Beginning the process

[jr1]

Hello Doctors,
I am a 20 year old male and I have had puffy nipples/ gynecomastia since age 13. They were mostly just puffy with very little gland development throughout high school but the past several years there has been substantial gland development. I am moving away from home in several months to attend university up state but am highly considering gynecomastia surgery as a 21st bday present to myself. I have went through a large amount of psychological torment in a multitude of ways and I am sick and tired of being sick and tired. I do have several questions: I am concerned that I have high estrogen levels, where could I have my levels tested? I do have several thousand saved, but am terribly worried about the cost due to my families limited funds and the fact that most of our available money will be going to my education in the next several years.

I had testicular torsion at the age of 12, ended up several surgeries to correct the problem. Could this be a possible cause?
I smoked marijuana frequently between the ages of 17-19, although rarely, if ever now.
I have binged drank in the past, although now I drink between 1-3 alcoholic beverages a week.
I weighed around 230 at age 18 and now I am between 175-180.

Any information at all helps, for I am ready to make a positive change in my life, I am just unsure how it is going to happen.

[DrBermant]

Hello Doctors,
I am a 20 year old male and I have had puffy nipples/ gynecomastia since age 13. They were mostly just puffy with very little gland development throughout high school but the past several years there has been substantial gland development. I am moving away from home in several months to attend university up state but am highly considering gynecomastia surgery as a 21st bday present to myself. I have went through a large amount of psychological torment in a multitude of ways and I am sick and tired of being sick and tired. I do have several questions: I am concerned that I have high estrogen levels, where could I have my levels tested? I do have several thousand saved, but am terribly worried about the cost due to my families limited funds and the fact that most of our available money will be going to my education in the next several years.

I had testicular torsion at the age of 12, ended up several surgeries to correct the problem. Could this be a possible cause?
I smoked marijuana frequently between the ages of 17-19, although rarely, if ever now.
I have binged drank in the past, although now I drink between 1-3 alcoholic beverages a week.
I weighed around 230 at age 18 and now I am between 175-180.

Any information at all helps, for I am ready to make a positive change in my life, I am just unsure how it is going to happen.

Testicular torsion can leave normal functioning testicular glands or impaired testosterone levels. A badly damaged liver can cause gynecomastia. There are many other possible issues that may be factors.

Gland growth is a common Symptom of Gynecomastia that are better stabilized before surgery.  Although I target gland first, gynecomastia surgery does not stop further breast growth. Working with an experienced Endocrinologist can help find the Cause of Gynecomastia.  Unfortunately, endocrinologists like surgeons each have their skills and areas of expertise. This is an area of medicine that can take a meticulous Sherlock Holmes like personality to focus on a vague and sometimes hard to define issue.

Stabilizing the problem before considering surgery is the best way to minimize the chance of recurrence.  Recurrence for my patients is quite rare, but I do see quite a few patients with recurrence and regrowth after other surgeons' operations when such issues are not stabilized first.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[jr1]

Makes sense. I am unsure what type of endocrinologist would work best? I was going to schedule an appointment in my area soon but they all specialize in different areas and as a result I am unsure of which one could help me identify my estrogen to testosterone ratio.

[DrBermant]

Makes sense. I am unsure what type of endocrinologist would work best? I was going to schedule an appointment in my area soon but they all specialize in different areas and as a result I am unsure of which one could help me identify my estrogen to testosterone ratio.

Yes, it can be a challenge finding an Endocrinologist who has a passion and particular skill for gynecomastia evaluation.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Litlriki]

You mention that you've had gynecomastia since puberty, and you also indicate that you were heavier at age 18. As you cut your body fat, the non-fatty, "glandular" tissue in your chest often becomes more obvious, not because it's growing, but because you can see it more readily as the surrounding fat dissipates.  This may account for your sense of increased glandular tissue, rather than some hormonal fluctuation related to an endocrinological problem. 

Nonetheless, as you've noted, it's important to be sure that your hormonal situation is stable before having surgery.  You haven't mentioned that you've had any basic testing of testosterone, estrogen and prolactin levels, which would be a reasonable place to start, and which can be obtained through your primary care physician. He or she should then be able to refer you further should additional testing be required. 

Good luck,

Rick Silverman

[jr1]

At the moment I do not have a physician but will be in the looks for one in the coming weeks. I do hope I have relatively normal hormone levels, but if not what can be done to correct them? It would be rather pointless to go ahead with cosmetic surgery if in fact it may quickly return due to hormone levels.

[DrBermant]

At the moment I do not have a physician but will be in the looks for one in the coming weeks. I do hope I have relatively normal hormone levels, but if not what can be done to correct them? It would be rather pointless to go ahead with cosmetic surgery if in fact it may quickly return due to hormone levels.

It depends on what the particular Cause of Gynecomastia. Over the years I have seen so many different problems as the underlying cause, each had their own solutions. In some cases there were multiple causes. Such issues are best explored with your Endocrinologist depending on what is found during the investigation.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Dr. Cruise]

Considering you had testicular torsion in the past, it isn't unreasonable to think this may have affected your testicle and therefore your hormone levels.  Going to your primary care doctor to have your hormones checked would be a good place to start.