Gynecomastia caused by testosterone

[tallman]

I have gynecomastia being caused by testosterone injections, and I am looking for doctors who can address hormonal issues, both through medication as well as through alternative means (diet, etc).  I am trying to strike a balance between having too little testosterone, cause erectile dysfunction and low libido, and too much causing gynecomastia through conversion to estrogen.  I am thinking that taking an anti-estrogen might be an answer, but my endochronologist refuses to prescribe one.

Are there doctors out there who are experts on the balance of hormones and the diets that can help with this balance, or is this site exclusively for surgical solutions?  I am not interested in surgery except as a last resort.  There's a lot on the web about anti-estrogen supplements, but I have no idea if they are effective or not.  Thanks.

[Litlriki]

None of the physicians on this site are experts on hormonal management--we're all plastic surgeons.  You would be best advised to see a different endocrinologist for another opinion. If your testosterone is supplemented correctly, you shouldn't have too much variation in your testosterone levels, which is when gynecomastia can develop.  You need to have testosterone and estrogen levels checked to determine the best approach to treatment. 

Good luck,

Rick Silverman

[DrPensler]

Gynecomastia that develops as a result of testosterone injections in my experience is primarily glandular in nature . Glandular tissue removal requires direct excision.There is no medical treatment for excess glandular tissue in the breast . As an aside the effects of testosterone are initiated by  the interaction of the hormone with a specific receptor  ( testosterone receptor ) on the cell wall.A drug which causes an effect on a different receptor ,for instance the estrogen receptor , would have no effect on the testosterone receptor and hence no effect on the cells testosterone metabolism.But for your general issues re hormone management I totally agree with Dr. Silverman ,you should consult an endocrinologist.

[tallman]

Yes, as I said, I am looking for an endocronologist for that reason.

The testosterone has elevated my estrogen, which is the most common cause of gynecomastia when taking testosterone injections.

There are plenty of medical articles about reversing gyno with antiestrogens.  Here's one from the International Journal of Impotence Research:

Case Report

International Journal of Impotence Research (2004) 16, 95–97. doi:10.1038/sj.ijir.3901154

Treatment of testosterone-induced gynecomastia with the aromatase inhibitor, anastrozole

Gynecomastia is an unusual side effect associated with testosterone replacement therapy (TRT) that has been traditionally treated with surgery, radiation, or discontinuation of testosterone supplementation. We report here our experience with two cases of gynecomastia in men undergoing TRT who were successfully treated with the aromatase inhibitor anastrozole.

(conclusion)

...both radiation therapy and surgical treatment are often regarded by patients and physicians alike as being too invasive a treatment for gynecomastia and, instead, testosterone treatment is often discontinued by patients if they are embarrassed by the breast enlargement. Successful treatment with an oral medication such as an aromatase inhibitor thus represents an attractive alternative therapy, and should be considered for symptomatic men.

[Litlriki]

Correct dosing of testosterone replacement should not lead to significant fluctuations in your testosterone level or excess conversion to estrogen to any great extent.  But if that's a problem, then treatment with an anti-estrogen would be appropriate and could prevent recurrence or worsening of gynecomastia.  I don't know if it will get a condition to resolve, and the studies I'm familiar with are mixed in terms of response.

RS