How can I increase my prolactin levels?

Methods to Increase Prolactin Levels

The most effective way to increase prolactin levels is through the use of dopamine antagonists, with cabergoline being the first-line medication recommended by the Endocrine Society for managing prolactin disorders. 1

Understanding Prolactin

Prolactin is a 23 kDa single-chain protein primarily synthesized and released by lactotrophs in the anterior pituitary gland. Its secretion is mainly under inhibitory control by hypothalamic dopamine and regulated through negative feedback mechanisms 2. The primary function of prolactin is during pregnancy and lactation, supporting mammary gland development, milk synthesis, and maintenance of milk secretion.

Pharmacological Options

First-Line Medications:

1. Dopamine Antagonists:

   • Metoclopramide: Stimulates prolactin secretion by blocking dopamine receptors in the pituitary 3, 4
     • Dosing: Typically starts at lower doses and titrated as needed
     • Side effects: May cause sedation, extrapyramidal symptoms, and restlessness
     • Caution: Extended use increases risk of tardive dyskinesia, especially in elderly patients 3

2. Other Dopamine Antagonists:

   • Domperidone: Crosses the blood-brain barrier less than metoclopramide, potentially reducing central nervous system side effects 4
   • Traditional antipsychotics (sulpiride, chlorpromazine): Effective but limited by adverse events 4

Non-Pharmacological Methods

1. Breastfeeding/Breast Stimulation:

   • Suckling or breast pump stimulation triggers prolactin release through a neuroendocrine reflex pathway 5
   • Studies show that breast stimulation continues to produce increases in prolactin levels even in long-term lactation 5

2. Herbal Supplements:

   • Fenugreek: Has been reported anecdotally to increase prolactin levels, though scientific evidence is limited 4
   • Consider risks versus benefits before using herbal supplements

Important Considerations

When to Measure Prolactin

According to AUA guidelines, serum prolactin levels should be measured in patients with low testosterone levels combined with low or low/normal luteinizing hormone levels to screen for hyperprolactinemia 6. This highlights the interconnection between prolactin and other hormonal systems.

Normal Reference Ranges for Prolactin

Population	Reference Range (ng/mL)
Non-pregnant females	3.0-30.0
Pregnant females	10.0-209.0
Postmenopausal females	2.0-20.0

Source: Endocrine Society and American College of Endocrinology 1

Monitoring and Precautions

• If using medications to increase prolactin, regular monitoring of levels is essential
• Persistently elevated prolactin levels can indicate pituitary tumors such as prolactinomas 6
• Patients with unexplained high prolactin levels should be referred to an endocrinologist for evaluation 1

Cautions

1. Potential risks of elevated prolactin:

   • In women: Menstrual disturbances, galactorrhea, infertility
   • In men: Hypogonadism, decreased libido, erectile dysfunction
   • Long-term elevation may increase risk of osteoporosis due to hypogonadism

2. Medical supervision:

   • Any attempt to artificially increase prolactin levels should be done under medical supervision
   • Self-medication with dopamine antagonists can lead to serious side effects

Clinical Decision Algorithm

1. Determine baseline prolactin level and whether increase is medically necessary
2. Rule out existing prolactinoma or other pituitary disorders
3. For mild increases needed (e.g., for lactation support):
   • Try non-pharmacological methods first (breast stimulation)
   • Consider herbal supplements like fenugreek under medical guidance
4. For significant increases needed (medical indication):
   • Start with lowest effective dose of metoclopramide or domperidone
   • Monitor for side effects and prolactin response
   • Adjust dosing as needed based on levels and clinical response

Remember that increasing prolactin levels without medical indication may lead to unwanted side effects and hormonal imbalances. Always consult with a healthcare provider before attempting to alter hormone levels.