How Long Should I Wait?

[SiamSam]

I am a 44 year old male and I take a medicine for a health condition i wont go into here although one of the side effects can be breast hypertrophy.

When I started taking the meds I noticed a small lump develop about a year later in my left hand chest. It became tender and sore and I got it looked at by a doctor and he told me it was gynecomastia (physical examination only). The lump became larger to about 2-3cm but and I also noticed breast hypertrophyat the same time an I was also gaining a lot of weight due to the medicine side effects also.

I decided to try to lose weight through diet an exercise and over time the breast hypertrophy has reduced somewhat as the fat has diminished and also the solid lump has flattened out over time. I can still feel something in the breast where the lump was but it is almost flat. There are also other lumps and bumps I can feel although more like a rope texture. However even though the main lump has receded there is fat that remains making the contour of the chest look strange with puffy like nipples.

Since the left hand side lump and sensitivity went away the fat seems to have remained making the nipples look puffy although the fat is reducing as I lose more weight the contour seems to remain. I also see the right side of my chest side now following the same pattern with a hard lump developed for the past 3 months. I am assuming this will follow the same pattern as the left side and the lump will hopefully go away over time. I notice the pain has gone first just like the left side did.

Incidentally I also have an descended testicle that was operated on when I was about 5 years old although I was told that it might never function properly or at all. So I am expecting low testosterone symptoms to develop at some stage in my life so I had my hormones tested just after the first lump appeared and testosterone was just on the lower side of normal range but since I have been working out and eating right my ever since then my t level is now mid range (range being 12-30) my tests are always around the 16 level.

My estrogen was very high on my first hormone blood test shortly after taking the medicine (the meds are not trt by the way they are medicines for a health condition) it has since gone back to normal mid range for a male. I have had my t and e levels tested regularly over the past 18 months every 3  months and except for the first test (before i started working out and eating right) my levels have been OK except for that first instance 18 months ago.

Anyhow, I have also recently changed my medication to another optional drug and I no longer feel the stimulating effect that I had some times on the older meds. I was hoping that since I have changed meds the gyne might go away completely or reduce to an unnoticeable level?

All this happened over a period of 18 months prior. Im working out and eating well. I haven't had alcohol for 8 years and I don't smoke. I have a clean lifestyle and I feel healthier than ive been for decades -- except for the gyne issue.

right now the situation is that the left side lump has gone away leaving some tissue I can feel under the skin but it isnt swollen. The fat is causing the puffiness. On the left side I has the same fat issue but the lump is also there and the pain has now receded.

I have attached a photo to show you the worst profile view of the problem. Just after I work out this is hardly noticeable but the photo shows the worst of it and without working out for a few days.

What do you think about the photo and will this go away on its own with further weight loss?

How long should I wait until I go for surgical a solution?

What was  the lump and how can that go away but leave the fat accumulation?

The images are:

1 - after workout good angle
2 - after workout another angle
3 -  no workout worst (depressing) angle

Sorry for posting these photos although every doctor I see so far tells me to lose more weight and that is OK if it is going to help in time?

Do I need surgery and should I wait or will time, diet and exercise not make a difference?

[Miguel Delgado MD]

Siam.
 Thank you for sharing your story. It certainly looks like you have gynecomastia based on your history and photos.  I would certainly have surgery if you want a flatter chest.  At your age, little will change and the skin quality only gets worse.  This would be a cure for the appearance of your chest. Waiting will not solve your condition because it is breast gland development.  Good luck.

[SiamSam]

Thank you for your response. I have not responded until now as I was convinced that maybe I could lose some more weight and the breast fat might reduce somewhat.

The reason I am confused is that my right side went through a painful swollen stage and about a year later the swelling and pain has gone away and now it feels like only fat remains (the image of the worst angle with what looks like puffy nipple) as I am unable to feel a solid mass directly under the nipple. I can however feel what I can only describe as a small residue of where the swelling was before located outside the areola area so not under the nipple at all.

The left side of my chest is now going through the same stages and after 8 months now I'm hoping the pain and swelling will reside. 

My testosterone is now in mid range but I had a hormonal imbalance when I first began taking medication and I also had a vitamin d deficiency at that time. When Is started taking the meds I gained a lot of weight quickly (about 15 pounds) at that time that seems to have triggered the hormonal imbalance and the swelling of the chest. 

However I have lost the weight and now I work out and eat well and my testosterone is in mid normal range and estrogen in normal range - however the breast 'puffyness' issue remains as you can see from the photo of that certain angle.

Im wondering If I lose weight will that fat go away - also I am unable to feel any solid mass directly beneath the nipple, I only feel what I can only describe as lumpy fat outside the areola area so this is confusing in itself. I thought that real glandular gyno could be felt directly beneath the nipple as a solid palpable mass?

To add to this I went for an ultrasound at a government hospital in S E Asia and the doctor told me there was no abnormal tissue there and only fat and that I would benefit from losing some weight. Considering Im twice the weight of the average local here I can understand that but the fat and 'pointyness' of the chest just seems a little odd to me since this occurred since the weight gain and a hormonal imbalance episode I experienced that I believe was caused by starting some medication and gaining a lot of weight rapidly. 

I'm confused because the ultrasound said nothing unusual although something doesn't look right from a certain angle??

Any ideas? Should I just try to lose more weight first before exploring surgery and could this potentially improve somewhat with weight loss?