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Suffering from hyperprolactinaemia. On cabgolin. Reason for low sex drive?

DOCTOR OF THE MONTH - Mar 2013
Mar 2013
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HI,
I AM 38 YEARS OLD MALE AND I AM SUFFERING FROM HYPERPROLACTIMIA. RIGHT NOW MY SERUM
PROLACTIN IS 205 AND I AM ON TAB CABGOLIN 0.5mg WEEKLY FOR LAST 3 MONTHS BUT TILL
DATE MY LIBIDO FOR SEX NOT BEEN INCREASED. SO PLEASE ADVICE ME WHAT TO DO ?
Posted Tue, 19 Mar 2013 in Blood Disorders
 
 
Answered by Dr. Aarti Abraham 30 minutes later
Hello XXXXXXX,
Thanks for your query.

Hyperprolactinemia is the name for higher-than-normal blood levels of the hormone prolactin. This hormone is made by the pituitary gland, which is located at the base of the brain. The main function of prolactin is to stimulate breast milk production after childbirth. High prolactin levels are normal during pregnancy and breastfeeding.

In other cases, prolactin can become too high because of a disease or the use of certain medications. Often, the cause is a prolactin-making tumor on the pituitary gland, called a prolactinoma. This tumor is almost always benign, meaning not cancerous. It is more common in women than men. Rarely, children and adolescents develop prolactinomas. Other brain tumors may also cause the pituitary gland to make too much prolactin.

Prolactin lowers levels of sex hormones (estrogen and testosterone) in both men and women. Too much prolactin and the resulting drop in estrogen or testosterone can lead to sexual dysfunction. Both men and women with high prolactin levels may have infertility, low sex drive, and bone loss. Men may have Erectile dysfunction-trouble getting or keeping an erection, Decreased body hair and muscle mass, or gynecomastia, that is enlargement of breast tissue,

Someone with a large prolactinoma may have headaches and/or vision problems. This is because the optic nerve, which is needed for sight, is near the pituitary gland and may be injured by a large tumor.

Some people with hyperprolactinemia have no symptoms.

Doctors detect excess prolactin with a blood test that measures the prolactin level. Most often, a single blood test is all that is needed. For most patients, a level below 25 μg/L (micrograms per liter) is normal, and above 25 is too high. A prolactin level above 250 μg/L most often indicates a prolactinoma. Mostly, drugs like cabgolin suffice to control prolactin levels. In rarer cases, surgery is required,
Rarely, neither medicine nor surgery works. In that case, radiation treatment may be an option to shrink the tumor.

Medicine-induced hyperprolactinemia due to certain drugs is common, and you need to check your drug history for that. Or, if you have infertility, low sex drive, and low bone mass, you may receive treatment with estrogen (for women) or testosterone (for men).

An underactive thyroid most often needs treatment with synthetic (laboratory-made) thyroid hormone.
Sometimes doctors cannot find a cause for hyperprolactinemia. This is called idiopathic.

Prolactinoma is the most common tumor of pituitary gland, comprising up to 45% of all pituitary tumours. Males present late till prolactinoma becomes large in size (macroprolactinoma) and start causing pressure over optic chiasm and presented as visual deterioration or visual field defects. They can also present with decreased libido.

Hyperprolactinemia causes infertility in around 11% of oligospermic males. There are many studies suggesting that hyperprolactinemia has a definite role in the male infertility, and is one of the reversible causes of infertility. It can be managed medically with simple medication, such as bromocriptine and cabergoline, which normalizes serum prolactin levels, restoration of gonadal function, reversing infertility caused by hyperprolactinemia .

It is a common and reversible cause of male infertility, and has excellent results with dopamine agonist drugs.

If you have not seen improvement in your sexual symptoms, you need to consult an XXXXXXX A detailed sexual history, medical history, personal history would be elicited. You will need testing of your gonadotropin levels, a complete semen analysis, physical genital check up, ultrasound of the scrotum and testes etc, in order to arrive at a cause for your infertility or diminished libido.

Based on the results you might need fertility medication, hormonal therapy, antioxidants or other supplements to correct the libido. Please remember that if your prolactin is normal, you might still need gonadotropin therapy for sexual well being, or you could be having another associated problem leading to decreased libido.

Please consult an XXXXXXX at the earliest for specific diagnosis and treatment,
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