doctor only. However, I will give you the answers, I think are correct. I am also interested to know what your Urologist told you about the test results, please let us know about it.

1." Do I have a hyperprolactinemia? If so, is a microadenoma of the pituitary possible? (remember it's been 5 years now) "

Do you have any symptoms of  head ache or mental confusion ? Five years is quite Ok, it seems there are cases of microadenoma not being detected for life and found out only during an autopsy. In any case, I would think you need to do further follow up tests like evaluation of  other pituitary hormones like TSH, LH, FSH etc. to find out where they stand. You will also need to do an MRI to find out if there is any microadenoma and get treated if it is there.  May be, you need to also consult a Neurologist or an Endocrinologist for these evaluations, if advised by your Urologist.

2- " Are such levels of prolactin and testosterone in a 21 year old man responsible for all these symptoms? "
Yes, with prolactin level I would think so, but the T level looks quite Ok to me.

3. " Total Testosterone: 521 ( normal between 100something - 1000 something ) but shouldn't it be around 670-700 at my age? "

I would think 521 as a good level.

Good luck,
Solace


Avatar universal
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. (he's not used to treat men with borderline levels)
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 caused a small reduction in T levels from 650+ to 521?)
Moreover, IF i do have HPRL, it can't be due to a macroadenoma. (usually leads to very high levels of PRL), I don't take medications. I have no liver or renal insufficiency.
hmmmmm what's left? hyperstrogenemia? (where will this come from?) primary hypothyroidism? (hmmm I have no flagrant hypothyroidism syndrome) microadenoma? (5 years on and it's still at 21.67ng/mL?)
I'm quite stunned.
You sure PRL at 21.67ng/mL causes trouble?
I need to find an organic cause for this erectile dysfunction. Can't be psychogenic!
Avatar universal
Hello,
  
Wish you a happy,prosperous and healthy New year.  
  
Nice to know that you are from the medical field, I would request you to share your knowledge here to help others in need.
I also can not buy the idea of psychogenic theory, there must be definite physiological factors behind. By the way, does the medical community believe that the Testosterone  level of a healthy youngster like you should necessarily be of the order of 700 ?, as far as I could understand, anywhere within the range should be acceptable so long as one does not suffer from any related health problems, mainly sexual health. As I understand, the graph of the T range is supposed to represent healthy twenty year old guys  covering a large population and geographical base and not the age factor. I can give you some medical links confirming my belief, please let me have your views about it.
I am sure, you would know more about the interaction of the hormones, but still why don't you take an MRI and rule out any possibility of any benign macroadenoma ?. As  I have already mentioned, some times they even go unnoticed and are detected only when tests are done for some other problems.

" You sure PRL at 21.67ng/mL causes trouble? "
Yes, that is what I think ( I am not from the medical field), please enlighten me if I am wrong.

" I need to find an organic cause for this erectile dysfunction "

  What ever you find in this connection, please come back let us know as it would help many youngsters who visit this site with such problems.

Good luck,
Solace
Avatar universal
Hello again
Actually, we, med students, learning endocrinology in books, don't have clinical experience like good endocrinologists do. Therefore, I'm only able to talk confidently about clearly elevated values of prolactin (35+ng/mL) and their effect on sexual function.
Problem with testosterone is that normal lab values cover a big big range going from around 100 to 1000. We never really got into this hassle and age-corrected advised values. I can't easily find scientific proof to what I'm saying in my endocrinology books but some websites (even though not that trustworthy) claim that testosterone levels in a 21 year old man should go far beyond 600 and that below 400 (even though 400 is "normal" according to lab) starts hormonal hell.
Here are some links to support what I am saying:
http://www.peaktestosterone.com/Testosterone_Levels_Male.aspx

http://www.mens-hormonal-health.com/normal-testosterone-levels.html
According to this link, I have the levels of a 65 year old man. hmmmm? prolactin effect? or is it, again, "normal"?

Besides, let me clarify something. A macroadenoma secreting prolactin is a >1cm benign tumor of the pituitary and it generally causes mass effect (sight problems and headache) as well as other deficiencies in general. In addition to these local symptoms, a MACROadenoma secretes a hell lot of prolactin with blood levels way beyond 200.
Thus, I cannot have a MACROadenoma.

Other things which can cause elevated blood prolactin levels are:
1- stress (puncture of the vein to draw blood as well as anxiety can elevate PRL levels)
2- exercise
3- primary hypothyroidism (marked by high TSH and low Free T4 as well as symptoms like face puffiness, fatigue, constipation, hypercholesterolemia, slow heart rate etc)
4- renal insufficiency (high creatinine and BUN)
5- liver failure (high ALAT and ASAT)
6- a lot of drugs
7- a MICROadenoma of the pituitary (1cm benign tumor of the pituitary and it generally causes mass effect (sight problems and headache) as well as other deficiencies in general. In addition to these local symptoms, a MACROadenoma secretes a hell lot of prolactin with blood levels way beyond 200.
Thus, I cannot have a MACROadenoma.

Other things which can cause elevated blood prolactin levels are:
1- stress (puncture of the vein to draw blood as well as anxiety can elevate PRL levels)
2- exercise
3- primary hypothyroidism (marked by high TSH and low Free T4 as well as symptoms like face puffiness, fatigue, constipation, hypercholesterolemia, slow heart rate etc)
4- renal insufficiency (high creatinine and BUN)
5- liver failure (high ALAT and ASAT)
6- a lot of drugs
7- a MICROadenoma of the pituitary (<1cm), secretes less PRL than a MACROadenoma.

My PRL level is bordeline. According to some website (and to common sense), I have a "mild" hyperprolactinemia. Can this slight elevation of PRL wreak havoc and shut everything off for 5 years? Hmmm
I do not take medications. I do not have kidney or liver problems. I cannot have a macroadenoma. I wasn't exercising before drawing blood.
I'm left with stress-induced hyperPRL or the hypothesis of a very small microadenoma.
I guess this needs to be reconfirmed with a new blood test.
I want to find an organic cause so badly. If I'm stuck with the "psychogenic" theory, I can't do much I fear. I cannot agree with my urologist. When you lose your morning erections, there must be something wrong. That can't be emotion-related only.

I will go ask my endocrinologist about all this. He's a legend and will surely know if that's the source of all this trouble.
Yet, isn't there anyone around here, who's had similar levels of prolactin and almost "normal" testosterone levels, but still had erectile dysfunction?

Prolactin acts this way:
When it goes up, it alters the normally pulsatile secretion of GnRH (LHRH) in the hypothalamus, therefore affecting the also-pulsatile secretion of LH and FSH, which will result in low testosterone levels.
When one's got a MACROadenoma secreting prolactin, his very high levels of prolactin will practically take his testosterone levels down to 150-200, which is quite logical, and cause hypogonadism.

The association between slightly elevated prolactin and "normal" testosterone (in the 400-500-600) + erectile dysfunction is possible, as far as I understand. I'm only sure of PRL beyond 35ng/mL.
In such cases, giving extra testosterone will not ameliorate the condition. PRL levels need to be taken down.

In addition to all this, prolactin has got a direct central effect on brain neurotransmitters and circuitry, altering erection and libido even more. That's why, perhaps in men with PRL beyond 25 and testosterone around 500, you can still have erection problems.

All my problem rises from the "borderline" prolactin value. I hope it's not stress-related. I need to find something wrong to hold on to and correct.

Sorry for the long post.
Glad to share with the community.
Avatar universal
Oops I wrote something wrong in (7) about the microadenoma. It is less than 1cm large and secretes way lower PRL quantities than a macroadenoma. Mass effect doesn't generally exist.
Avatar universal
Hello,
      You are right about the effect of prolactin, slightly over the normal range appears not to affect much, only macroadenoma  (>1cm) secreting high values of prolactin is said to affect libido and its mass effect is supposed to be more of a problem both on pituitary and on optic nerves. In any case, please let me know regarding the views of your Endo.

As far as I could make out from most of the medical sites, the full range of testosterone is applicable to youngsters like you, and the range is given to cover large population base and geographical areas. There is a separate age adjusted graph given to include the age factor. For example, have a look at the graph B given in the following article for age related adjustment of the T reference range :

http://www.andrologyjournal.org/cgi/reprint/29/6/610

Or, have a look at the age related reference range specified by Mayoclinic :

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/83686

Again what really matters is free T and bio available T and not the total T value.

Now, leaving prolactin effect  for the time being, what about your levels of adrenal hormones, are you sure they are Ok? If you are not sure, you should check them also.

Hoping to get more feed back from you,

Solace  
Top Men's Health Answerers
1622896 tn?1562368567
London, United Kingdom
139792 tn?1498589250
Indore, India
11369760 tn?1449507972
Southwest , MI
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Get the facts about this disease that affects more than 240,000 men each year.
How to lower your heart attack risk.
Here are 12 simple – and fun! – ways to boost your brainpower.
Sean Cummings discusses which available erectile dysfunction treatments may have the best outcome for you
They got it all wrong: Why the PSA test is imperative for saving lives from prostate cancer
10 prostate cancer misconceptions debunked.