Seeing female patients with anxiety/depression, irregular menstrual cycles and perhaps marked PMS?  How about male clients with decreased libido, low measurable testosterone and perhaps even impotence or infertility?  All of these signs and symptoms could actually be the result of elevated prolactin. 

Traditionally associated with being the hormone of lactation & sometimes elevated in PCOS, our understanding of prolactin’s many other roles (immune, neurological, cardiovascular) and potency has increased dramatically.  Consequently, hyperprolactinemia may be associated with increased risks of autoimmune and cardiovascular disease as well as causing major endocrine disruption via its interference with the release and activity of LH and FSH.  So if you’re seeing patients with these types of presentations perhaps prolactin testing is worth considering.  Best time to test is fasting in the morning when prolactin levels tend to be at their lowest, ensuring the patient avoids exercise, stress and nipple stimulation prior to the test.  If the patient has a result outside of the reference range, repeat the test.  Two elevations are considered confirmation of hyperprolactinemia and will require specialist investigation with an endocrinologist who will want to rule out underactive thyroid (a common cause), a prolactinoma (a benign prolactin producing tumour of the anterior pituitary), iatrogenic causes etc.  High prolactin can be stress induced, secondary to high oestrogen and completely idiopathic but it is important to rule out everything else first.  Check out this free full review paper for more information