Question: Hell-o,
I am a 65 year old male diabetic. I have a long history of health issues. Here is a summary of key events:
Date           Event
Jan-92           Back surgery
Jun-96           surgery to remove lump in left breast
Jan-97           sleep study reveled severe sleep apnea. Started on BiPap machine
Jul-97           first diagnosed with diabetes
Aug-97           surgery to remove lump in right breast
Nov-97           first surgery on throat for sleep apnea Dr XXXXXXX
Jan-98           Broke Lt shoulder - surgery to repair w/3 pins
Dec-99           second surgery for apnea. Front of throat reconstructed Dr XXXXXXX Discontinued BiPap
Sep-00           Heart rate was considered too high and started medication to control pulse rate.
Oct-01           Irregular and rapid heart beat (Afib) first detected at doctor's office. Dr Schroeder
Feb-02           stasis dermatitis caused ulcers to open on my legs.
Apr-02           Admitted to hospital with heart failure. I was "flushed" of excessive water and my heart was resynchronized
Apr-02           Cardiac catheterization Hospital with positive results. Back on BiPap.
May-04           Cellulites in right leg
Dec-04           Cellulites in right leg
Jul-10           Cellulites in right leg
Dec-10           Surgery to remove Squamous Tumor on Rt leg
Aug-12           Surgery to correct eye alignment Dr. M McCarthy (Toledo)
Nov-14           Ablation procedure at BVH to correct A-Flutter
Nov-15           Lump in Rt Breast Reaccurred
Jan-16           ER Visit with bulge on right abdominal wall
May-16           MRI pituitary gland Indication: Hyperprolactinemia Dr. DEPAOLO
Jul-16           Colonoscopy & Esophagogastroduodenoscopy Dr. EL-ZUBEIDI

My current concern and the reason I am writing is the most recent occurrence of a lump in my right breast and the MRI indication of Hyperprolactinemia. At the time, I was referred to an endocrinologist. He ordered blood test for hormones and found Prolactin very high and Testosterone low He then ordered the MRI. He told me the high Prolactin was caused from the Hyperprolactinemia and this caused the low Testosterone. He said drug treatment could lower the Prolactin and this would help the Testosterone level. He prescribed Cabergoline 2.5 mg twice a week. Over the next couple months, my Prolactin level dropped to below the normal range but had no effect on the T levels. He ran several other blood test and then prescribed testosterone 1 ml, intramuscular once every two weeks.
At this point, my endocrinologist moved out-of-state. I live in a rural area. The closest other endocrinologist is a 100 mile round trip for me. My family doctor is helping me as much as possible but really wants he to see a specialist. I have a lot anxiety about traveling and would very much like to avoid the 100 mile trip.
My question today is it possible to get the specialized support I need, in conjunction with my family doctor,
From your online service? If so, what do I need to do to proceed?

Thank you in advance for your support.

What are your suggestions regarding follow-up treatment for Hyperprolactinemia and low Testosterone?

A microscopic tumor on my pituitary gland is the cause of high prolactin (22-26 ng/mL before treatment). After the tumor was discovered with the MRI (May of 2016), I was prescribed Cabergoline 2.5 mg twice a week. Over the next couple months, my Prolactin level dropped to below the normal range (.28-.30 ng/mL). Cabergoline dosage was adjusted to 2.5 mg once a week. Prolactin levels have increased slightly (.4-.6 ng/mL) still below normal range. More recently, Cabergoline dosage was adjusted to 2.5 mg once every two weeks.
After starting the Cabergoline, my T levels remained low (110 - 180 ng/dL). I suffered symptoms of low testosterone (low energy, depression, sex performance). I started testosterone (1 ml, intramuscular once every two weeks) in December last year. Six weeks later, T levels still low (148 ng/dL). Testosterone dosage increase to 1.5 ml every two weeks. In May this year, T level checked in normal range (463 ng/dL) but the free T was above range (17.1 ng/dL). Currently, Testosterone dosage adjusted to 1.25 ml every two weeks.
Please let me know if I’m on the right track or if more testing is required.

It seems that you may have over looked the original reason for the MRI and the detection of the pituitary microadenoma when you suggest that it go untreated. I had a lump growing in my right breast. After starting the Cabergoline and Prolactin levels dropping, the lump shrank and now is almost nonexistent. I am very concerned that unchecked Prolactin will cause breast lumps to reoccur. Is this concern justified? Also, I am concerned that my current condition of low Prolactin is not acceptable either. Do you believe the adjustment of Cabergoline dosage from 2.5 mg once every week to 2.5 mg once every 14 days will normalize Prolactin? What action do you suggest?

Testosterone gel is not covered by my drug plan so I am stuck with shots. My question here is what should I target as “normal”? Should I be more concerned with Total T or Free T? Are there other blood test that should be concered?
I look forward to your reponse.