Quote from: DuchessBianca on December 02, 2016, 07:00:18 PMThough my doctor did suggest something that I'm curious if any of you have ever experienced. My prolactin level went from 10.01ng/mL at 2 months to 21.0 ng/mL at 6 months and he said it's elevated and has told me to only take 1/3 of my usual estradiol dosage daily for 2 weeks and then get retested for my prolactin level. He mentioned that he wants to rule out any possible cause of the elevated levels thats not a result of the estradiol (specifically mentioned brain tumor) as he mentioned that if the blood levels lower then he finds no issue at all and to resume full dosage. Have any of you had their doctor mention such things?
As estrogen increases, prolactin levels will increase too. This is how nature works, preparing the body for lactation, post-partum. My estradiol levels are between 1,000-4,000 pg/ml and prolactin levels between 80-130 ng/ml (typical of first term pregnancy levels), this is perfectly normal and my doctors aren't concerned the least bit. When my estradiol levels drop on day 5 after my injection, so do my prolactin levels.
Ciswomen during pregnancy have very high levels of estradiol and progesterone, and as a result, prolactin levels that can go as high as 600 ng/ml (Am J Obstet Gynecol 1972 ; 113 : 14-20.). Prolactin levels continue to be elevated post-pregnancy if a woman breastfeeds. Are women asked to avoid pregnancy and lactation due to the possibility of a tumor (prolactinoma) developing? No.
Prolactin
edited by Nelson D. Horseman, 2001« neither pregnancy (77) nor prolonged usage of hormonal contraceptives have been demonstrated to induce "de novo" appearance of prolactinomas (78)." No cause and effect established.
Even in women who have a micro-tumor, pregnancy, a time when estradiol levels are very high (up to 75,000 pg/ml, Cancer Epidemiol Biomarkers Prev. 2003 May;12(5):452-6), is not contraindicated. Nor is breastfeeding.
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."
In transsexual women, there have been 8 cases of prolactinoma reported despite very aggressive and high doses of hormones used in the past.
Andrologia. 2015 Aug;47(6):680-4."
Prolactinomas in oestrogen-treated MtoF persons are
rare. In the Amsterdam Gender Clinic between 1975 and
2006, 2306 MtoF transsexual subjects were treated. The
mean age at initiation of treatment was 29.3 +/- 12.7 years,
with a range of 16–83 years. Mean follow-up in these
subjects was 21.4 years, providing a total of 51 173
person-years of exposure and follow-up. Follow-up of
20 years or more was available of 303 individuals,
including follow-up of 30 years or greater in 151.
In this
population, only one case of a prolactinoma was encountered."
"In Trangender Clinic of Hospital das Clınicas, at the
Medical School of University of Sao Paulo, 166 MtoF
transsexuals have been followed since 1996. Unsupervised
use of oestrogens was estimated in 88.2% of the total
cases. The mean age at initiation of oestrogen use was
21.4 +/- 7.2 years, with a duration of oestrogen administration
ranging from 9 to 48 years. In this population,
abuse of injectable hormones was noted sometimes in
combination with oral oestrogens. (...)
Even though the majority of subjects followed at our
clinic have used extremely high doses of oestrogen during
several years, the frequency of prolactinomas in our
group was very low. This was also the case in the Amsterdam
gender clinic in subjects who had used very high doses of
oestrogens."
The only incidences of prolactinomas (tumors) reported in transsexual women were associated with the use of cyproterone acetate (5 cases), a progestin known to affect prolactin synthesis quite strongly and with either non bio-identical estrogen or progestogens.
Not once has a prolactinoma been reported with the use of exclusively bio-identical hormones. Out of the 7 cases, these were the prolactin levels found:
- 353 ng/ml
- 346 ng/ml
- 68, increasing to up to 133 ng/ml
- ranging between 245-292 ng/ml
- 365 ng/ml
- 87, increasing up to 109 ng/ml
- 1,887 ng/ml
If prolactin levels remain high despite E levels dropping, then this could possibly mean a tumor and this is why, in my case, for instance, my doctors aren't concerned.
Symptoms of a tumor/prolactinoma typically include galactorrhea (milk leaking out of breasts without stimulation), chronic headaches, vision problems.
According to
https://medlineplus.gov/ency/article/003718.htm"The normal values for prolactin are:
Males: 2 to 18 ng/mL
Nonpregnant females: 2 to 29 ng/mL
Pregnant women: 10 to 209 ng/mL"
So your 21 appears to be within normal range of nonpregnant females and well under the values found in transsexual women diagnosed with a prolactinoma.
To recap and based on the above findings, it would seem the risk of a prolactinoma with bio-identical hormones is very low, if not, completely non-existent even if levels increase substantially as it would during pregnancy in response to higher and higher progesterone and estrogen levels. On the other hand, if non bio-identical estrogens and progestogens (especially cyproterone acetate) are administered, there could be a risk (although low, only 8 cases reported), especially if levels begin to rise above 60 ng/ml and there are physical symptoms. As far as anti-androgens such as spironolactone, bicalutamide and LhRh agonists go, there also doesn't seem to be an effect on prolactin.
Endocrine Society's 96th Annual Meeting and Expo, June 21–24, 2014 - Chicago"CA treatment was associated with a pronounced increase in prolactin levels, in comparison to other anti-androgenic therapies,
independent of estradiol levels. Our results shed a new light on the pathophysiology of hyperprolactinemia during cross-sex hormonal treatment of transsexual women, with possible clinical implications."
CA = cyproterone acetate
You could share this information with your doctor and see what they say. I'm not a doctor.
