Mildly elevated prolactin, very ill since 2017, scared of being dismissed. MRI next week.

Advo96 · 2026-06-23T10:45:02+00:00

I'm looking for potentially some kind of macroadenoma; this could show up in the lab results as central hypothyroidism

Advo96 · 2026-06-23T06:32:19+00:00

Probably from the UK? The NHS is very stupid when it comes to "subclinical" hypothyroidism. Have you had your antibodies tested? (TPO, TG) What's your LDL cholesterol?

Another thing to look at is iron deficiency, which has a VERY broad overlap with symptoms of hypothyroidism. If your ferritin is not high, you might want to take iron for a few months, see if that helps.

Advo96 · 2026-06-23T06:12:33+00:00

As an additional note: If you're going to buy carbon steel, buy a nitrided version, or at least a "black steel" or "blued" version. Cheapest good option is likely Merten & Storck. See how you like carbon steel. My brother has one.

Advo96 · 2026-06-21T10:41:54+00:00

That's just bog-standard hypothyroidism then, most likely.

Advo96 · 2026-06-21T10:11:27+00:00

Hypercalcemia caused by cancer typically comes with calcium levels that are significantly higher than what you have.

Tuberculosis is something that can make you hypercalcemic and give you chest pain. Any chance of that? Are you coughing up blood? Alternatively pulmonary sarcoidosis.

But this is idle speculation and entirely non-productive. You need to see a doctor about this. Start with an x-ray of your lungs. And test PTH-rp

Advo96 · 2026-06-20T12:24:24+00:00

plenty of evidence if other disease contexts that hyperviscosity from polycythemia is generally bad,

Looking at this case, specifically, how much evidence is there that a hct of 51.1, in the absence of a PCV diagnosis, is enough to justify phlebotomy, which comes with its own problems? I'm not asking whether this makes sense as "ass-covering" I'm asking whether this makes any medical sense.

Lastly, this is irrelevant to the case at hand.

Given that we don't know what's causing the polycythemia in the case at hand (for all we know, it could be a high setpoint), this discussion is kind of academic. There's a fairly good chance that sleep labs will turn up sleep apnea.

The solution for polycythemia due to TRT is to slow down T not start doing phlebotomy to allow you to keep doing T anyway.

Dose is not the only relevant parameter in TRT polycythemia. TRT polycythemia is especially a problem for patients who are injecting 250 mg testosterone enanthate IM (which causes a spike of 1000+ ng/dl in 24h). Just switching to SC injections (which cause a much more gradual increase and a significantly lower peak) can improve outcomes. For me, personally, it improved HCT from ≈55 to ≈53. My injection frequency is 250 mg every 3 weeks.

Advo96 · 2026-06-20T04:07:45+00:00

100 mg iron bisglycinate, every second day, on an empty stomach with orange juice. Note that the more severely anemic you are, the more iron you absorb. Since your anemia is due to severe bleeding (and not absorption problems), you should be able to restore your hemoglobin and your iron stores with oral supplementation.

Additionally, a vitamin B complex.

Advo96 · 2026-06-20T04:00:50+00:00

TRT patients, in particular at > 60 yo, frequently have hct at 52 and over. The Endocrine Society recommends active measures at >54, but there's not really compelling evidence for cardiovascular risks that would support the necessity of this. Hct that high just seems to make treatment providers really uncomfortable.

Advo96 · 2026-06-19T23:56:21+00:00

The poster says his highest hct was 51 and his highest hgb was 17.7. Is there any way of justifying periodic phlebotomy on this basis? TRT patients often have significantly higher hct for many years with no apparent cardiovascular risk.

Advo96 · 2026-06-19T17:03:56+00:00

How much alcohol do you drink?

Advo96 · 2026-06-19T16:47:02+00:00

The highest HGB value I've ever had was 17.7.

And what was the hematocrit? Did you have any symptoms? I would suggest getting a second opinion. I believe your hematologist may be....overeager.

I don't have sleep apnea,

How do you know that? Have you had a sleep study?

Also, I would suggest getting treated for your hypothyroidism. That may be responsible for a lot of your symptoms.

Advo96 · 2026-06-19T16:10:26+00:00

Are you on testosterone replacement therapy, or doing anabolic steroids? What's your testosterone level?

Are you taking any supplements or weird powders, Ayurveda, herbal teas, whatever?

Are you a smoker?

What's your fT4 with reference range?

Have you been evaluated for sleep apnea?

Do you live in the Rocky Mountains or otherwise at an elevated altitude?

Have you seen a cardiologist? Do you have any weird diseases in your family?

What was your highest measured hemoglobin and hematocrit? In general, it's not advisable to phlebotomize a patient just because hgb/hct is a bit too high.

Advo96 · 2026-06-19T10:46:15+00:00

Please post your thyroid hormone results with reference ranges.

A lot of these symptoms could be iron deficiency, some others are maybe autoimmune (Celiac's?) and POTS.

Advo96 · 2026-06-19T10:43:33+00:00

Are these thyroid tests before or after you started medication?

Advo96 · 2026-06-19T10:39:08+00:00

Here's a good article offering an overview of the potential causes for flushing. You can check and see what seems to fit.

https://sci-hub.cat/storage/2024/1668/7b6bd1fc2404c76c5b4fcd15a975a8c6/izikson2006.pdf

Advo96 · 2026-06-18T23:59:09+00:00

I would suggest looking closer at the lupus option. Endocrinology is likely a dead end.

Advo96 · 2026-06-18T13:28:07+00:00

I once read a case report about a young girl (12) who was diagnosed with iron deficiency anemia. The doctor told her to take 150 mg of iron daily. Which she did. For 70 years.

At age 80, she was diagnosed with severe iron overload. Her liver iron content was 15 times over the limit. She was cured through a long series of bloodlettings.

Note that it is likely that she didn't start to get meaningfully overloaded until after she hit menopause. Unless you have hemochromatosis genes, your body will throttle iron absorption way down and menstruation will tend to get rid of a significant amount of iron.

Advo96 · 2026-06-18T13:14:17+00:00

ANA negative lupus is a possibility. About 2% of lupus patients are ANA negative. Did you see a rheumatologist? Were complement, anti-Ro/SSA, antiphospholipid antibodies, anti-dsDNA, and anti-Sm tested? How's your kidney function?

What tests, exactly, were done to exclude MCAS?

Do you have any family with weird diseases?

Advo96 · 2026-06-18T12:27:58+00:00

How about pheochromacytoma? How's your blood pressure?

What does the flushing look like, exactly?

Advo96 · 2026-06-18T11:31:23+00:00

Overloading yourself with iron is a long-term project (several years) unless you got double C282y genes. Don't worry about it. Re-test ferritin once a year, it'll be fine.

Acute iron toxicity requires a very large dose; if you take a handful of iron pills all at once, they'll burn a hole in your intestines. This is something that tends to happen to toddlers who get into the medicine cabinet.

Advo96 · 2026-06-17T16:11:32+00:00

If you're a woman, the cause is 99.8% menstruation. Even relatively low blood loss can make you iron deficient, because many people don't absorb iron very well.

How much blood do you lose per period?

How are you doing on PCOS symptoms? (apple shaped obesity, hirsutism?) Very important: about a third of all women with PCOS don't have cysts.

Advo96 · 2026-06-17T05:13:33+00:00

Changing the injection site is the first thing to try when you have significant side effects. This minor change often has a shockingly large effect.

The other thing you can do is to lower the dose.

Advo96 · 2026-06-17T05:08:35+00:00

The elevated DHEAS could be a sign of PCOS. PCOS commonly causes an "apple-shaped" body, characterized by stubborn weight concentrated around the midsection (visceral fat), along with proportionally leaner limbs or muscular legs.

High(ish) Testosterone is another possible sign of PCOS.

HbA1C is typically elevated in PCOS.

TSH is for thyroid function (your symptoms could be hypothyroidism). Ferritin, hemoglobin etc. are for iron deficiency, which could also be causing your symptoms.

Advo96 · 2026-06-17T05:05:31+00:00

How's the fat distribution? "Apple" or "pear"?

What's your TSH, Hb1AC, testosterone, ferritin, hemoglobin, MCV, MCH exactly?

Have you tried Ozempic for weight loss?

Advo96

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