Dostinex against prolactin induced gyno?

[brm]

Some guys sometimes report a little success on  this site with AI like arimidex or SERM like tamox against estrogen induced gyno. Is it imaginable that Dostinex that inhibits prolactin might help partly revert a prolactin induced gyno? After all, gyno is one of the official therapeutic indications of the drug.
Any thought or experience?
Thanx.

[Hypo-is-here]

What makes you think the cause of your gynecomastia is high prolactin?

If you do have high prolactin have you had endocrine investigations to try and ascertain why this is so?

[brm]

october 2005: gyno pushes out. Estradiol: 17pg/l. lower than normal from the lab's bracket... prolactin: 24.4. Higher than normal from the lab's bracket. Then, 2 months on arimidex. Then estradiol: 17, unchanged (!) and prolactin: 24, unchanged. hence my post...

[Hypo-is-here]

Why on earth would you have taken arimidex when you had low estradiol?

Your estradiol would have gone down further, it is just that the estradiol reference ranges and equipment calibration would have been skewed around female values and the differences not picked up at the low end of the spectrum.

At such low levels you can usually expect one or more of the following;

thyroid function out
Fatigue
Lowered libido
Erectile dysfunction
Bone pain

If you didn't suffer from any of the above then you were fortunate.

You say your prolactin level was 24, what was the reference range given?

What made you think that Arimidex was to be used for lowering Prolactin?

If Prolactin was high then what investigations were conducted to evaluate why it was high?

[brm]

OK. let's review it all. After 5 months on 1mg  finasteride daily + one avodart pill  every third day + 25mg DHEA daily, gynecomastia appeared. I went to a doc that ordered bloodtests and prescribed arimidex + parlodel (weak antiprolactin drug) + andractim since he said those meds were the only ones that could cure me. Bloodtest:
DHT: 4.13 nmol/l (1.03 - 3.65) which is high, though.
IGF1: 153ng/ml (31 - 298 )
free test: 33.9 pmol/l (41.6 - 138.6) which is very low
estradiol: 17pg/ml (inf 55) which is about normal
FSH: 4.9 UI/l (1.7 - 10)
LH: 5.83 UI/l (1.5 - 15)
prolactin: 24.4 ng/ml (inf 24) which is high.
TSH: 1.48micrUI/ml (0.3 - 3.1)
SDHEA: 1176ng/ml (1450 - 3670) which is low, though
SHBG: 3.5mg/l (0.6 - 3.6) which is high.
free cortisol: 139nmol/24h (30 - 200)
17 total cetosteroids (urinary): 102.6 micromol/24h (17 - 49) whi ch is very high
17 OH-corticoids (urinary): 19.19 micromol/24h (9 - 23)

Then, after 2months on arimidex and andractim plus dropping avodart and returning to 2.7mg of fin daily alone:

Free test: 39.1 pmol/l (41.6 - 138.6) which is still low
DHT: over 10 (1.03 - 3.65). But I had applied andractim gel 2 hours  before the test, hence the result.
estradiol: 17pg/ml unchanged!!!
prolactin 24ng/ml, unchanged!!!!

Then 3 months on 2.7 mg fin, dropping DHEA, arimidex, parlodel, and andractim:
estradiol: 20pg/ml a little higher
prolactin: 9.8 ng/ml back down
TSH: 1.38.
DHT: 5.71 back lower, but high though

One year and a half later, same regimen but another lab.
SDHEA: 919ng/ml (889 - 4270) back very low
SHBG: 3.5 mg/l (1.3 - 4.5) still quite high
Free test: 65.3 pmol/l (41.6 - 138.6) much better
DHT: 8.52 (1.03 - 3.65) very high

and another lab:
FSH: 6 (1 - 9)
LH: 3.2 (1 - 10)
prolactin: 3.6microg/l (below 15) back very low
TSH: 1.61 (0.15 - 3.70)
estradiol: 5pg/ml (22 - 50) very very low!!!!

Then 4mg finasteride daily and for one month and:
Free test: 44.6 (41.6 - 138.6) back low
total test: 24.6 nmol/l (9.9 - 27.8 ) surprisingly high
DHT: over 10!!! incomprehensible...
Androstanediol glucuronide: 5.2 nmol/l


What can you make of all  that, if any, Hypo?
Thanks.

[Hypo-is-here]

Fire your doctor is what I make from that!!!

A decent endocrinologist would not prescribe multiple endocrine altering drugs all at the same time.  Doing so makes it impossible to know why endocrine changes occur.  It is like kaos theory!!

Also a doctor that prescribes arimidex in a man with low estradiol?

A doctor who prescribes finasteride or other anti androgens in the treatment of gynecomastia when they cause gynecomastia?

A doctor who in the US who also happens to prescribe DHT which actually has the opposing affect of the very antiandrogens/finasteride he is prescribing?

I tell you what I make of this.

I think you're the doctor and you need to fire yourself and let a professional take over.

I say this because I simply cannot see any doctor acting in the manner that you have suggested, it is so poor and all over the place.

Your problem if the reference ranges are correct is a low free testosterone, very likely as a result of an elevated SHBG level.

This would not be surprising as SHBG binds testosterone and relatively small increases in SHBG produce quite substantial drops in free testosterone.  So a significant rise/level of SHBG would decimate a free testosterone level.

I have seen a few people of late who have had high SHBG (something usually typically seen in older men, those with poor liver function, androgen deficiency, growth hormone deficiency or hyperthyroidism).  

I suspect that increasing SHBG and resulting low free testosterone levels are a result of anti-androgen and of finasteride medication.  Dr Eugene Shippen one of the worlds leading authorities has previously commented on how difficult it can be to treat a form of hypogonadism or lowered testosterone levels caused by such medications.

I think this is because of where the problem stems from.  It is easy to add testosterone, but how much of that will be active/free given the elevated SHBG and how much would endogenous testosterone be reduced by a following reduction in GnRH and LH?

I don’t know if this is an answer, doubtful I would say.  

The problem is not one of a poor androgen to estrogen ratio due to elevated estradiol, if it was it would be relatively easy to treat via an aromatase inhibitor, something that would lower estradiol, increase endogenous serum testosterone and greatly increase active/free testosterone.


But this is not the answer because your estradiol level is low and lowering it further will cause problems of its own kind and SHBG still stands there blocking serum testosterone from becoming free testosterone.

The answer is;  

You need a very competent endocrinologist/andrologist that has experience in dealing with hypogonadism and androgen related issues who is up-to-date with all matters in this area, someone like Dr Eugene Shippen.  You need them to help you lower your SHBG, they may have ideas/methods or medications, that they feel does this best.  You will also need to get rid of all the anti-androgen medications.

Either that or given that your free testosterone is low but not hypogonadal you need to get yourself off all medications and see how you are in three months with a assessment of your HPTA with an endocrinologist.  You may find this the easiest option.

I have little doubt from everything you have told me that you have caused your own problems here by going down the route of self medication.  If this is not true then your doctor is one of the most incompetent and irresponsible I have ever come across in which case you have my apology and wish to have them fired and reported for their actions.

[brm]

Thank you Hypo.
No, I am no doc and I need prescriptions to bu  the meds. In fact, those bloodtests were prescribed  by different docs as I was never satisfied with any. Those prescriptions are written by them all. I am fully aware that the problem lies in  finasteride from  the very  start. And  that everything chains down from there for worse. I may indeed consider dropping  fin in the coming year but losing hair will have awful mental consequences. I must first (and I am doing so) settle a whole battery of topical treatment before unclenching fin's grip. And after all, though I suffer from low sex drive (and am worried by this), my physical condition is not bad in many respects. I would simply be glad  to drop fin without provoking an earthquake on  my head.

[Hypo-is-here]

Ok that explains a lot.

You need ONE doctor who is going to help you who is in charge/aware of everything going on, someone who you trust.

It is unfortunate but a reality that as men we often loose hair or go bald.  Male pattern baldness occurs because of a recessive gene in combination with testosterone and its metabolite dihydrotestosterone (DHT).

If you don't have the recessive gene and have high testosterone and DHT you do not loose hair or go bald, likewise if you have the recessive gene but vey low levels of androgens then you don't tend to loose hair or go bald.

This is why men in certain families go bald but the women don't.  it is why the condition is called male pattern baldness.

If you are a man that has the recessive gene then the inevitable consequence of having normal levels of testosterone and its metabolite DHT is hair loss.

To try and stop this process from occurring by messing with hormones you are actually lowering/taking away what it is that hormonally differentiates you from being a woman.  Lowering free testosterone and DHT will reduce hair loss, but on the other side of the balance sheet it can cause you to develop gynecomastia, loose your libido, have erection problems, increase adipose visceral fat, lose muscle mass etc.

It can if taken far enough cause depression, lowered bone density, cause a statistical increase in the likelihood of developing diabetes, stroke Cardio Vascular Disease (CVD) Alzheimer’s etc

The big question is;

What is more important your maleness or your hair?

Because that is what it comes down to if you are medicating against hair loss with endocrine affecting drugs.

Aren’t there plenty of men in the world who do very well and are seen as attractive by the opposite sex but just happen to have less hair?

If this is a big issue for you why not consider options that do not involve endocrine affecting medications such as hair transplants or none endocrine affecting medications?

Surely it is not worth forgoing your maleness just to avoid hair loss?

P.S

In about ten years time we might see the development of Selective Androgen Receptor Modulator medications  (SARMs) that can help target specific actions such as muscle, libido, bone, prostate growth etc that avoid things like hairloss, gynecomastia etc, until then the choice when it comes to the endocrine system is a direct one or the other.