High Testosterone But Low Sex Drive? Check Your Prolactin

Increased testosterone levels from hormone replacement therapy are expected to bring on a ravenous sex drive in men. However some men either realize a short term increase in desire when testosterone replacement therapy is initiated and then is trails off, or it never comes on like expected. What gives? High testosterone levels are supposed to make your women run and hide! Believe it or not, prolactin is a hormone that causes pregnant women to produce breast milk! I know, seems kind of backwards, right? But, a high prolactin level (in men) is probably what is suppressing your libido. Abnormally high levels blunt the actions of dopamine, which is what primarily regulates your sex drive.
Prolactin, also known as lactogenic hormone, is produced by the pituitary gland.


Prolactin plays an important role in the reproductive health of both women and men. In women, prolactin acts to trigger lactation (the production of milk) after childbirth. In men, however, the specific function of prolactin is not well known. Although, in both men and women, prolactin levels seem to indicate a measure of sexual satisfaction. Prolactin is what tells your body that it’s satisfied after sex, and lets the arousal mechanism (dopamine) know it can settle down and get ready for round two.



As far as sex drive in men goes, high prolactin levels inhibit the release of gonadotropin-releasing hormone, which in turn causes a decrease in luteinizing hormone, which leads to reduced follicle stimulating hormone, which leads to decreased testosterone production. These decreases cause a reduction of sperm production, impaired sperm motility, and poor sperm quality. The overt physical symptoms of such an impaired hormone cascade such as gynecomastia, erectile dysfunction and lost libido, may not appear until prolactin has been elevated for an extended period of time.


Unfortunately, no one agrees on what the optimal prolactin level is for men, although a blood test could tell if it has significantly increased. 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 prolactin. Your prolactin levels change throughout the day, so the blood test is usually given, like most blood tests, first thing in the morning - about three hours after you wake—to establish a consistent reference range.


If your prolactin level is very high (hyperprolactemia), it’s time to look for the cause. A level of 200 mcg/L, more or less, would usually prompt a clinician to do an MRI to look for a prolactinoma, a tumor in the pituitary gland that actually secretes excess prolactin. Other pituitary problems, or tumors in its vicinity, may cause an unusually high prolactin level. Your doctor may also look at other medications you may be taking to look for an adverse interaction; certain medications can raise the level of prolactin. Examples include antidepressants, proton pump inhibitors, select blood pressure medications, and several anti-psychotics. Cocaine use can also raise prolactin.


You might also have a high prolactin level if you have kidney disease, an under active thyroid, or a disorder involving the thalamus—the area in your brain that controls the pituitary gland—or hypothalamic disease. Obviously, treatment for hyperprolactemia depends on the cause. Medication-related causes may be solved simply with an adjustment by your doctor. For tumors, the treatments generally target shrinking the tumor and limiting its secretion with drug therapy (dopamine or dopamine agonists).


Drugs that dampen prolactin production and its release, such as bromocriptine, cabergonline and HCG can lower serum prolactin levels enough to restore male fertility and libido. In any case, men with reduced libido, with a concomitant a high testosterone level, can put the lead back in their pencil once prolactin levels are brought back down.
April 21, 2017 by Richard Rodriguez

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