Having gynecomastia surgery next week - I have to make an important decision.

[a42]

Hi
Background:
I got gynecomastia during puberty (I think I was about 13 or 14) I waited for it to go away on its own. It didn't.
When I was about 17, the doctor prescribed Tamoxifen for the gyno but that also didn't help.
Later I was diagnosed with low testosterone and the doctor told me to start testosterone replacement therapy (it might have been a stupid decision at the time but I'm 23 right now so I'm over it and probably dependent on it)

The surgery:
Now I have the money for the surgery and scheduled one with a plastic surgeon next week.
The complication is the testosterone replacement therapy. I asked my doctor and he said that the TRT might make the gynecomastia come back.
So I have the option of either removing the ENTIRE breast gland so that gyno has less chance of coming back (which could cause inverted/caved in nipples) OR leaving a little breast tissue (the professional approach)

Also as I've dealt and dealing with hormonal imbalance, That makes me a little paranoid about getting breast cancer someday, it could be because of my lack of medical knowledge, but that's the way i feel about it. Should I remove the entire gland to hit two targets with one shot? (getting rid of gyno forever + preventing possible breast cancer in the future)

P.S. sorry for my bad English.
Thank you for your time

[Dr. Elliot Jacobs]

Your English is quite good.

Excellent question -- I understand your dilemma.  And here is a possible solution.  But first you need an explanation.

Breast tissue, on both men and women, is scattered throughout the chest -- it is not contained within a "wall" (doctors call it a capsule).  Hence any attempt to absolutely remove every last cell of breast tissue is likely impossible -- and at the very least, would leave you mutilated.  All men have some normal (albeit small) amount of breast tissue.  Hence appropriate gyne surgery (by an experienced gyne surgeon) will remove sufficient tissue (both breast tissue and fat) to provide you with a normal appearing contour -- but not so much tissue removed that you would have a post-op problem, such as a crater deformity.

If you have low T, then it would be best to consult with an endocrinologist to find out how best to manage it.  If T replacement is recommended, then sometimes some of the T that is added will convert to estrogen, which in turn could make your breasts enlarge.  The answer is for careful monitoring of both your T and E.  If the estrogen begins to increase, then a blocking medication can be prescribed.  This would allow your T to rise but keep your E in check.

If you do this, then you can indeed have your cake and eat it too -- surgery to remove your gyne (hopefully by an expert in the field) as well as a normalization of your T.

Good luck!

Dr Jacobs

[a42]

Thanks a lot for your help, doctor.

[Litlriki]

Dr. Jacobs has nicely addressed your question.  The only point I would make is to clarify the difference between testosterone replacement therapy for low testosterone as compared to "performance enhancement" with testosterone for athletic purposes.  The difference between these two uses of testosterone has to do with levels.  Namely, with testosterone replacement, the goal is normal physiologic levels, whereas performance enhancement is predicated on high levels of testosterone.  Such high levels will lead to increased levels of estradiol from aromatized testosterone, and because this tends to be done with cycles, the fluctuating levels lead to high estrogen in the face of dropping or low testosterone (after a cycle).  This is when gynecomastia is stimulated to develop.  Monitored constant levels of testosterone achieved with replacement doses doesn't cause gynecomastia, and in fact, would serve to prevent it as long as estrogen levels are controlled.

Rick Silverman

[a42]

Thank you, Dr. Silverman.