Dear Dr. Roach: I am a 63-year-old man. At a recent visit to my endocrinologist for my annual thyroid check (I have Hashimoto’s disease), I revealed that I have been suffering from fatigue and erectile dysfunction. After additional blood work was performed, my doctor indicated that I have low testosterone levels and high prolactin levels.
Rather than moving forward with testosterone replacement therapy, he suggested that we first try a prescription medication called cabergoline. After reading numerous negative reviews online about the side-effects from those who’ve taken cabergoline in the past, I am tentative about taking it. It seems to me that it is not worth the risk of these effects, given the limited amount of benefits it would provide. Are there long-term concerns for high prolactin levels in men?
J.F.
Prolactin is a hormone that, as its name implies, promotes milk production. In men, high levels of prolactin commonly cause erectile dysfunction and low libido. Low testosterone itself can cause these symptoms as well.
The most important next step is to discover where the prolactin is coming from. In addition to a careful exam, an MRI scan of the brain (specifically of the pituitary gland) is normally recommended. Unless your endocrinologist is sure the prolactin is coming from a medication (estrogens, risperidone, metoclopramide, some antidepressant drugs, cimetidine, methyldopa and verapamil are common causes), it’s critical to be sure that there isn’t a tumor causing high prolactin levels. Very high levels almost always indicate a tumor.
Even if you have a tumor, cabergoline is a reasonable medication to start with. Not all pituitary tumors will require surgery. Cabergoline causes most tumors to shrink and sometimes disappear. The dose must be slowly increased to reduce side effects, such as nausea and dizziness.
Dear Dr. Roach: I am a 35-year-old woman and have recently began donating blood regularly. My hemoglobin level was initially around 15 g/dL when I started donating, and it has tapered down to around 12-12.5 g/dL with regular donations. 12.5 g/dL is the minimum requirement for donating. I had to wait an extra month after I didn’t meet the requirements to donate.
I regularly menstruate and eat a fairly healthy diet. I would like to continue donating regularly and want to try supplements to increase my hemoglobin level. I have heard suggestions regarding chlorophyll, but I am only aware of iron supplements/pills. I would like to know your thoughts on chlorophyll drops versus Maltofer or a pill containing ferrous sulfate as it pertains to increasing hemoglobin.
J.M.
It is very likely that your iron levels are low enough where your ability to make blood is limited, but iron blood tests can confirm that.
Menstruation only causes a small loss of iron. Published estimates vary widely, but 1 mg of iron is a reasonable guess for a woman with normal periods, whereas women with heavy periods lose 5 or 6 mg. However, every time you donate a unit of blood, you lose about 200 mg of iron, which requires a lot of iron intake — either through diet or supplements.
Chlorophyll does not contain iron. I looked at several over-the-counter chlorophyll supplements, and none contain iron. Iron sulfate and iron polymaltose (Maltofer) contain lots of iron. We used to prescribe iron several times daily, but research shows that once daily, or even every other day, is just as good and has fewer side effects.
Thank you for regularly donating.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
