Well, I got my lab results over the weekend. Everything OK but prolactin, at 30 ng/mL. Nope, I'm not pregnant. I'd just run 5.3 miles a couple hours before the blood draw. Yeah, oops.
So, I re-tested this morning two hours after waking, after avoiding everything on the lists of stuff that elevates prolactin. Everything. The results just came back. 34 ng/mL. Normal range for assigned male at birth is 0-18 ng/mL.
So, estrogen is on hold now, and spironolactone is at fractional strength. HRT is on hold, and now I've got that crazy fear that I'll be stuck here forever. :-\
I can't help but wonder if this is just the pituitary being part of my screwed up brain, and it has always been this way. Or maybe I'm just 'lucky' enough to have caught a little bitty prolactinoma very early. But goddess, what a complete bummer. It's got me down tonight, and I just need to vent.
that was never a problem for me so i don't know... what is it? i heard of some having to stop before but i just kept it in that category of things i didn't want my anxiety to run with....
Quote from: veritatemfurto on June 14, 2016, 01:08:07 AM
that was never a problem for me so i don't know... what is it? i heard of some having to stop before but i just kept it in that category of things i didn't want my anxiety to run with....
Well, prolactin is a hormone that is a thundering nuisance in male bodies, but is essential in female bodies for triggering lactation. It's produced by the pituitary gland, a little gland in the center of the brain that rests in a bone socket in the skull. Mine is apparently overproducing for some reason. The fear is that it might be a tumor (not cancerous) called a prolactinoma. These are fueled by estrogen and make prolactin. The gotcha is that as they grow, they'll cause the pituitary to press on some surrounding bits that we need for vision.
So, since going blind or having double vision would be bad, I'm not to feed any possible prolactinoma, so no estrogen for me. Meanwhile, the endocrinologist is on vacation, so I'll be on hold for a while until they're back and order more tests to improve the guesswork.
Quote from: Michelle_P on June 14, 2016, 01:39:18 AM
Well, prolactin is a hormone that is a thundering nuisance in male bodies, but is essential in female bodies for triggering lactation. It's produced by the pituitary gland, a little gland in the center of the brain that rests in a bone socket in the skull. Mine is apparently overproducing for some reason. The fear is that it might be a tumor (not cancerous) called a prolactinoma. These are fueled by estrogen and make prolactin. The gotcha is that as they grow, they'll cause the pituitary to press on some surrounding bits that we need for vision.
So, since going blind or having double vision would be bad, I'm not to feed any possible prolactinoma, so no estrogen for me. Meanwhile, the endocrinologist is on vacation, so I'll be on hold for a while until they're back and order more tests to improve the guesswork.
Oh Michelle, I'm so sorry about this bump in the road. There must be a way round it? Just keep going. I'll be hoping for you.
How are you finding electrolysis?
My prolactin level was off the scale last blood result I had as well but it dropped down on the retest but only just into the acceptable range. More tests are ongoing...
Hopefully it'll be OK for both of us!!
Quote from: alex82 on June 14, 2016, 12:27:49 PM
Oh Michelle, I'm so sorry about this bump in the road. There must be a way round it? Just keep going. I'll be hoping for you.
How are you finding electrolysis?
Like the guy who saw the demons circling said, "It's just one damn thing after another." I'll probably just have to get dressed, get out of the house, and do some shopping. Purely for therapeutic reasons. Especially the shoes and wigs...
The electrolysis went very well. This was an intro session, so we talked hair growth, what needed to be done, and so on, followed by an easy hour in the chair working on my chin. Realistically, it's a spa session for me, with Jodie taking care of me while I relax. She seems to have a good clientele of MtF folks. She's using thermolysis on me, which works pretty well for me. Very little discomfort, redness or swelling, and only three tiny red dots visible the next day.
The next session will be for two hours, and we'll see about getting a regular 4 hour block if I tolerate that well.
Quote from: Michelle_P on June 14, 2016, 12:51:04 PM
Like the guy who saw the demons circling said, "It's just one damn thing after another." I'll probably just have to get dressed, get out of the house, and do some shopping. Purely for therapeutic reasons. Especially the shoes and wigs...
The electrolysis went very well. This was an intro session, so we talked hair growth, what needed to be done, and so on, followed by an easy hour in the chair working on my chin. Realistically, it's a spa session for me, with Jodie taking care of me while I relax. She seems to have a good clientele of MtF folks. She's using thermolysis on me, which works pretty well for me. Very little discomfort, redness or swelling, and only three tiny red dots visible the next day.
The next session will be for two hours, and we'll see about getting a regular 4 hour block if I tolerate that well.
Good - keep pushing through. Yep - one damn thing after another.
I find electrolysis so boring - I've just returned from another one - it wouldn't be so bad if you could read a magazine or a newspaper or anything. I looked at a place in Belgium that does 8 hour sessions for 4 days straight. I'm seriously considering it, just to get it done. That'll be very attractive by day 5 for the flight home.
Quote from: SashaGrace on June 14, 2016, 12:30:39 PM
My prolactin level was off the scale last blood result I had as well but it dropped down on the retest but only just into the acceptable range. More tests are ongoing...
Hopefully it'll be OK for both of us!!
Thanks, Sasha.
I'm wondering if maybe this is just a really common thing with MtF patients? We know our brains are a bit different, and perhaps this is just another common variation. I mean, how many men are ever tested for prolactin without symptoms? Yes, the level gets checked when a pituitary problem like double vision from pressure, or erectile dysfunction crops up, but the levels there are sky high.
For this level, it might be a tiny prolactinoma or overactive pituitary, either of which should be easily treated with a drug to tweak dopamine levels seen by the pituitary. And I've never heard of a doctor turning off a ciswoman's estrogen to treat high prolactin levels, so I'm a little annoyed at being put on hold.
How was blood sample taken? Taken just once, or did they take 4 samples during 45 minutes, or hour, in 15 minutes intervals while you lay and rest on the bed?
Quote from: alex82 on June 14, 2016, 01:02:25 PM
Good - keep pushing through. Yep - one damn thing after another.
I find electrolysis so boring - I've just returned from another one - it wouldn't be so bad if you could read a magazine or a newspaper or anything. I looked at a place in Belgium that does 8 hour sessions for 4 days straight. I'm seriously considering it.
Woof! That'll clear a crop of hair! I'd just be worried about looking like a cute gorilla for days after that much plucking. I've thought about it, too. We have Electrolysis 3000 in Texas (Texas!), and a place in Chicago that do that sort of treatment. It's a bit far for me to travel, though. If there was one in San Francisco I might think about it. (And why isn't there one in SF? There's a huge community of Us in the region.)
Quote from: mmmmm on June 14, 2016, 01:07:50 PM
How was blood sample taken? Taken just once, or did they take 4 samples during 45 minutes, or hour, in 15 minutes intervals while you lay and rest on the bed?
No, this is Kaiser. Take a number, when it is called, show your card and photo ID (*SNORT*); take yer tags, sit in Chair 5; "I'm a student, mind if I draw your blood?"; *POKE*; done.
It probably didn't help, that's for sure.
Quote from: Michelle_P on June 14, 2016, 01:12:50 PM
No, this is Kaiser. Take a number, when it is called, show your card and photo ID (*SNORT*); take yer tags, sit in Chair 5; "I'm a student, mind if I draw your blood?"; *POKE*; done.
It probably didn't help, that's for sure.
Ok. This is completely useless way to measure prolactine levels. Prolactine samples must be taken while you rest, preferably lay down, in 15 minutes intervals. First measurement is ALWAYS incorrect and irrelevant. Prolacin level is artificially raised by stress levels, like fear of needles can push it 5 times above actual levels, and even standing (or sitting) in the line to give blood sample, will show way to high results. If taken correclty, it would show decline of levels, from the first blood sample, to second, to third and fourth, and based on the curve, they can actually see if the levels at third and fourth sample are about the same (or still falling). If there wasnt much difference between third and fourth levels, this means that fourth level should be very close to correct measurement, and its the one that counts. If the curve would still fall, this would mean irrelevant reading, and the longer test should be repeated, this time with 8 blood samples, in 15 minute intervals.
They way your blood sample was taken, its completely irrelevant what the number is, because it doesnt tell anything about your actual prolactine levels.
Prolactinoma isnt common. The indication for prolactionoma would likely show levels 10 times higher (or even more) than the max. average range. Even then, its not necessarily prolactinoma. If (actual) levels would indicate possibility, you would need MRI scans to confirm it.
If you ask me (Im not your doctor...), you can freely continue to take estrogen until you actually get proper prolactine tests done.
Quote from: Michelle_P on June 14, 2016, 01:08:10 PM
Woof! That'll clear a crop of hair! I'd just be worried about looking like a cute gorilla for days after that much plucking. I've thought about it, too. We have Electrolysis 3000 in Texas (Texas!), and a place in Chicago that do that sort of treatment. It's a bit far for me to travel, though. If there was one in San Francisco I might think about it. (And why isn't there one in SF? There's a huge community of Us in the region.)
I saw the one in Texas - I looked at their website at the weekend.
Can you imagine how raw you'd be after such a marathon! But it might be worth it. It's something I'm keeping in mind. I contacted the Belgian place. It's in Antwerp - which I love, but for this I wouldn't really be able to go out and explore, or sit on a sunny terrace in the evenings. Well I could - with a very red, swollen face.
It's only a couple of hours on the train, but I'd rather fly - make it more of an event, and crucially, put some quick distance behind myself and the venue afterwards.
Why can't they just invent a pill that makes everything apart from the hair on your head, your eyebrows, and eyelashes just fall out!
Quote from: mmmmm on June 14, 2016, 01:33:03 PM
They way your blood sample was taken, its completely irrelevant what the number is, because it doesnt tell anything about your actual prolactine levels.
Prolactinoma isnt common. The indication for prolactionoma would likely show levels 10 times higher (or even more) than the max. average range. Even then, its not necessarily prolactinoma. If (actual) levels would indicate possibility, you would need MRI scans to confirm it.
If you ask me (Im not your doctor...), you can freely continue to take estrogen until you actually get proper prolactine tests done.
Yah. After I looked at all the possible things that could affect the test (How well did you sleep? How many hours since you woke? Feel any stress? :P ), I concluded that this wasn't much more than a screening test and not really reliable. It makes a great gatekeeper, though.
I'll probably have to get a referral to the Multispecialty Transition Clinic that Kaiser operates to gain access to an endocrinologist with experience in older MtF transgender patients. I may be the oldest transwoman this endocrinologist has ever seen at the ripe age of 62.
Ann Endocrinol (Paris). 2007 Jun;68(2-3):106-12.
"In women with microadenomas, pregnancy generally has little impact on their adenoma, delivery is normal and breast-feeding is allowed."
Pregnancy and breast-feeding are times when prolactin levels are VERY high, in the upper double digit range and up to 600 ng/ml during pregnancy. Estrogen levels are also very high during pregnancy (especially mid and late), way above what we could ever experience.
"While the literature has little to say on this subject and provides no adverse information, professional experience suggests that this attitude should be amended and that women presenting microprolactinoma should be allowed to use current contraceptive pills"
J Clin Endocrinol Metab. 2007 Aug;92(8):2861-5.
"observational studies have shown that pregnancy has a favorable effect on the natural history of preexisting prolactinomas. Prolactin levels are lower after delivery than before conception and complete remission of hyperprolactinemia has been reported in 17–37% of women after pregnancy (19, 20). Changes in tumor vasculature resulting in pituitary necrosis, microinfarction, or hemorrhage have been suggested as potential mechanisms to explain how pregnancy might lead to normalization of prolactin (21)."
Growth Horm IGF Res. 2003 Aug;13 Suppl A:S38-44.
"A review summarized results of 16 series reported between 1979 and 1985 totaling 246 women with microadenomas and 91 women with macroadenomas who became pregnant [17]. Subsequently, three series totaling an additional 117 women with microadenomas and 60 women with macroadenomas have been reported [18], [19] and [20]. When these data are combined [17], [18], [19] and [20], only 5 of the 363 women (1.4%) with microadenomas had symptoms of tumor enlargement (headaches or visual disturbances or both) (Table 1). In no case was surgical intervention necessary."
in ciswomen, pregnancy is rarely (1-5 % of time) associated with symptoms that would suggest an enlargement of an already existing prolactinoma when the prolactinoma is small and this frequency of enlargement is estimated to not be different from what it would be, in the absence of pregnancy. Hence, the risk is negligible. This number, however, significantly increases to 20-40% when the prolactinoma is large. No studies have shown that pregnancy can cause a prolactinoma.
No prolactinoma has ever been observed in transsexual women taking only bio-identical estradiol and bio-identical progesterone. Most commonly, the use of cyproterone acetate has been associated with prolactinoma, other progestins and non bio-identical estrogen.
Thanks, Kay. The information will be useful at a future appointment. The bio-identical estradiol never producing an observed prolactinoma is particularly interesting. The non-bio identical versions of estradiol are looking more and more problematic to me.
Just an update: I'ved got a telephone appointment with the endocrinologist for mid-July. I expect there will be more tests, possibly an MRI (hitting max-out-of-pocket on the high deductible insurance. Ouch.), and in a sane world, a prescription for a dopamine agonist, which seems to be the standard treatment whether or not something appears on the MRI. I'm pretty sure ciswomen don't have to stop E while dealing with high prolactin. ("Doctor, you're prescribing a hysterectomy for slightly high prolactin?")
With any luck I'll get my estradiol in a few months. Meanwhile I AM still on the spironolactone, which I've been ramping up to the prescribed level while taking plenty of fluids, raising salt intake from 700 mg/day to 1400, and watching my blood pressure like a hawk. I think I'm feeling the effects a little already.
So, I'm currently on track to transition to a frail eunuch with osteoporosis. Yay me! :) It's a start. (I'll need the estradiol eventually to maintain bone density, and shake the lethargic low-T feeling.)
I suspect over time the lethargic feeling will fade. With what I know now, my estradiol levels have never been and still are not out of the male range and I lost my T source in 82. The last 10 years I was both T and E free. I don't feel lethargic and in some ways, getting that dirty word T out of my system as allowed me to concentrate more. I think I have lost some physical stamina but that was to be expected once the T was gone.
How about an update? I can do that!
Yesterday, I got stomach cramps about a half hour into my daily exercise routine. WTF? I've never had that before. They went away after half an hour, and I went about my day. Then, during group therapy in the late afternoon, I got a series of fairly intense hot flashes. Again, WTF? I wonder if this is significant, as in "Congratulations! Your hormone levels are now so low we gonna celebrate with mock menopause!"
It was weird. It also hasn't repeated yet.
Meanwhile, I've still got that telephone appointment with the endocrinologist next week, to see what I can or should do next.
Meanwhile meanwhile, I think I looked and sounded a bit distressed in group. I was feeling miserable this morning about what I worried was my disintegrating marriage. The wife doesn't want to talk or hear about any trans-related issues I am having, doesn't want to see me as myself, and is pretty much in denial. When I'm at my most bummed out this morning, the phone rings. My therapist had a cancellation and thought I could use an extra appointment early next week. Yes, please!
Meanwhile meanwhile meanwhile, the wife comes home, and I start coming apart at the seams about myself, and she's actually sympathetic. Then the phone rings. "Michelle? This is the Multi-Specialty Transition Center". "We want to schedule a telephone session for you tomorrow to see about covering your electrolysis." What! OK, yes, please!
I'm already riding an emotional roller coaster without the estrogen!
Quote from: Michelle_P on July 07, 2016, 08:39:09 PM
"Michelle? This is the Multi-Specialty Transition Center". "We want to schedule a telephone session for you tomorrow to see about covering your electrolysis." What! OK, yes, please!
DEEEEECLINED!
Oops. Silly me. I failed to comply with the undisclosed secret rules.
Quote"You bumped into the ceiling which now has to be washed and sterilized, so you get nothing! You lose! Good day, sir!"
-- Willy Wonka
In order to get on HRT, They wanted to see signs that I was serious about moving forward, such as being on electrolysis. Besides that, I HATE having a beard and shaving (dysphoria triggers...), and am prone to razor burn and ingrown hairs. Before I started HRT, I wanted to get electrolysis rolling. So, I did, and the areas where I used to get the most ingrown hairs are now nice and smooth.
But... There's ALWAYS a but...
Getting electrolysis covered requires me to be on an androgen blocker at least 6 months. The insurance folks think that might reduce hair growth to the point where I don't need electrolysis. Maybe on a Tanner 2 14 year old, but on a 60-something? Then, at the 6 month point, I'm to be evaluated by a dermatologist, just in case there's enough non-gray hair to make me a laser candidate. (Nope!)
The thought has crossed my mind to stop all facial hair removal, including shaving, and show up as a mountain man with boobs... I'd probably lose my mind before that point, though. (Lemme check my pockets... I know it's here somewhere...)
Pay up Michelle!
I understand your trigger. For me that's the top one. I can't stop stroking my upper lip - it's cleared and it thrills me. I haven't felt it like this since the 90s.
I haven't been able to touch it for nearly twenty years - only indirectly with a razor followed swiftly by a generous helping of YSL touche éclat concealer.
1998 high school portraits - I couldn't even look at mine, let alone take it home for approval because of the above - using my mothers leg razor once a week was no longer working and had caused a rash. I went to a chemist that day and bought an electric razor in the most humiliating shop purchase I've ever made.
1999 - I took that one home. I'd learned by then how to work with it, my hair was lightened from the sun*. I'd learned what brands and products were good combination for me. Objectively I quite like it as a good picture of a nice looking teenager.
*And 'Sun-In'. A revolting spray that was activated by heat. I used to hairdryer it while the excess dripped down my face. I can still remember the smell of it. I don't know if it's still on the market.
I had my endocrinology telephone appointment, and it went pretty much as expected. I need my head examined. ::) There is an opening in the MRI schedule tomorrow afternoon, which I took. I'll be getting routine imaging of the pituitary to look for any little oddities.
A macroprolactin lab work up has also been ordered. That will look for isoforms of prolactin that can throw off the basic test, but which are not biologically active. (Lots of exercise can be a cause of elevated prolactinoma. :) )
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719302/
If the MRI is negative, I have the go-ahead to start Estrodiol.
I'm so sorry to hear about your struggles with prolactin. I'm in a similar boat right now except I've been on estrogen for 6 weeks now. My level is 30 too. I just got a referral to an eye doctor, even tho I'm not having any vision problems. I do know I don't want to stop or ever go back (I've been getting great results) but it is scary. I'm trying not to get too worked up about it because I know we can overly obsess with something like this. As I'm sure you know.
Quote from: Michelle_P on June 14, 2016, 12:10:25 AM
So, I re-tested this morning two hours after waking, after avoiding everything on the lists of stuff that elevates prolactin. Everything.
Did you find a comprehensive list of things online somewhere? My list includes, no breast massage 24 hours before test, stop SSRI's, test at least 3-4 hours after waking. That's pretty much it.
I personally beat my head against the prolactin/anxiety/fear wall for such a long long time, only to find that elevated prolactin only means the estrogen is doing as it should. It is a biological consequence of the changing hormonal landscape. This is known by all doctors who take enough interest in the new cutting edge research on transgender hormone treatment, and 'not' only reference the old studies. I've had the optic nerve mapping, you name it, finally to meet a Dr. who knows what she is doing. Your call though.
The triggers for prolactin are pretty much what you've got there. Mechanical stimulation of the chest (massage, repetitive exercise, my aerobics routine...), chest injury, SSRIs (common psych drugs), and some other odds and ends. Stress. LOL! The Kaiser website had some info on this I was referred to.
Since I'm not on estrogen yet, the decision was to hold off on it until we get a peek at what might be going on around the prolactin factory, the pituitary gland. It's possible for pressure on the pituitary stem, for example, to trigger this, as well as overgrowth of prolactin-producing cells (various sizes of prolactinoma). That lead to today's fun and games.
I was the first body in the MRI queue after lunch, so everybody was rested and in a good mood. The tech had me leave all metal out in a little dressing room at one end of the MRI trailer (yup. Trailer. The whole thing is tucked in a 40 foot long truck trailer. Easier to ship back to the factory for service.). Oh, and no wigs for head scans. ;)
I lay down, got slid into the head focusing frame, made sure the foam earplugs were seated, and the foam wedges to lock my head in position were tucked in. Then, into the machine! It felt like taking a nap in a torpedo tube, but with better ventilation. For those who haven't so napped, I was in a 'pipe' deep in the core of the MRI machine's magnet torus, maybe 2 feet across. It's lit, and there's even a periscope mirror on the head frame so I can see the closed door at my feet and the tech outside the door window.
Then, the machine goes into action. Some shots to find the area of interest...
*BRAP*. Kerchunk, bzzzzt, kerchunk, bzzzzt...
And away we go...
*BRAAAAAAAAAAAAAP*tic*BRAAAAAAAAAAAAAP*...
12 minutes later, I get slid out. Still immobilized, I hear "Make a fist." Time for the MRI contrast dye. It helps make some tissue types stand out.
Back into the tube, and...
*BRAAAAAAAAAAAAAP*tic*BRAAAAAAAAAAAAAP*...
After about 8 minutes, I slide out, the wedges are pulled and the frame slides off, and I can sit up.
The scans are sharp, crisp, nice and clear, and I really hope they are boring. This last words I want to hear from a radiologist are "This is interesting..."
I've known several individuals who have experienced the high prolactin levels - including myself. My doctor insisted I was pregnant and had me take tests to confirm I was not -- ugh!! (I had momentary fantasies of having a baby and how I so wished it were true, but it would have been an estrogen baby) He was not aware of my t-status. My best friend at the time also had alarmingly high prolactin levels and her doctor's nurse called her to tell her that she had a brain tumor and was going to die. Yes, she was told that point blank. She never had a tumor or anything wrong. I convinced her to fire her doctor and get another. I do believe its a common place occurrence for girls who use estrogen. But its always better to err on the side of safety and confirm its nothing. You just never know.
I really like your new outfit Michelle, it looks very smart.
Yeah, I kind of figured that was it. If I find anything else I'll let you know. I hope your next eval goes well.
Quote from: Newgirl Dani on July 14, 2016, 03:43:14 PM
I personally beat my head against the prolactin/anxiety/fear wall for such a long long time, only to find that elevated prolactin only means the estrogen is doing as it should. It is a biological consequence of the changing hormonal landscape. This is known by all doctors who take enough interest in the new cutting edge research on transgender hormone treatment, and 'not' only reference the old studies. I've had the optic nerve mapping, you name it, finally to meet a Dr. who knows what she is doing. Your call though.
That sounds right.
Quote from: alex82 on July 15, 2016, 05:09:46 PM
I really like your new outfit Michelle, it looks very smart.
Thanks, Alex. I'm going for "older professional" (what I used to be, in the wrong body!), as a step up from "grandma goes to the mall". Yeah, I'm arbitrarily tagging people by perceived activity and manner of dress. :)
Back on prolactin: Prolactin levels are really just indications of activity of cells that produce that messenger protein, just like all the other levels we are used to seeing. One persons normal is another persons OMG!. The 'normal' bands just represent where 90% of people with no medical issues fall within.
We already know that we aren't like 90% of the population. This is just one more variation in a poorly studied subpopulation, and the variations are typically without an identifiable cause, what the medical pros call "idiopathic".
So, I'll likely spend the weekend with this rattling around in my head, but I'll have a better idea of what's up next week. So it goes. So it goes.
I had my appointment with my endo last week to discuss further treatment and my heighten prolactin level (32).
Before I went to see her, I found the following article:
http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2014.RE.19.SAT-0111 (http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2014.RE.19.SAT-0111).
She only confirmed that it was related to taking Androcur, as described in the article and I should not be worry about it. Still we decided to stop Androcur at all, based on my E level of 233 and the fact that I took just a very small dose of CPA every other day for the past couple of weeks. So I should be fine on E alone and see how I feel.
I know that you take Spiro, but based on the article - if I understood it correct - it can also heighten prolactin, not to the same extend as CPA but still.
Alas, I got my 30 ng/mL prolactin reading before I started spiro. I was on finasteride for several years, but there's no medical data out there suggesting a correlation between finasteride and prolactin levels.
I'm just waiting for the MRI results. Hoping for a normal looking pituitary, and no mystery lumps or bumps along the pituitary stem. (If there are, treatment is very straightforward with medication, although challenging to the stomach. Pesky dopamine agonists...)
My prolactin when last tested in March was 39.4. I am on a high dose of E. My doctor said in his note to me, "nothing to worry about".
Well, today was interesting. The MRI results were in. Nice sharp images of my brain...
It's a girl. :)
Oh, and there's a 'questionable hypoenhancing nodule within the left pituitary gland measuring 3.5 mm.' That's a possible adenoma.
I've got the approval to start estrogen, so maybe sometime this week I'll pop on the first patch. Oh, who am I kidding? I slapped that sucker on before I even finished reading the rest of the message from my endocrinologist.
I'll be doing another prolactin measurement in a month to see if I'm feeding my little monster, and if it's up I'll be adding cabergoline, a dopamine receptor agonist that blocks signals to the prolactin factory.
I'm so glad that you were finally able to start Estrogen. Congrats. Glad your results on the most part were good. Hugs
Mariah
Wow this has been an interesting read especially because I'm a total hypochondriac and worry about the my prolactin (Plus my kidney going and everything else in general lol) even tho my prolactin on last measurement was 6.
Six? Oh, Marissa, that's a great number for one of us.
You'd be amazed at what whacky numbers we can have in our blood tests and still keep chugging along just fine. I'm 62, weighed up to 215 lb in the past, now 140, facing my second transurethral prostate surgery (Prostate? WTH is that doing in me?), and I've had various strange numbers turn up in my blood work.
Sometimes I get good advice, and I make adjustments to bring things in line. Sometimes I've gotten fantastically bad advice, from a real live licensed doctor person, and wondered if he was playing Candy Crush when I was giving him my history. (Yay, second opinions!)
Stuff works out. It's hardly ever terminal nevergetoveritis. Anyone strong enough to do what we do in our lives, living with our problems, is strong enough to overcome darn near anything.
I wish you luck, I'm sure it will be OK :)
More numbers; I had a complete pituitary hormone panel done last week, to see what my little monster was doing. (The adenoma on my pituitary. What? You don't give your odd growths nicknames?)
So, at 5 weeks+ on spironolactone, and 42 whole hours on Estrodiol patch, I have:
40 ng/mL prolactin
Um. Yeah, that's three data points on an upward trend line. I sense a dopamine receptor agonist in my future. Retest in three more weeks.
The good news is that everything else looked pretty reasonable. Testosterone was down from 650 to 251 (bottom of the normal male band), so that is moving in the right direction. :)
One odd effect I've noticed; After 11 days on estrogen patches at a very low level (half of minimum transition dosage in most guidelines), I'm already seeing enlargement, tenderness, and darkening of the areola and formation of buds. I suspect the prolactin (now at late third trimester levels) is boosting things a bit.
It appears that age 62 may not be too old to see physical changes. ;)
Another data point: I had my prolactin level measured again today, 4 weeks later, to see how my little monster is doing. Good news: He's staying little!
Before HRT: 30 ng/mL and 34 ng/mL
2 days into estrogen: 40 ng/mL
4+ weeks on estrogen: 38 ng/mL
The last two numbers were taken in as close to identical conditions in terms of activity and time after waking as I could manage.
And yet another data point, plus some interesting new results; Michelle haz a happy! :D
I just got my three month labs (except for testosterone; still in the counter...)
Prolactin: 40 ng/mL
Estradiol: <50 pg/mL
Sodium and potassium levels look good. I'm on spiro so we track those. Creatinine and the lipid panel are disgustingly healthy. ;D
OK, so why are these bad numbers good news?
The prolactin test isn't clever enough to tell the difference between monomeric prolactin, the stuff that helps us start nursing, and the giant megaprolactin molecules that are inert. A chromatographic test that separates them shows monomeric prolactin at 9 (normal range 3.4-14.8). So my little monster is just a boring microprolactinoma and won't be causing me any problems with growth or lactation.
But, the low estradiol? I'm on biweekly patches, one per week. These patches deliver for 84 hours, and rapidly drop off after that. Serum estradiol has a biological half-life of just a few hours. The lab blood was drawn 98 hours after the patch went on, so I expected the result to be below the minimum of the basic test.
So, now that we know my biology works like most humans, and my prolactin issues are an inert molecule bogey, I have the go-ahead to use two patches per week. Yay me!
= The End = ;D