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Based on the current evidence, cabergoline appears to be a highly effective treatment option for patients with hyperprolactinemia compared to bromocriptine; however, our results did not show a statistically significant difference in efficacy between these agents. Normalizing prolactin levels appears to be necessary to relieve the inhibitory effect on testosterone production. Nevertheless, we observed an upward trend in testosterone levels following treatment with dopamine receptor agonists, although the change was not statistically significant (Fig 1B). Elevated prolactin levels can lead to endothelial dysfunction, characterized by impaired NO production, which is essential for vascular relaxation and increased blood flow to the penis.
Keeping the hematocrit in a safe range ensures we reap testosterone’s benefits without undue risk. It’s one of the most common reasons a doctor might have to lower the testosterone dose or temporarily halt therapy. Sometimes this is beneficial – for example, if a man had anemia of testosterone deficiency, TRT can correct it. If a man’s PSA rises rapidly or above the normal range while on TRT, the therapy might be paused and a urological evaluation (possibly a biopsy) done to exclude cancer. For the average hypogonadal man without red flags for other issues, extensive pituitary testing isn’t necessary, but it’s something to keep in mind if symptoms don’t fully resolve or if other signs point to multi-hormonal problems. In short, thyroid hormone is another piece of the puzzle – comprehensive care means not overlooking a thyroid problem that could be contributing to the patient’s symptoms or even to the prolactin elevation. If maintaining fertility is a priority, there are alternative treatments for low testosterone.
Improvement in sexual function(the number of patients with IIEF-15 scores Fig 1D). Eighteen of the men presented with PRL levels less than or equal to three times the upper limit of normal (≤ 45.6 ng/mL). For total testosterone, the reference range for men is 2.49–8.36 ng/mL.
Furthermore, the concept of testosterone 'crash' is well recognized by clinicians, with large differences between peak and trough levels potentially leading patients to become symptomatic towards the end of the cycle despite having therapeutic trough testosterone levels. Given the half-life of approximately seven days, it is reasonable to obtain testosterone levels four weeks after starting therapy. Initial studies of testosterone patches demonstrated increases in total testosterone from a baseline 167 ng/dL to a peak of 1,154 ng/dL at 5.7 hours, with a decrease to 490 ng/dL over the next 12 hours.424 Following removal, the observed testosterone half-life was 116 minutes.425, 426 A multicenter, open label study confirmed mirroring of the circadian rhythm when the patch is applied in the evening with a morning peak of 740 ng/dL and a night-time trough of 213 ng/dL.427 If insufficient testosterone levels are achieved with one topical agent, including with dose adjustments, substitution with another topical agent is a viable treatment strategy.420 Differences in age, geography, date of initial testing (testosterone immunoassay testing was more commonly used before 2005), comorbid conditions, and baseline and therapeutic testosterone levels across studies introduce heterogeneity in the pooled population. As mentioned above, combination therapy with low dose hCG has been described as a means to maintain intratesticular testosterone levels394 and preserve spermatogenesis336 for men on exogenous testosterone.
Two patients with ED show clinical improvement(Table 1, patient 7 and patient 15). Meanwhile the mean IIEF-15 score was significantly increased by treatment (52.96 ± 11.19 versus 65.48 ± 8.28, P Fig 1C). All patients were treated with bromocriptine, except for five patients who were intolerant to bromocriptine switched to cabergoline (0.5 mg/week). Medical treatment with dopamine agonists was given to all affected men following diagnosis.

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