Dr. Divakara. P
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My doctor wants me to get an MRI after my blood work. I wanted to get a second opinion, and I have attached my blood results. My prolactin is 20.4 ng/mL (above normal), total testosterone is 269.3 ng/dL (below normal), free testosterone is 8.9 ng/dL (normal), FSH is 3.7 mIU/mL (normal), LH is 2.9 IU/mL (normal). I have had a history of low testosterone, and it was 150 and 130 in the last two years. This recent test was done this month. I have no low libido or erection problems with my wife. I do notice that I am not waking up with a morning erection. But if my wife arouses me in the morning, I immediately get an erection. I must admit that I was eating a lot and not exercising as much, but I started to change that. Do you think an MRI is needed? Should I see another local physician or urologist? Or should I just get medicines to lower my prolactin level?
Hi,
Welcome to icliniq.com.
Thanks for posting your query. See, your prolactin levels are high. There are only two reasons for that Problems in the testes and Problems in the pituitary gland located in the brain. Now your endocrinologist wants to know if there is any pituitary problem, which is causing high prolactin levels. He is perfectly right in thinking so. Alternatively, if you want to avoid getting the MRI of the brain, then you can ask him to evaluate for testicular problems first, and if it comes clean then go for the MRI. Hope this information was useful to you.
Patient's Query
Hello doctor,
Thanks for your advice. Do you think it could be something life-threatening? I know there can be a tumor on the pituitary, which is usually benign and can be treated with medication. But I noticed that when a tumor is there, the levels are usually really very high. I am just nervous. Also, can you have low testosterone and high prolactin without any of the symptoms? What concerns me is not having the morning erections.
Hi,
Welcome back to icliniq.com.
Thanks for the follow-up. Lack of morning erection is itself an early symptom of low testosterone. You are right, in the case of pituitary tumors, the prolactin levels are very high, but in early cases and if the tumor is small, then the levels can be slightly high. Also, there are other conditions other than tumors, like a granulomatous disease, that can cause mild elevation of prolactin. However, I do not see anything that you need to be worried of, as none of these conditions is life-threatening. Regards.
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Internal Medicine
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