Is this prolactin level high enough to cause symptoms?

[Steven05]

Prolactin 417 mU/L range 86-324


I know it isn't as high as someone with a pituitary tumor, but here's why I'm curious about this test result: Since I took finasteride a few years ago (d'oh) I've had a substantial reduction in orgasm intensity. I can get an erection and ejaculate as normal, but the sense of pleasure that goes with it is maybe 2 out of 10.

I haven't made much of an attempt to treat this problem because I have other hormone imbalances which I've been trying to fix first which are proving very difficult.

There was a study done last year using the drug Cabergoline (which lowers prolactin as I'm sure most of you know) on patients with this problem and almost 70% of them reported either partial or complete resolution of the problem.

Here it is: Drug Restores Normal Orgasm in Men

So, based on the fact that I have this problem and my prolactin is elevated, is it possible that Cabergoline would be worth a try?

 

[zkt]

Long term- the heart valve issues are a big problem. As a diagnostic- might tell you something.

 

[Michael Scally MD]

It might be worthwhile, but what you have is NOT anorgasmia. I believe the study subjects would have been overjoyed at an ORGASM, regardless of "score." Also, the abstract states, "The response is associated with the duration of therapy and concomitant testosterone replacement therapy." Are you on TRT? What other labs?


1495: Cabergoline for the Treatment of Male Anorgasmia
http://www.aua2012.org/abstracts/printpdf.cfm?ID=1495

Introduction and Objectives - Anorgasmia is the persistent or frequent absence of orgasm after normal sexual arousal. The risk factors are usually psychological but can also be drug-related or post-prostatectomy sequilae. A prolactin surge has been observed during the post-ejaculatory refractory period, decreasing erectile and ejaculatory potential. We hypothesize that the inhibitory effect of cabergoline on prolactin be a desired endpoint in the treatment of male anorgasmia.

Methods - A retrospective review was performed on anorgasmic patients undergoing treatment with cabergoline in a single andrology clinic from 2009 to 2011. All patients were treated with cabergoline 0.5 mg twice a week. Data were analyzed using a linear regression multivariate model.

Results - A total of 107 men treated with cabergoline were identified, and 35 were excluded because of treatment unrelated to anorgamia (e.g. hyperprolactinemia). Data from the 72 remaining anorgasmic patients showed improvement of orgasm in 50 (69%). 26 Of these 50 men (52%) returned to normal orgasm after therapy. Multivariate analysis revealed that the duration of therapy and the concomitant testosterone replacement therapy were associated with significant response to treatment (p=0.02 and 0.03). Mean duration of therapy for non-responders and responders to cabergoline was 214 and 296 days, respectively. No differences in efficacy were found between topical and injectable testosterone replacement. There was not a statistical significant difference of testosterone and prolactin level pre and post treatment. Age or prior prostatectomy did not influence outcome of cabergoline treatment (p=0.9 and 0.42).

Conclusions - This is the first report of cabergoline as an effective treatment option for male anorgasmia. The response is associated with the duration of therapy and concomitant testosterone replacement therapy. Further study is needed to better understand the pathophysiology of male anorgasmia as well as cabergoline’s mechanism of action in these patients.

 

[mikes75]

Long term- the heart valve issues are a big problem. As a diagnostic- might tell you something.

The heart valve issues is seen only with the 10-100 times higher parkinson diseas dosages.. so 0,5mg a/week want have theese issues but are enough to get your prolactine level down, , but retest your prolactine (few hours after awakening) it can be half of your level next time because it varies quite much. If your test levels are ok i think it wont do shit to lower.

 

[zkt]

IMHO anorgasmia involves many more neural signaling pathways than PRL contributes to. I would be very surprised if Ach isnt a big part. Easily tested pharacologically.

Mike75: post your sources.

It might be worthwhile, but what you have is NOT anorgasmia. I believe the study subjects would have been overjoyed at an ORGASM, regardless of "score." Also, the abstract states, "The response is associated with the duration of therapy and concomitant testosterone replacement therapy." Are you on TRT? What other labs?


1495: Cabergoline for the Treatment of Male Anorgasmia
http://www.aua2012.org/abstracts/printpdf.cfm?ID=1495

Introduction and Objectives - Anorgasmia is the persistent or frequent absence of orgasm after normal sexual arousal. The risk factors are usually psychological but can also be drug-related or post-prostatectomy sequilae. A prolactin surge has been observed during the post-ejaculatory refractory period, decreasing erectile and ejaculatory potential. We hypothesize that the inhibitory effect of cabergoline on prolactin be a desired endpoint in the treatment of male anorgasmia.

Methods - A retrospective review was performed on anorgasmic patients undergoing treatment with cabergoline in a single andrology clinic from 2009 to 2011. All patients were treated with cabergoline 0.5 mg twice a week. Data were analyzed using a linear regression multivariate model.

Results - A total of 107 men treated with cabergoline were identified, and 35 were excluded because of treatment unrelated to anorgamia (e.g. hyperprolactinemia). Data from the 72 remaining anorgasmic patients showed improvement of orgasm in 50 (69%). 26 Of these 50 men (52%) returned to normal orgasm after therapy. Multivariate analysis revealed that the duration of therapy and the concomitant testosterone replacement therapy were associated with significant response to treatment (p=0.02 and 0.03). Mean duration of therapy for non-responders and responders to cabergoline was 214 and 296 days, respectively. No differences in efficacy were found between topical and injectable testosterone replacement. There was not a statistical significant difference of testosterone and prolactin level pre and post treatment. Age or prior prostatectomy did not influence outcome of cabergoline treatment (p=0.9 and 0.42).

Conclusions - This is the first report of cabergoline as an effective treatment option for male anorgasmia. The response is associated with the duration of therapy and concomitant testosterone replacement therapy. Further study is needed to better understand the pathophysiology of male anorgasmia as well as cabergoline’s mechanism of action in these patients.

The heart valve issues is seen only with the 10-100 times higher parkinson diseas dosages.. so 0,5mg a/week want have theese issues but are enough to get your prolactine level down, , but retest your prolactine (few hours after awakening) it can be half of your level next time because it varies quite much. If your test levels are ok i think it wont do shit to lower.

 

[Dr JIM]

Now DOC that's a well done study, MANY THANKS!

 

[Steven05]

It might be worthwhile, but what you have is NOT anorgasmia. I believe the study subjects would have been overjoyed at an ORGASM, regardless of "score."

I understand what you're saying, however, it's worth mentioning that I've seen a lot of reports online of Cabergoline making people's orgasms stronger too, not just enabling them to have one.

Also, the abstract states, "The response is associated with the duration of therapy and concomitant testosterone replacement therapy." Are you on TRT?

Nope, not on TRT.

What other labs?

I have a lot of labs but not many that show anything out of the ordinary I'm afraid.

 

[Steven05]

Long term- the heart valve issues are a big problem.

Yeah that's definitely something I'd be worried about, but I'm pretty sure I've read the same thing that mikes75 mentioned - that those kind of side effects only occur at very high doses. The study I posted above ran for 296 days and no serious adverse effects occurred.

 

[Steven05]

Just noticed that it does mention heart valve issues in the study, but only exacerbation of preexisting conditions.

 

[mikes75]

Posted by mikes75
The heart valve issues is seen only with the 10-100 times higher parkinson diseas dosages.. so 0,5mg a/week want have theese issues but are enough to get your prolactine level down, , but retest your prolactine (few hours after awakening) it can be half of your level next time because it varies quite much. If your test levels are ok i think it wont do shit to lower.

Mike75: post your sources.

Long-term cabergoline therapy is not associated wi... [Pituitary. 2009] - PubMed - NCBI
Low dose cabergoline for hyperprolactinaemi... [Eur J Endocrinol. 2008] - PubMed - NCBI
Cardiac valve disease and low-dose dop... [Clin Endocrinol (Oxf). 2011] - PubMed - NCBI