Prolactinemia

Prolactinemia, including hyperprolactinemia, is a common cause of hypogonadism, low sperm count and male infertility.

Prolactinemia

Prolactinemia is a fairly common cause of hypogonadism so we’ve written up a little primer about what it is and how it can impact your fertility. In most cases prolactinemia means hyperprolactinemia: an excess of prolactin released into your bloodstream. It is a common and reversible cause of male infertility accounting for about 11% of men whose sperm concentration is low.

What prolactin does for men

Prolactin is a hormone produced in your pituitary gland, and secreted into your bloodstream. What most people know about prolactin is that in women, it induces lactation after birth and during pregnancy enhances breast enlargement to get ready for breast feeding.

Prolactin is an integral part of everyone’s complex endocrine system, which puts out myriad chemical signals to the body: grow, remain, recede, eat, run, don’t eat, punch, kick, sleep, have sex, have more sex, burn calories, get hard, slow your heart rate, be hairier, secrete, put out signals, don’t put out signals, etc. Prolactin binds to specific receptors in the gonads, lymphoid cells, liver, heart, lungs, thymus, spleen, pancreas, kidney, skeletal muscles, skin, central nervous system, mamillary glands, and female reproductive organs, among other sites.

It not only helps regulate testosterone production in men, but also helps to regulate immune functions, salt and water balances, metabolic functions, endocrine system, brain and behavior, and growth and development. Prolactin is what tells your body that it’s satisfied after sex, and lets the arousal mechanisms (aka dopamine) know they can settle down for a bit.

Because higher levels of prolactin are found in fathers of young children and in expectant fathers, as compared to un-mated males, according to a large-scale study in the Phillipines, behavioral endocrinologists have theorized that a modest rise in prolactin helps prepare men for the task of fatherhood. It quiets the sex drive, they figure, and along with oxytocin—with its weird reputation for being both the “cuddle” hormone as well as a byproduct of stress—helps dads of young children bond to and empathize with their offspring.

What too much prolactin looks like on men

Elevated levels prolactin in the blood signals the gonads to make less testosterone (hypogonadism). This means that hyperprolactemia can indirectly but definitely cause decreased libido, erectile dysfunction, dimished ejaculate volume, and a low concentration of sperm (oligospermia), and enlarged breasts (in men this is called gynaecomastia).

Other sources can cause these problems, but the case of hyperprolactinemia, these symptoms may be subtle or not noticeable in every day life. If you put on a bit of weight, those man boobs might seem like nothing the treadmill can’t fix (until you notice they’re more like rubber than fat); if you’re not trying to conceive, changes in sperm concentrate or ejaculate volume will go undetected; and finally, the loss in the areas of libido and erectile function may happen so gradually as to obscure the problem.

What’s more, sperm quality will be affected first, when through hormone-signaling cascade, high prolactin inhibits release of the gonadotropin-release hormone, which results in turn in decreased release of LH and FSH. Together with decreased testosterone secretion, these decreases cause spermatogenic arrest (interruptions in making sperm so you don’t make as much), impaired sperm motility (your boys can’t swim well enough to reach the egg), and altered sperm quality. More obvious physical symptoms of the hypogonadism, such as gynaecomastia or erectile dysfunction, may not appear until prolactin has been elevated longer.

Rarely, hyperprolactemia may be accompanied by headaches or eye problems.

Diagnostic tools: the trusty blood test

A few caveats. One is that no one agrees on what the right prolactin level is for men, although a blood test could tell you if it’s skyrocketed. A typical prolactin level may range from 2-18 mcg/L but a high prolactin level might be 10-20 times the reference range.

There are some normal fluctuations in this hormone. Your prolactin levels change throughout the day, so the test is usually given between 8 a.m. and 10 a.m.—about three hours after you wake—to establish a consistent reference range.

Sometimes levels also go up during periods of stress, even briefly. And, they go up when your nipples are stimulated—so put those nipple clamps away and keep your sweetie away from your pecs for a day or so before the blood test. Even exercise or a high-protein meal can bump the levels up a bit, but don’t sweat it. Small rises are not likely to be the cause of a big problem.

It can be helpful to look at prolactin levels next to testosterone levels, because ongoing high prolactin secretion will signal the body to lower testosterone production. Your doctor may also repeat the prolactin test to verify an elevation wasn’t a temporary fluctuation, especially if the testosterone level is normal-range.

Prolactin levels through the roof

If the value is very high, then it’s time to look for the cause. Levels in the ballpark of 200 mcg/L may prompt an MRI to look for a tumor in the pituitary gland that actually secretes excess prolactin (called a prolactinoma). Other problems with your pituitary or tumors in its vicinity may cause an unusually high prolactin level. Very large tumors, which are rare, may also press on the neighboring optic chiasm, causing eye problems and headaches.

Your doctor may also review your medication list, as certain medications can raise the level of this hormone—some more than others. Examples include antidepressants, some drugs that treat stomach problems—including PPIs or proton pump inhibitors, many of which are available over the counter—select blood pressure medications, and several antipyschotics. Talk with your prescribing doctor before making any medication changes.

Cocaine use can also raise prolactin. You don’t need to ask your doctor’s permission, pass go, or collect $200—flush the blow if you’re planning to be a dad.

You might also have a high prolactin level if you have an underactive thyroid (hypothyroidism), kidney disease, problems with your thalamus—the area in your brain that gives orders to the pituitary gland—or hypothalamic disease, or trauma to/irritation of the chest wall.

Treatment for hyperprolactemia depends on the cause. Medication-related causes may be solved simply with a doctor-prescribed adjustment in type or dose. For tumors, the treatments generally target shrinking the tumor and limiting its secretion effects with drug therapy (dopamine agonists). Drugs that dampen prolactin production and its release, such as bromocriptine and cabergonline, can lower serum prolactin levels enough to restore male fertility. These regimen normally reduce the size of the prolactinoma as well. In rare and difficult cases of prolactemia-induced male infertility, such as stubborn macroprolactinomas (large tumors), hormone therapy may be added to the normal drug regimen.

 References

Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.
Sara SDx

Author: Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.

15 thoughts on “Prolactinemia”

  1. I am 70years young and have had a diagnosed pituitary gland tumour for over 25 years..I am taking CAMBERGOLINE for treatment..unlike others my sex life has increased since medication,I still have man boobs (enlarged breasts) which are not a problem however my manhood eg penis started to shrink and continues to do so,my specialist and doctor aren’t concerned but I am…is this normal or is it my age and is there anything that can be done. Thank you.

  2. Question,

    My prolactin test was 20 MG but my free testosterone was 7.2 pg and serum 220. Do you think this may be a tumor? I’m thinking maybe due to being 20-30 pounds overweight and poor diet along with stress but worried it could be more.

  3. I’ve had a low sex drive for at least year now, and generally feeling lack of energy and foggy headed. My GP did some tests, and found i have very low Free T and T, and high (90) Prolactin and TPO. Plus, suddenly my Total cholesterol is a bit too high (212) which is never was before.
    Looking forward to more tests and hopefully getting the right treatment, cause I WANNA LIVE AGAIN!

    1. Good luck. It looks like you are on the path to discovering what’s going on! I’ll be wishing you luck that you can get to the bottom of it and get your life back!

  4. I am a man and have the following weird problem: During masturbation I get a strange feeling in my neck and brain. It causes fatigue and sometimes nausea. Especially after an ejaculation I wake up the next day with feelings of anxiety and mild depression. Often I have strong feelings of fatigue as well. These feelings usually increase the first two days after the ejaculation and last for at least one week. There is no decreased seks drive during that period.

    I have visited several doctors and neurologists. Here in The Netherlands there’s a doctor who studied and defined POSS, Post Orgasmic Stress Syndrom and I have visited him a couple of years ago. However, he relates the POSS symptoms (similar to flue) to allergy for the man’s own sperm.

    I consider to ask my doctor to test my blood for prolactine levels prior and after an orgasm.

    I have never read at fora about other men having this trouble (except for headaches close and after orgasm) and I have been active at the Neuromanger brain forum of the Harvard university for a very long time without reading about any other similar case.

    Due to the discomfort I abstain from masturbation and seks because its is simply disabling.

    I hope you may have and idea how to get to the root of the problem. I have asked a neurologist to make an FMRI prior, during and after orgasm to check what happens in the brain. He declined. His argument was that there’s no reference material…

    Thanking you in advance for your reply.

    Kind Regards,

    Rody Mulder

    1. I’m sorry to hear your troubles. It can be very frustrating to experience something that medicine doesn’t know a whole lot about.
      Are the symptoms only coming from masterbation or do they occur with sex as well?

      I think you are doing the right thing by continuing to seek out doctors who may be able to help. I would look into researchers as well. There may be people who are studying issues related to problems with sex who might be able to help. There are also doctors that specifically focus on sexual dysfuntion disorders who may have some better ideas of what to do. You might research the doctors on this site to see if there might be one who would be a good fit. http://www.issm.info/

  5. I’m suffering from hyperprolactinemia & resulting not having weak erection, and I also experience very quick ejaculation…pls your advice iz needed…

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