Of all the potential side effects connected to AAS use, decreased libido and sexual dysfunction are regarded as two of the most undesirable and for good reason. Not only do they interfere with one of man’s most prized activities. Although excess estrogen and testosterone deficiency are often responsible for these side effects, elevated prolactin, which has begun to afflict steroid users with increasing frequency, also deserves its share of the blame. When it comes to the latter, we can fairly point the finger at 19-Nors like Trenbolone and Nandrolone - two mainstays in the world of AAS.

Although steroids are the primary culprit when it comes to prolactin-induced side effects, certain Growth Hormone (GH) peptides also have the potential to increase prolactin levels, although to a much smaller extent than the aforementioned AAS. Generally speaking, the increase in prolactin witnessed with this class of supplementation is inconsequential, as levels do not rise high enough to cause problems. In fact, this effect is so mild that levels usually remain within a normal physiological range. However, when combined with other prolactin elevating drugs, they may add further fuel to the fire, giving cause for consideration. Lest anyone decide to shy away from GH peptides for this reason, when used alone - and often even when used with other prolactin elevating drugs - the benefits far outweigh the risks. It is only when one’s prolactin levels are already high that they increase the potential for side effects. Of the different GH peptides on the market today, only GHRP-6, GHRP-2, and Hexarelin are capable of increasing prolactin levels.

What Is Prolactin?
Most commonly referred to as the lactation hormone, prolactin is responsible for the production of breast milk in nursing mothers and also plays a critical role in the growth & development of the mammary glands. Despite its connotation with pregnancy, it is a diverse hormone, having influence over a large number of functions and being implicated in over 300 separate actions. When it comes to steroid users, most are interested in circumventing just two of these—the development of glandular tissue in the breast (gyno) and lactation.

However, prolactin also encourages bodyfat storage by directly increasing the production of a specific protein called lipoprotein lipase (LPL). Lipoprotein lipase plays an important role in fuel metabolism by hydrolyzing triglycerides from circulating plasma chylomicrons (chylomicrons are fat globules which transport dietary triglycerides from the small intestine into circulation) and other low-density lipoproteins, providing free fatty acids to adipose tissue for storage. The higher one’s LPL levels, the more likely one is to accumulate bodyfat. Prolactin has also been shown to increase estrogen receptor concentration within breast tissue, increasing one’s sensitivity to circulating estrogen and making the individual more susceptible to gynecomastia and other estrogenic side effects.

When reviewing the effects of elevated prolactin on the male body, it becomes readily apparent that it is in one’s best interest to keep this hormone under control. While some of the side effects associated with increased prolactin are readily recognizable, others, such as increased bodyfat and estrogen receptor proliferation, are frequently attributed to other causes or not recognized at all. Regardless of one’s awareness, excess prolactin will wreak hormonal havoc on the body, directly working against our bodybuilding goals while simultaneously initiating the development of female secondary sex characteristics. All bad—all preventable.

Choosing Your Medicine
Until recently, alleviating hyperprolactinemia (excess prolactin) involved the routine administration of one of various side effect-laden pharmaceutical preparations. In many cases, the accompanying side effects were worse than the primary condition one was trying to treat, negating the drug’s beneficial effects and leaving the you between a rock and a hard place. For years Bromocriptine was the go-to of defense when it came to lowering prolactin for dopamine agonists. It was effective, readily available, and reasonably priced, but many found the resultant side effects just too much to handle. But today, most will either use Cabergoline (Dostinex) or Pramipexole (Mirapex)

First Line Of Defense
When you're wanting to preventatively take action against prolactin, a Dopamine Agonist may not be the best choice to start with as they come with many unwanted sides and can be harsh drugs. You should always have a Dopamine Agonist on hand if you wish to take a 19-Nor, but if you wish to run something preventatively, you should start with some supplements.

Supplements To Help Control Prolactin:

PLEASE READ: Prolactin-Inhibiting Supplements Wiki Page

Vitamin B6 (Pyridoxine Hydrochloride & P-5-P) - To lower prolactin levels it's recommend you take 50-200mg of P-5-P a day, in divided doses. If you want to take regular B6, which can sometimes cause minor side effects, take 300-1000 mg per day in divided doses.

Read the label before you buy B6 (if you choose not to get P-5-P), because the Pyridoxine Hydrochloride type of B6 (in most supplements) has been shown to be a prolactin inhibitor, but Pyridoxal Hydrochloride has been shown to be ineffective at lowering prolactin – make sure you buy the right type!

Vitamin B6 - Examine Page
Vitamin E - When using Vitamin E as a prolactin inhibitor, it's recommended that you take 300-400 IU per day of natural Vitamin E – this can be raised up to dosages such as 1000 IU for greater prolactin control, but be aware of the possible side effects outline here

Natural Vitamin E is labelled D-Alpha Tocopherol whereas synthetic is labeled DL-Alpha Tocopherol – the natural form works best. D-Alpha Tocopherol with mixed natural tocopherols or D-Alpha Tocopherol with mixed natural tocotrienols are the absolute best forms to take.

Vitamin E - Examine Page
SAM-e - Take 400-1200 mg a day of SAM-e along with Vitamin B6 and Vitamin E. An added bonus is SAM-E's ability to detoxify the liver.

SAM-e - Examine Page
Other Effective Prolactin-Inhibiting Supplements

Remember, only use your Dopamine Agonist if blood work shows elevated levels or if your nipple(s) leak ON THEIR OWN. Do NOT squeeze your nips and force liquid out, even natural guys can do this, by doing this you will stimulate and cause an increase in prolactin.
DO NOT TOUCH YOUR NIPS.

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The Dopamine Connection
Anti-prolactin drugs work by mimicking the activity of a substance in the brain called dopamine, thereby classifying them as dopamine agonists. Dopamine itself is a neurotransmitter; a chemical messenger between nerve cells in the brain. When levels of this neurotransmitter are normal the body functions properly, but if levels become imbalanced serious problems can develop, such as Parkinson’s or Restless Leg Syndrome.

However, in order for dopamine to have an effect it must first attach to dopamine receptor sites, which are found on the surface of the cell. Once attached, the receptor receives, recognizes, and responds to this chemical signal. Dopamine Agonists works by stimulating these same receptor sites, thereby producing the same effects as dopamine, but you may be wondering, how is this relevant to prolactin?

As one of the predominant regulators of prolactin, dopamine has a direct impact on its production. More specifically, dopamine works to reduce prolactin levels by attaching to D3 receptors, which inhibit the production of prolactin by lactotrophs (lactotrophs are prolactin producing cells located in the pituitary). Acting as a dopamine substitute, dopamine agonists works through the same mechanism, fooling the body into thinking that dopamine levels are high. This shuts down, or reduces the production prolactin, depending on the dosage administered.
Exactly how the steroids trenbolone and nandrolone increase prolactin levels, we can’t be sure, but one thing we do know is that many who use these drugs have experienced dramatic elevations of this hormone—sometimes far above normal levels. This can and often does lead to one or more of the aforementioned side effects. Dopamine agonists works to address the issue directly, shutting down prolactin production at its root.

Cabergoline (Dostinex)
Cabergoline (Caber) will lower both progesterone and will inhibit prolactin/lactation. It’s a dopamine agonist means it wont allow your body to lactate since it will occupy your dopamine receptors which are responsible for lactation. Caber is the best prolactin support when running any 19-Nor since the side effects are minimal – no drowsiness, doesn’t affect sleeping patterns, and in general as far as dosing goes is far more flexible than Pramipexole or Bromo. Also there is no withdrawal when ceasing use of Caber like with Prami.

Caber is a recognized ED med, it reduces downtime (not to be confused with multiple orgasm) so if you need 24 hour recovery between sessions two weeks after taking Caber you will see a significant decrease in downtime you will need 12-16 hours to be ready for the next session, if you need 2 hours you will need 1 hour with Caber.

Also its known for its potential multiple orgasm effect - when you ejaculate you will feel as if you are releasing two or three loads at the same time. This needs some input for the user though its not instant, the more you hold it in the more orgasms you will potentially have in the end.

Common Dose On Cycle: 0.25-.5mg E3D or E3.5D
Common Does To Stop Lactation: 1-1.5mg E3-5D

Pramipexole (Mirapex)
Pramipexole (Prami), like Caber, will decrease progesterone and will inhibit prolactin/lactation. It’s a dopamine agonist, like Caber, so it will occupy dopamine receptors which are responsible for lactation.

Pramipexole (Prami) is a very peculiar drug! You need to taper up really slowly to get to the desired dose and also taper down slowly to avoid the mild withdrawal effect it will cause. Prami is an addictive substance and /r/steroids is hesitant recommending it, as the more you use it the harder it will be to come off it, also you will find you will want to increase the dose to maintain the ed effect. Prami’s ED effect is not as good as Caber. It does reduce downtime like Caber does but that’s about it there is not potential enhancement in your orgasm or your libido contrary to caber. Only advantage of Prami over caber is that if taken at the right time (2-3 hours) before bedtime it can work as good as a Benzo to knock you out to sleep. Which when running Tren is a bonus. If, however, you dose it wrong (unwillingly of course) say 30 minutes – 1 hour before bed time you will find that after 2-3h of sleep you will be wide awake and probably sweating since the dopamine you suppressed 4 hours ago rebounds and you feel as if you just had a hit of coke in your sleep, not a good feeling. Also every time you up the dose it takes some adjusting even if you are used to the substance.

Sleep sides like vivid dreams and waking up mid night can be avoided by taking Prami at the right time so you got to experiment with this (the earlier you take it the better). Make sure you never take Prami in the morning or too early in the evening you are going to feel drained, dizzy, nauseous and like a zombie all you will think its when the time comes to go to sleep.

The worst part with Prami starts when you quit, for the first few days after you quit, you will wake up in your sleep many times as if you were quitting cigarettes or weed even, then you will have the lightest sleep ever as if you were sleeping with your eyes open and the dreams will be negative and intense. Basically you get all the Prami sides you had earlier only they cant be avoided since you don’t take Prami anymore. This will subside completely after 5 – 7 days.

Common Dose On Cycle: taper up from 0.125mg to 0.25mg-0.50mg (the high dose only if you are stacking two 19-Nors or high dose of tren). After you are done with your cycle taper down even slower from 0.50mg to 0.125mg and stay one week on each increment then quit. No matter what you do expect some discomfort the first 3-5 days after you quit.
Dose To Stop Lactation: You would probably need 1-2mg per day to stop lactation, but wouldn’t recommend it, it would take ages to rump up to that dose, if you are already lactating, use Caber worse thing that could happen when jumping to a high dose of caber would be to get a flush face that lasts 12-14h (annoying but much better than puking your guts of for hours).

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