From the Research
A female with hyperprolactinemia can potentially receive testosterone replacement therapy, but careful medical supervision is essential to address the underlying cause of elevated prolactin levels before initiating treatment. The primary concern should be investigating and managing the prolactin elevation, which may result from conditions like prolactinomas, medications, hypothyroidism, or polycystic ovary syndrome 1. Testosterone therapy would typically be considered only after the prolactin elevation is managed appropriately. When prescribed, testosterone doses for women are much lower than for men, usually starting at 2-4 mg daily via transdermal application or 25-50 mg implants every 3-6 months. Potential benefits include improved libido, energy, and muscle mass. However, testosterone may theoretically exacerbate hyperprolactinemia in some cases, as androgens can influence prolactin secretion through various pathways. Regular monitoring of both testosterone and prolactin levels is crucial during treatment, along with screening for potential side effects like hirsutism, acne, voice deepening, and lipid changes.
Some key considerations in the management of hyperprolactinemia include:
- Differentiating between medication-induced hyperprolactinemia and pathologic causes 2
- Using dopamine agonists as the primary treatment for hyperprolactinemia, with cabergoline being a preferred option due to its efficacy and tolerability 3, 4
- Individualizing treatment based on symptoms, hormone levels, and the specific cause of hyperprolactinemia
- Considering the potential consequences of hyperprolactinemia on gonadal and sexual function, and the role of sex hormone replacement therapy in managing these consequences 1
In terms of the most recent and highest quality evidence, a 2020 study published in Pituitary suggests that observation alone, with monitoring of serum prolactin levels, may be a suitable approach for managing microprolactinomas, with treatment options including dopamine agonist therapy or gonadal steroid hormone replacement 1. The decision to use testosterone therapy should be individualized based on symptoms, hormone levels, and the specific cause of hyperprolactinemia, with careful consideration of the potential benefits and risks.