If you are using Testosterone Optimization Therapy (TOT) long-term, and start suffering an unexpected decline in libido, we encourage you to get your serum prolactin levels measured. What is Prolactin? Prolactin is a hormone found in your bloodstream that can interfere with testicular function, ultimately lowering your testosterone levels and interfering with your sex life. Excessively high prolactin levels are also associated with gynecomastia or what is commonly referred to as “man boobs.” Studies have found that elevated prolactin levels in men (>30 ng/dL,) a condition known as hyperprolactinemia, are linked to low sexual desire, erectile dysfunction, and galactorrhea or milk production. Men with severe hyperprolactinemia frequently show mild hypogonadism (low testosterone) and complain of a loss of libido and sexual dysfunction. Controlling High Prolactin Levels with Cabergoline The medication used to control elevated prolactin levels is Cabergoline. Cabergoline is a potent dopamine receptor agonist that directly has a suppressive effect on prolactin cells. Many age-management practices are using Cabergoline regularly in their practices with men to boost libido and improve sexual function. Anecdotal studies show that a 0.5 mg Cabergoline tablet taken twice a week enhances the quality and intensity of your sex drive, arousal, and orgasms. It is an “off-label” usage of this medication due to the lack of peer-reviewed research data about these specific benefits. Multiple studies have shown, however, that the long-term use of Cabergoline on prolactinomas (i.e., pituitary adenoma) is safe. Testing Your Testosterone Levels When working with a TOT specialist, it starts with having him order your blood test. Make sure to inform your doctor about your long-term goal of using TOT productively. Some doctors are more flexible in their criteria for justifying blood tests and will work with you to ensure that everything is evaluated carefully. For men who have total testosterone levels below 150 ng/dL before starting TOT, it is crucial that an experienced physician runs tests to ensure that a pituitary adenoma is a cause. In rare circumstances, an extremely high reading (> 300 ng/dL) may require an MRI of your pituitary gland to determine if the issue is a pituitary adenoma. It is a benign (i.e., non-cancerous) pituitary tumor that may cause vision problems and headaches if left untreated. It is either monitored regularly over time while prolactin levels are controlled via medication, or surgically removed through an amazingly routine procedure known as Transsphenoidal surgery. Without a doubt, testosterone is the most potent male sex hormone, and many male sexual issues can be reversed through a well-designed testosterone improvement regimen. To read much more about how Testosterone has the power to improve your sexual confidence and heighten sex drive and libido, purchase The TOT Bible.