High prolactin after SRS

[galaxy]

Hello,

i always had a bit higher prolactin since HRT. All the doctors and specialists i asked in the last years didnt had any answers. The level was a bit higher but acceptable.

After SRS my prolactin raised very high after a few month. My estradiol dosage is the same as always - but now my hormones going crazy after SRS. 2014 i already had an MRT - no results, no prolactinome. But now my levels 2-3 times as high as 2014, so i'm afraid again to may have an prolactinome. Ive no breast growth, nothing - only that high level. I was taking a long time Tramadol in a low dosage after SRS - its an opiate. Dont know if this had any bigger effects on prolactin. 

How can i decrease my prolactin??

[KayXo]

i always had a bit higher prolactin since HRT. All the doctors and specialists i asked in the last years didnt had any answers. The level was a bit higher but acceptable.

How were your prolactin levels before HRT? When taking estrogen and progesterone, prolactin levels naturally increase but with non bio-identical estrogens, cyproterone acetate and Perlutan (which contains estradiol enanthate and dihydroxyprogesterone acetophenide), levels may be abnormally high. In some instances, where these have been prescribed to transsexual women, prolactinomas have been found. Bilateral galactorrhea was a common symptom, sometimes headaches and less often, vision problems such as double vision.

After SRS my prolactin raised very high after a few month. My estradiol dosage is the same as always - but now my hormones going crazy after SRS. 2014 i already had an MRT - no results, no prolactinome.

I was taking a long time Tramadol in a low dosage after SRS - its an opiate. Dont know if this had any bigger effects on prolactin.

I read that tramadol may slightly increase prolactin levels (one study) but so far, only read of one case where prolactinoma was found and causation cannot be established.

What does your HRT consist of? What have you taken in the course of your HRT?

High prolactin levels on their own don't necessarily mean one has a prolactinoma. Your MRI proves this. Other studies in transsexual women proved this as well. In many of these cases, cyproterone acetate was taken.

But now my levels 2-3 times as high as 2014, so i'm afraid again to may have an prolactinome. Ive no breast growth, nothing - only that high level.

How high were they in 2014 (when MRI detected no prolactinoma) and how high are they right now? Mine are very high but my E levels are very high as well, so this is normal.

Prolactin may be increased by stress.

How can i decrease my prolactin??

Doctors need to first find out the cause of your high prolactin levels. These may not be suggestive of a prolactinoma and in that case, you shouldn't worry, I think.

[KayXo]

Also,

you mention taking cyproterone acetate after SRS due to hairloss and skin problems, suggesting hyperandrogenicity which could have, indeed, been the result of cyproterone acetate withdrawal since cyproterone acetate also blocks androgens and may have reduced androgen levels to a greater degree. But, cyproterone acetate can strongly elevate prolactin levels. Out of the 7 cases of prolactinoma examined (out of 8 total reported in transsexual population), 3 were taking a high dose of cyproterone acetate, 1 a very low dose and 1 had taken a high dose in the past. Prolactin levels measured in these women ranged from 68-1,887 ng/ml.

If it were me and I was taking cyproterone acetate (which I wouldn't personally be taking for the above reasons and more as it can cause depression, fatigue, interfere with adrenals, etc.), I would ask my doctors to regularly check my prolactin levels and if they were above 60, to ask for an MRI, based on the available evidence.

[galaxy]

Prolactin level preOP was around 60 ng/ml. Now its around 170 ng/ml. Never changed any dosage. Actually ive estrogen as gel and a very low dosage cpa. Estrogen levels around 100pg/ml, testo 0,2 ng/ml.

[KayXo]

Because you are taking CPA, I would seriously consider asking for an MRI. A prolactinoma can affect other hormones as well, like thyroid and growth hormones. If found negative, bring the results to another team of doctors, just for a second opinion. Keep us posted.

Are you experiencing galactorrhea, chronic headaches, problems with vision, pain and aches in bones? Have you lost significant weight recently or feel unusually fatigued?

[galaxy]

I take cpa in a low dosage since 3 years and never had any significant side effects. Cpa cant explain the high rising after the op. Like i said my level always was around 60 ng/ml prolactine with cpa. Ive no prolactinoma. My level 3 month ago, shortly post op was 38pg. So the high level actually must be have any other reason.

Same with my thyroid hormones. I always had a light underfunction. Shortly after the op my levels where as the years ago and i decide to take a higher dosage thyroxin. Now 3 month later ive a overfunction.

It seems to me that all hormones i take has the doubled effect now. My SHBG raise up to 45nmol. I never had so much SHBG. It seems my body is much more sensitive now. But how can it explained? And even when it is more sensitive: why estradiol has still no effects like the years before? Ive so much prolactin like a pregnant woman but no breast tissue.

[KayXo]

I take cpa in a low dosage since 3 years and never had any significant side effects. Cpa cant explain the high rising after the op. Like i said my level always was around 60 ng/ml prolactine with cpa. Ive no prolactinoma. My level 3 month ago, shortly post op was 38pg. So the high level actually must be have any other reason.

Even if you are taking a low dose of CPA, I think it would be prudent to regularly monitor prolactin levels and also perhaps do MRIs on occasion to check for the presence of prolactinoma or meningioma, especially if you have symptoms such as galactorrhea, headaches, vision problems. I personally would not continue taking it, as you are post-op (harm exceeds benefits) but this is between you and your doctor only.

CPA may also cause depression and lethargy in some. 

Same with my thyroid hormones. I always had a light underfunction. Shortly after the op my levels where as the years ago and i decide to take a higher dosage thyroxin. Now 3 month later ive a overfunction.

This could be part of the problem you are having. But, your doctors should determine this.

My SHBG raise up to 45nmol. I never had so much SHBG.

This is certainly NOT high.

From one source:

Males: 10-57 nmol/L
Females (non-pregnant): 18-144 nmol/L

Pregnant women have in the hundreds, mine is above 200 but it's to be expected as E is very high. Your SHBG is increased by estrogen and your low (in my opinion) SHBG shows you are taking a low dose of E non-orally.

why estradiol has still no effects like the years before?

A few thoughts:

1) Thyroid function may be interfering, this should be resolved with your doctors.
2) CPA also acts as a partial ANDROGEN AGONIST, hence could potentially be inducing more androgenic activity than if you were taking none, considering you are post-op and have low amounts of T and DHT.
3) dosage of estrogen is too low

1) and 3) seem most likely. But, these should be further explored with your doctor. I am post-op and with levels under 300-400 pg/ml, nothing good happened.

Ive so much prolactin like a pregnant woman but no breast tissue.

But, if the above factors aren't right, it doesn't matter.

[galaxy]

You missunderstand me in all points ... okay.

1.) I'm 3 years under professional supervision of specialist for transgender endocrinology.

2.) My doctor (and a few others i asked) know about my problems. I asked thousand questions. No answers. Ive some genetic defects and nobody (on the whole world) cant explain it. Maybe you need hunderts of bloodtest to detect andy gen-mutation or similar ... nobody has this time and the money

3.) My problems: Genetic low SHBG level, abnormal high prolactin levels, very low effect of E2 (even with levels around 1400pg/ml) - all indepent from any mediaction, w/o CPA, w/o Progesteron, High/low levels of E2 ... you always will have these 3 main problems in different levels

4.) Because of 1-3.) i studied a very lot material in the last 3 years about endocrinology - i'm half of a doctor. I dont need any information "how it works". I know how it all works. But here: ive 3 main problems and need advanced advices. We already tried this standard stuff - but like i said, ive genetic defects (or so) and standards doesnt work here.

E2 is around 100 pg/ml after 6h. Its not low dosage, its a normal level like cis have too. Ive absoluty no side effects from CPA. Since 3 years. I always took it and have no problems with it - not too much prolactin, nothing. Ive no symptomes of any prolactinome. I'm healthy.

The only problem is the new high prolactin level shortly rised up after op. 2-3 month - its a number only but i want to fix it. And i want to know what made my prolactin rised so high. CPA - no, impossible - take it since 3 years. E2-dosage: no, same dosage as everytime ... what is it??? Its all the same like 3 years. What made the surgery to my body???

[galaxy]

Maybe an additional info:

My blood levels of prolaction show an second value named "prolactin after PEG" ... thats a test to detect macroprolaction. Macroprolactin is inactive. Value of "real prolactin" is here 118 ng/ml. Means 1/3 is inactive macroprolactin only.

[KayXo]

Ive some genetic defects

Has this been tested and confirmed? Or just your suspicion?

My problems: Genetic low SHBG level, abnormal high prolactin levels, very low effect of E2 (even with levels around 1400pg/ml) - all indepent from any mediaction, w/o CPA, w/o Progesteron, High/low levels of E2 ... you always will have these 3 main problems in different levels

If you explained in more detail your chronology of medication taking with corresponding values, I would have an easier time following.

How were your prolactin (and thyroid) levels before HRT?
Were your prolactin levels even high when you had low levels of E and when you hadn't taken CPA for at least 6 months?
Was SHBG still low when your E levels came back at 1,400 pg/ml? Was it tested at the same time as your E levels of 1,400 pg/ml?
When E levels were high, were you on injections? If so, how frequent were injections? And how long did you stay on them? Did you take anything else at the same time?

Because of 1-3.) i studied a very lot material in the last 3 years about endocrinology - i'm half of a doctor. I dont need any information "how it works". I know how it all works.

Even doctors don't know it all, sometimes ignore certain things, are not infallible, are human. Sometimes, working together can help. I also have researched this matter thoroughly for more than 10 yrs and have access to thousands of entire studies. I don't pretend to know it all. I make mistakes and I'm FAAAAAR from being a doctor but I consider myself pretty well versed in transsexual hormone treatment.

It's important to be humble and open-minded, at all times. Even the best of scientists and doctors should be, as they too can make mistakes and cannot know everything there is to know.

I'm trying to help you, as best as I can because I care about your well-being. Your doctors of course have final authority.

E2 is around 100 pg/ml after 6h. Its not low dosage, its a normal level like cis have too.

Normal range in ciswomen is 20-650 pg/ml. Take the average (650+20/2) = 335 pg/ml. You are below average. I consider these levels low relative to ciswomen and especially so, if you compare them to pregnant women. After all, ciswomen go through pregnancy too, it's a normal event of their reproductive years.

Regardless, this level may be too low FOR YOU. Sensitivity varies across individuals. This should be determined between you and your doctor, based on your feminization and well-being at different doses. At levels under 300-400, I did not have good results, others do VERY well. It depends.

Ive absoluty no side effects from CPA. Since 3 years. I always took it and have no problems with it - not too much prolactin, nothing. Ive no symptomes of any prolactinome. I'm healthy.

You started this thread because you were concerned about your prolactin being too high and that you were afraid of getting of a prolactinoma. Now you say you don't have any issues or concerns with this but high prolactin levels *can* be a symptom of a prolactinoma. You also say you are healthy and yet you state you have thyroid "overfunction" and you had a light thyroid underfunction for which you took a drug. You also took an opiate for a long time. This doesn't indicate good health.

You also now say you took CPA since 3 yrs and that you have been taking hormones for that same amount of time under supervision. Assuming you started HRT at the time of supervision, you then took CPA constantly. Earlier, you say that there was a time when you didn't take cyproterone acetate. I don't understand.

There may be no symptoms at the moment from it or there may be (depression) which you are unaware of (until medication is discontinued for at least 8 weeks). But, there may be, in the future, as this drug has been strongly implicated in the etiology of meningiomas in transsexual and ciswomen and men. Also, most of the prolactinomas seen in transsexual women were associated with the use of CPA. Even if the risk is low, why take the risk at all, especially considering this is an anti-androgen and that you are post-op? Do you want to risk having problems later? Is the risk really worth the benefits? Can those benefits be had in another way?

The only problem is the new high prolactin level shortly rised up after op. 2-3 month - its a number only but i want to fix it. And i want to know what made my prolactin rised so high. CPA - no, impossible - take it since 3 years.

Have you studied prolactinoma cases in transsexual women? You will note in some, even though the same regimen is continued or even withdrawn, prolactin levels can still rise over time or can continue to rise. It could well be that, at first, everything is fine but eventually, a prolactinoma appears. I would personally stay away from CPA given these results due to its effects and findings with it. I would still ask for another MRI, and continue checking levels as long as CPA is taken.

If CPA has indeed been taken for 3 years and you have always noted prolactin levels to be high (higher than average) for those years, especially rising now, it could well be due to CPA, sorry to say.

STRESS can also increase prolactin levels.