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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Endocrinology · Hyperprolactinemia

Symptoms and Complications of High Prolactin

At a Glance

High prolactin acts as a biological brake on your reproductive system, causing irregular periods and infertility in women, and erectile dysfunction and low sex drive in men. Left untreated, it can also lead to hidden complications like bone loss, insulin resistance, and cholesterol changes.

High prolactin levels act as a biological “brake” on your body’s reproductive and metabolic systems. Because prolactin’s natural role is to support breastfeeding, the body responds to high levels by shutting down other hormonal processes that it deems less “essential” during that time [1][2]. This section helps you connect what you are feeling to the underlying science of hyperprolactinemia.

The “Master Switch”: How Hypogonadism Happens

You may have heard your doctor use the term hypogonadotropic hypogonadism. This is a complex way of saying that high prolactin has turned off the “master switch” for your reproductive hormones [3].

In a healthy system, your brain releases a hormone called GnRH (Gonadotropin-Releasing Hormone) in steady pulses. Prolactin blocks this by suppressing kisspeptin neurons, which are the specialized cells that trigger those GnRH pulses [4][5]. Without these pulses, your body stops producing the signals—specifically Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH)—needed to make testosterone or estrogen. This is why high prolactin leads to low sex drive and infertility [4][6].

Symptoms: Men vs. Women

While the underlying “brake” is the same, the symptoms often look very different depending on your sex.

For Women

  • Menstrual Changes: The most common sign is amenorrhea (periods stopping entirely) or oligomenorrhea (irregular, infrequent periods) [1][7].
  • Galactorrhea: This is the production of breast milk in someone who is not pregnant or nursing [1][8].
  • Infertility: Because the hormonal “brake” prevents ovulation, many women first discover high prolactin when they have trouble conceiving [3].
  • Vaginal Dryness and Dyspareunia: Because prolactin suppresses estrogen, women may experience vaginal dryness leading to painful intercourse [1].

For Men

  • Erectile Dysfunction (ED): Prolactin can cause ED in two ways: by lowering testosterone and by directly blocking the biological pathways (the PI3K-Akt-eNOS pathway) needed to achieve an erection [1][9].
  • Loss of Libido: A significant and often distressing drop in sex drive is a hallmark symptom in men [1][10].
  • Gynecomastia: This is the enlargement of breast tissue in men, though it is less common than sexual symptoms [1].

The “Hidden” Complications

Some of the most serious effects of high prolactin aren’t things you can feel day-to-day.

1. Bone Health (Osteoporosis)
Persistent high prolactin is an independent risk factor for bone impairment [6]. When sex hormones (estrogen and testosterone) are low for a long time, bones lose density, particularly the trabecular bone (the spongy bone found inside your vertebrae and the ends of long bones) [11]. This increases your risk for fractures and osteoporosis [12]. Men are at a particularly high risk for long-term bone damage from this condition [6][13].

2. Cardiovascular and Metabolic Risks
High prolactin can disrupt how your body processes fats and sugars. In men, hyperprolactinemia is associated with a higher risk of cardiovascular mortality (death related to heart and blood vessel issues) [14]. It is also linked to:

  • Insulin Resistance: Making it harder for your body to manage blood sugar [15].
  • Dyslipidemia: Abnormal levels of cholesterol and triglycerides in the blood [16][15].

The Good News: Normalizing your prolactin levels with treatment—such as dopamine agonists—has been shown to significantly improve cholesterol profiles and help protect your bone density [17][18].

Back to Home.

Common questions in this guide

Why does high prolactin cause infertility and a low sex drive?
High prolactin suppresses the brain signals that tell your body to produce reproductive hormones. This drop in estrogen or testosterone turns off your body's normal reproductive processes, leading to a loss of sex drive and difficulty conceiving.
What are the symptoms of high prolactin in women?
Women may experience irregular or completely stopped periods, vaginal dryness, and infertility. Another common symptom is galactorrhea, which is the production of breast milk when not pregnant or nursing.
How does high prolactin affect men?
Men with elevated prolactin typically experience a significant drop in sex drive and erectile dysfunction. Less commonly, it can also cause gynecomastia, which is the enlargement of male breast tissue.
Can high prolactin cause osteoporosis?
Yes, persistently high prolactin levels can lead to bone loss. The condition lowers sex hormones over a long period, which causes bones to lose density and increases the risk of osteoporosis and fractures.
Are there hidden metabolic risks with high prolactin?
High prolactin can interfere with how your body processes sugars and fats. This can lead to insulin resistance, making it harder to manage blood sugar, as well as abnormal cholesterol and triglyceride levels.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Do my current symptoms, such as my loss of libido or erectile dysfunction, suggest that prolactin is directly affecting my physical pathways or my testosterone levels?
  2. 2.Given the risk of bone loss, should I have a DXA scan to check my bone density now?
  3. 3.Are my cardiovascular risk factors—like blood pressure or cholesterol—being monitored more closely because of my hyperprolactinemia?
  4. 4.Is my loss of periods (amenorrhea) related to the suppression of kisspeptin in my brain, and will treatment restore my natural cycle?
  5. 5.Should I be taking calcium or Vitamin D supplements to protect my bone health while we work on lowering my prolactin?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (18)
  1. 1

    [Current diagnosis and treatment of hyperprolactinemia].

    Melgar V, Espinosa E, Sosa E, et al.

    Revista medica del Instituto Mexicano del Seguro Social 2016; (54(1)):111-21.

    PMID: 26820213
  2. 2

    Update on prolactinomas. Part 1: Clinical manifestations and diagnostic challenges.

    Wong A, Eloy JA, Couldwell WT, Liu JK

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 2015; (22(10)):1562-7.

    PMID: 26256063
  3. 3

    Fertility and pregnancy in patients with prolactinoma.

    Stumpf MAM, Queiroz NL, Glezer A

    Best practice & research. Clinical endocrinology & metabolism 2026; (40(2)):102081 doi:10.1016/j.beem.2026.102081.

    PMID: 41565497
  4. 4

    [Prolactin and its receptor: From animal models to pituitary pathophysiology].

    Begon E, Bernard V

    Biologie aujourd'hui 2022; (216(3-4)):105-110 doi:10.1051/jbio/2022019.

    PMID: 36744975
  5. 5

    Acute Suppression of LH Secretion by Prolactin in Female Mice Is Mediated by Kisspeptin Neurons in the Arcuate Nucleus.

    Brown RSE, Khant Aung Z, Phillipps HR, et al.

    Endocrinology 2019; (160(5)):1323-1332 doi:10.1210/en.2019-00038.

    PMID: 30901026
  6. 6

    Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas.

    Andereggen L, Frey J, Andres RH, et al.

    Scientific reports 2021; (11(1)):5122 doi:10.1038/s41598-021-84606-x.

    PMID: 33664388
  7. 7

    [Management of Hyperprolactinemia at the Hôpital du Mali].

    Mariko M, Traoré B, Sow DS, et al.

    Le Mali medical 2020; (35(2)):26-31.

    PMID: 37978778
  8. 8

    Pituitary hyperplasia: an uncommon presentation of a common disease.

    Neves CP, Massolt ET, Peeters RP, et al.

    Endocrinology, diabetes & metabolism case reports 2015; (2015()):150056 doi:10.1530/EDM-15-0056.

    PMID: 26279852
  9. 9

    Prolactin impairs erectile function via eNOS suppression independently of testosterone.

    Cheng X, Xiao Y, Qiu D, et al.

    Toxicology and applied pharmacology 2025; (504()):117532 doi:10.1016/j.taap.2025.117532.

    PMID: 40848920
  10. 10

    Effect of increased prolactin and psychosocial stress on erectile function.

    Fiala L, Lenz J, Sajdlova R

    Andrologia 2021; (53(4)):e14009 doi:10.1111/and.14009.

    PMID: 33595132
  11. 11

    Hyperprolactinemia Due to Prolactinoma has an Adverse Impact on Bone Health with Predominant Impact on Trabecular Bone: A Systematic Review and Meta-Analysis.

    Nagendra L, Dutta D, Mondal S, et al.

    Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry 2024; (27(1)):101453 doi:10.1016/j.jocd.2023.101453.

    PMID: 38064881
  12. 12

    Exposure to risperidone versus other antipsychotics and risk of osteoporosis-related fractures: a population-based study.

    Clapham E, Bodén R, Reutfors J, et al.

    Acta psychiatrica Scandinavica 2020; (141(1)):74-83 doi:10.1111/acps.13101.

    PMID: 31545521
  13. 13

    Interpretation of Serum Gonadotropin Levels in Hyperprolactinaemia.

    Abbara A, Clarke SA, Nesbitt A, et al.

    Neuroendocrinology 2018; (107(2)):105-113 doi:10.1159/000489264.

    PMID: 29660734
  14. 14

    Hyperprolactinemia and the Association with All-Cause Mortality and Cardiovascular Mortality.

    Krogh J, Selmer C, Torp-Pedersen C, et al.

    Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 2017; (49(6)):411-417 doi:10.1055/s-0043-107243.

    PMID: 28437810
  15. 15

    Hyperprolactinemia alters insulin resistance profiles in overweight males.

    Rashed HM, El-Ghlban S, Mahfouz MK, Marie YMA

    Endocrine regulations 2025; (59(1)):160-166 doi:10.2478/enr-2025-0018.

    PMID: 41217054
  16. 16

    Lipid Profile Differences in Monomeric Hyperprolactinemia, Macroprolactinemia, and Healthy Controls: A Comparative Analysis.

    Bahçebaşı S, Gökay F, Şimşek Y

    Neuroendocrinology 2025; (115(9)):719-729 doi:10.1159/000547540.

    PMID: 40864600
  17. 17

    Successful Improvement of Metabolic Disorders, Including Osteopenia, by a Dopamine Agonist in a Male Patient with Macro-Prolactinoma.

    Takeno A, Yamamoto M, Okazaki K, et al.

    The American journal of case reports 2016; (17()):160-4 doi:10.12659/ajcr.894712.

    PMID: 26971354
  18. 18

    Treatment of hyperprolactinaemia reduces total cholesterol and LDL in patients with prolactinomas.

    Schwetz V, Librizzi R, Trummer C, et al.

    Metabolic brain disease 2017; (32(1)):155-161 doi:10.1007/s11011-016-9882-2.

    PMID: 27525431

This page provides educational information about the symptoms and complications of high prolactin. It does not replace professional medical advice, diagnosis, or treatment from your endocrinologist or healthcare provider.

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