Prolactin level jump after 2 years HRT

[bernadette]

Its been 2 years since I started my HRT and had very good levels of everything right through. However at the last test my prolactins jumped from 15 to 74 (testing interval 3 months). The doctor ordered another test which I have done, but due to work related travel I can't get the results or do anything about it for another 3 weeks.

Anyone else had their prolactins leap up like this? I have to spend the next 3 weeks wondering if I have a pituitary tumour 

[PrincessDayna]

have you recently had any surgery prior to those labs like an orchie or anything?

[KayXo]

Are you taking cyproterone acetate? Premarin? Ethinyl Estradiol?

[bernadette]

Yes - that result was 3 months after changing from Spiro+Finasteride to Cypro. All the other readings apart from prolactin were right in the middle of the range.

I am on Estradiol patches (estradot) and 17b Estrodiol (estrofem) orally. My partener who is also trans uses the same doctor - she went for some tests after my second test results were in and the doctor told her to tell me not to worry about original high reading.

Regardless, it will be Tuesday 2nd of Dec when I get to see the doctor about the second lot of tests.

[LordKAT]

You can usually call for test results instead of actually going in.  Maybe the new results will be different.

[Monkeymel]

Regular exercise or cardio training can also elevate prolactin levels without tumor. Mine spiked, but also went down naturally when I reduced my cardio training and did more yoga.

[mynees]

15 and 74 of what? Dont you think a name of what measure would be important? If you mean 74 ng/mL, than yes, that is way above normal levels.. get your second blood test results rather sooner than later.

[bernadette]

Sorry about the lack of units - yes its ng/ml. I cannot go to the doctor any sooner because I am 900km away working. She said she would ring me if there was anything that needed immediate action and she did indicate to my partner who also went to the doctor (post my results getting to the doctor) that I need not worry about it. Its not standard practice in Australia to give out results over the phone - they normally want you there in person.

It was a curious jump after 2 years of stable prolactins.

Perhaps it was the change of anti-androgens (Spiro+finasteride to just Cypro) that made it jump. Thanks for the replies and I will update the thread after after my next appointment on the 2nd of December. 

[mynees]

Cyproterone acetate can very well be the reason for your prolactin levels. If you're worried, you can take only half of what you were taking, I suggest you ask your doctor about it. Another thing, you were taking finasteride before, probably for hair related reasons? Cyproterone acetate isn't exactly doing anything better at blocking DHT than spironolactone, other than there is less testosterone to be converted. So if you have concernes about hair-loss, or want a possible regrowth, consider taking finasteride (or dutasteride) again.

[KayXo]

Yes - that result was 3 months after changing from Spiro+Finasteride to Cypro. All the other readings apart from prolactin were right in the middle of the range.

Then, it is obviously the cypro. It's known to do that, that's one of the reasons I personally don't like it.

It was a curious jump after 2 years of stable prolactins. Perhaps it was the change of anti-androgens (Spiro+finasteride to just Cypro) that made it jump. 

Not at all a curious jump, very predictable, to be expected with cypro. Doctors should know this, it's been widely documented and many transgirls report this. It's due, I think, to the inhibition of dopamine which could also be related to depression that is sometimes noted in people when they take cypro. 

Cyproterone acetate isn't exactly doing anything better at blocking DHT than spironolactone, other than there is less testosterone to be converted.

From the info I've come across over the years, it appears cypro is a stronger anti-androgen at not only reducing androgen but blocking it.

[bernadette]

I finally got the results off the doctor today and it was a mixed bag.
The prolactin levels were:
16.8 micrograms/litre before changing to Cypro (previously on Spiro) - 30 July 2014
74.5 micrograms/litre on 13 Oct 2014
28.7 micrograms/litre on 10 Nov 2014

Meanwhile the Oestrodiol varied 415, 241 and 714 pmol/litre on the same dates in that order. Estrogen dosage remained unchanged over the last 18 months.

Testosterone readings on the same dates were 1.0, 0.6 and 1.0 nmol/litre.

Its now in "wait and see" mode for 3 months before any dosage changes are considered.

[mynees]

Hey..
That's good news. 28.7 micrograms/litre is a little higher than ideal, but you shouldn't be worried about. If it goes higher again, your doctor will probably suggest a lowered estradiol dosage. If it comes down from 28.7, it means it was just a reaction of your body to cyproterone acetate. I find it strange however, that your doctor prescribes you both estradiol patches and oral estradiol, as patches on its own are more than enough. Most endocrinologist (as far as I know) don't like to prescribe more than one way of estradiol administration at the same time. Your estradiol levels varies because of that, as oral estradiol makes peak levels, and fast decline over next 12-15 hours, so it is almost impossible to know the exact hormone level, as it is half hour later different than before. So it varies if you took a pill 2 hours before bloodtest, or 20 hours before bloodtest. With patches (and pellet-implants) you have the most consistant hormone level, and it is the easiest to determine. That probably also means the safest.

[KayXo]

28.7 micrograms/litre is a little higher than ideal, but you shouldn't be worried about. If it goes higher again, your doctor will probably suggest a lowered estradiol dosage.

The increased prolactin level is due to cyproterone acetate, I think this is clear from results, that as soon as CPA was added, prolactin went up. So, lowering estradiol would not, in my opinion, do much to lower prolactin levels, the culprit seems most evidently to be CPA and it is a well-known fact that CPA tends to raise prolactin significantly in many due to dopamine inhibition.

patches on its own are more than enough

Not always. The strongest patch tends to deliver too little for most of us, is mostly suited for post-menopausal symptoms (was designed for this purpose) and wearing 2-4 at the same time is quite inconvenient. This is the reason probably why the doctor also prescribes pills.

With patches (and pellet-implants) you have the most consistant hormone level, and it is the easiest to determine. That probably also means the safest.

Safety appears to be associated with type of estrogen and method of administration, non-oral being the safest. Nothing indicates that it has anything to do with levels fluctuating and peaks. Injectables are quite safe, as found in several studies with men with prostate cancer patients and levels constantly fluctuate in ciswomen. 

[mynees]

The increased prolactin level is due to cyproterone acetate, I think this is clear from results, that as soon as CPA was added, prolactin went up. So, lowering estradiol would not, in my opinion, do much to lower prolactin levels, the culprit seems most evidently to be CPA and it is a well-known fact that CPA tends to raise prolactin significantly in many due to dopamine inhibition.

Not always. The strongest patch tends to deliver too little for most of us, is mostly suited for post-menopausal symptoms (was designed for this purpose) and wearing 2-4 at the same time is quite inconvenient. This is the reason probably why the doctor also prescribes pills.

Safety appears to be associated with type of estrogen and method of administration, non-oral being the safest. Nothing indicates that it has anything to do with levels fluctuating and peaks. Injectables are quite safe, as found in several studies with men with prostate cancer patients and levels constantly fluctuate in ciswomen.

Increased prolactin levels can happen for many different reasons, cyproterone acetate being just the most probable here. I think this is up to her doctor to confirm, not you or me. Higher than ideal estradiol levels are the usual reason for raised prolactin levels, with trans patients who use other AA or none. So yes, lowering estradiol has much to do with prolactin levels, even though it is not necessarily related, often even in contrast- higher estradiol/lower prolactin.

Who is most of us? Do you mean, non-transitioning transwomen, or pre-op transwomen, or post-op transwomen, or who is us? Most transwomen actually take an estradiol dose which is above what they need and should be taking. Because most of us are quite ignorant in biology department, and because most of us think that more will lead to better results in the short and long term. This is however quite wrong. Blood test (and how one actually feels) should be the only true indicator of what and how much one should be taking. And this (among other things) is why oral estradiol isn't the safest form of estradiol, because it is very difficult to determine what a real level is, and how much is enough, or how much is too much. The same is with injectable form of estradiol... well I'm shure you get what I meant.

[KayXo]

Increased prolactin levels can happen for many different reasons, cyproterone acetate being just the most probable here. I think this is up to her doctor to confirm, not you or me.

I agree.

Higher than ideal estradiol levels are the usual reason for raised prolactin levels, with trans patients who use other AA or none. So yes, lowering estradiol has much to do with prolactin levels

Indeed, quite high levels of estradiol can raise prolactin significantly but I have seen no evidence, personally, to be concerned about high prolactin (if related to estrogen exclusively) and estradiol levels when we take bio-identical E non-orally because ciswomen will experience MUCH higher levels again and again during their lives, during the course of their pregnancy and breastfeeding without doctors raising concerns about this or obvious harmful repercussions on womens' health; otherwise, our world population would be declining and women less populous than they are at the moment. Of course, I'm not a doctor but like I said, I've seen no direct evidence of harm from either situation in the context I described.

Who is most of us? Do you mean, non-transitioning transwomen, or pre-op transwomen, or post-op transwomen, or who is us?

I mean transgirls who take hormones for the purpose of feminization and well-being.

Most transwomen actually take an estradiol dose which is above what they need and should be taking.

So, are you saying that doctors, in general, are giving too high doses to transsexual women and what exactly do you base yourself on to say that more than what is needed is given to them?

Because most of us are quite ignorant in biology department, and because most of us think that more will lead to better results in the short and long term. This is however quite wrong.

In my case, a low or high dose of oral E was not effective. When I switched to injections where levels were quite high with higher than usual P, things really took off and I felt 1000% better. Sometimes, more is needed, sometimes, less. It is up to the doctor to determine this, based on what the lowest effective dose is for the person in question without jeopardizing their health. We all differ.

Blood test (and how one actually feels) should be the only true indicator of what and how much one should be taking.

My doctors don't pay attention to E levels though. Only general well-being, feminization and general health based on blood test results which we both agree are important measures.

And this (among other things) is why oral estradiol isn't the safest form of estradiol, because it is very difficult to determine what a real level is, and how much is enough, or how much is too much. The same is with injectable form of estradiol... well I'm shure you get what I meant.

In my unprofessional opinion, based simply on common sense and everything I've read so far in my 10 yrs+, I think it's quite easy to know how much is needed, just the lowest amount that gives well-being, feminization and maintains/improves health.