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Slightly elevated prolactin and very low T in 29 male

I am set to go to an Endocronologist this Tuesday to follow up on two low testosterone tests (40 & 82 (based on lab range of 320-1100), abnormally normal FSH and LH test and slightly elevated prolactin (18 based on lab range of 3-15). I am concerned I might have some kind of pituitary tumor as my eye sight was significantly worse at my ophthalmologist appointment this past summer (prescription got strong and newly diagnosed with astigmatism. I have been doing a lot of reading, and I'm just not sure what to think. I am worried that the Endo might dismiss the elevated prolactin, and like my primary doctor be confused on what FSH and LH should be when you have low testosterone (normal FSH and LH when you have very low testosterone is 'abnormally normal,' according to some well cited articles I've read. My symptoms are all of the traditional low T symptoms, including fatigue to the point where I am unable to stay awake all day even with a Nuvigil prescription (I also have sleep apnea). This doctor is the same one who dismissed my high fasting glucose as insignificant (normal is below 90 when fasting. Mine is around 109 most mornings). Any knowledge I can be armed with ahead of time would be helpful.
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Avatar universal
what are your prolactin levels? did you get referred to have an MRI of the brain?
do you take medications? or have a recent infeciton?
Avatar universal
Prolactin is slightly elevated (18 (range for test was 3-15)) but the test was done at 11:30 a.m. and I've heard it is highest after you first wake up. I wake up at 4 a.m. most days because I don't sleep very well. The reason my primary doc passed me over to the endo is because hormones other than low t start getting into a gray area for him, he said. I pushed to have my T tested by my primary on a hunch it had something to do with me being so fatigued all the time and falling asleep a million times a day, and he obliged, probably expecting nothing to come of it. Needless to say, he was shocked when the test came back with a level 42 (range of ~320 - 1200) of testosterone in a 29-year-old. It was the lowest he and his partner had ever seen, ever. He had me rush in to check my testicles thinking I may have had cancer or a testicular failure. He retested T and it came back as 82 (with free T of 91 (range for my age is 128 - 430). FSH and LH were abnormally normal at 5.3 and 5.2 respectively. He was ready to just call it there and put me on the T-shot. I said I was willing to do the shot, but I asked him to test prolactin, again on a hunch after reading about possible causes of low T. As I said at the beginning of this post, the prolactin came back slightly elevated at 18 (with a lab range of 3-15).

I do take a few different medications: I take Vitamin D 50,000 units once per week; I take Lisinopril for HBP; I take Nuvigil 250 mg daily for Excessive sleepiness (I also have sleep apnea with residual excessive daytime sleepiness). The fact that after a month of CPAP therapy I was still feeling so darn tired and sleepy all the time is why I went to my primary for help again (he referred to me the sleep lab/neurologist when I talked to him about my tiredness). When he did the first T test at my request, he also tested my vitamin D, which was very low, too. I am also a recovered addict with 6 years of clean time under my belt. I still take 2 mg sublingual (under the tongue) subutex (no nalaxone like suboxone, only the active ingredient buprenorphine). I have also had lab reports come back saying that I have impaired fasting glucose (when I wake up in the morning I have slightly elevated blood sugar level usually around 109).

I have in the past six months gained about 55 pounds, after losing 60 pounds in the six months prior to that. I stopped running daily when the weather changed and then ran less and less until I was no longer running. Eating habits pretty much stayed the same during weight loss and gain and the weight came back. My TSH always comes back normal.

I hope I've given enough detail here. Anyhow, my main concern is will the Endo take a slightly elevated prolactin level seriously? I've read some articles that have me discouraged. I really would like to have an MRI of my brain and pituitary.
Avatar universal
No prolactin lvl at 18 is within normal range, slight elevation is no concer. men range should 3-18, if it was something like 40-100 i will be concerned.
did you ever get tested for diabetes? i know diabetes can throw your whole body out whack. are you going to get a full metabolic blood test?

I suggest stopping your vitamin intake, it seems excessive, you can actually get sick from eating too much vitamin(vitamin poisoning.). vitamins supplements are not regulated, so there can be all sorts of stuff in there that are not good for you.

how interesting, i think this could be the side effects of the drugs you are taking.
look up Lisinopril, and Nuvigil side effects. and bring this up with your doctor.
Avatar universal
The vitamin D is prescribed by my doctor and must be bought at a pharmacy and I take it once per week because, as I said, my lab report showed my vitamin d was 12.1. Normal is between 30-80. I will follow my doctor's instructions on that.

Whether prolactin is normal or elevated depends on the specific lab performing the test. This lab says for their test, normal range for a man is between 3-15. Which would mean the level is slightly elevated, as I stated before.

Anyone else want to way in here? If anything Nuvigil would cause a drop in the prolactin level, as it is a D2 agonist, which is exactly why dopamine agonists are givin to people to help lower prolactin levels. Lisinopril is not one of the blood pressure medications that affects prolactin level. I've already looked up all my meds and ruled them out as having an effect on prolactin in any kind of negative way.
Avatar universal
slightly elevated doesnt mean a disease state, its only slightly out of range, its still within normal parameters, standard is usually around 3-18, you wouldnt say your in a disease state if your "substance" lvl in your blood stream is above a range slighty. if your range was 40-100, that is a concern.
both of your meds can cause other symptoms side effects. impotence is one of them. DID YOU GET tested diabetes, i strongly still suspect your "symptoms" are from the drugs, or a metabolic disorder.
i dont get what you are trying to find out, have you considered that your drugs could be causing side effects.
Avatar universal
since only your doctors can interpret the test results, and a specialist is required to do it.  Is your insurance in a network of doctors/specialist where they can communicate with each other, in an online system, like KAISER? this is very useful in coming down with a correct diagnosis, instead of a doctor getting a piece of a puzzle from another one.
Avatar universal
you should really have your doctor do a full metabolic panel, as chronic tiredness, low hormone level can indicate a serious metabolic disoder, or some other condition. like diabetes
Avatar universal

Hi,
I also feel your prolactin level may not be the culprit. As suggested, you may need to do a full metabolic panel test.Your  TSH level alone may not show  the thyroid functions just as your LH level alone does not reflect the T level, you need to measure both T3 and T4 levels.

The long term substance abuse might have affected the CNS feedback system. So,in case the tests do not show any specific issue, you may consult a Nature Cure Center to regenerate your body functions.

Solace
139792 tn?1498585650
See you after a long time. you are warmly welcome.
Avatar universal
I can tell you from personal experience that doctors unfortunately aren't very helpful sometimes. I've had many of the same problems your having. Is there a chance that you may have vericocele veins in your testicles preventing testoterone production? A urologist can look for those. This would explain a low T level and normal LH and FSH. Wouldn't hurt to get an MRI for a possible tumor. Mine was normal and then I found out that a low Growth Hormone level is the real problem especially with sleep apnea. It's not an easy hormone to test for and treat but there are natural ways to increase GH levels. Also a great way to increase LH is by taking Clomid as "off-label" for men. Endocrinologist should help you with that.
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