Question About Pain And Hyper-Sensitivity

[UniquelyDefined]

I am a thirty four year old male who experimented with cross gender hormone replacement therapy because I was questioning my gender. I won't go into that further, but it was a mistake and I immediately regretted it once it began to cause radical and rapid changes to my chest. I used Spironolactone and Estradiol for one month, and during that time developed gynecomastia that an ultrasound has measured as three centimeters. The ultrasound found nothing malignant or unusual beyond enlarged breast gland tissue. It has now been nine weeks since I stopped hormone replacement. I have been using Tamoxifen for two weeks and the ultrasound was taken after that time, and probably represents some improvement.

My problem is not appearance. I think I look just fine. It looked worse before, but the look of my chest has basically normalized over the last nine weeks. My nipples seem to be permanently enlarged, however, and are about three times their original size. My problem is that I have persistent pain and hyper-sensitivity in my right breast. It makes it difficult for me to wear clothing because my nipple feels too sensitive to rub on fabric. I also feel that there is a deeper pain beneath the skin, which I find difficult to locate, but which is constant and interferes with my ability to focus on anything else. It is not a livable situation.

My question is: Do I need surgery to correct this pain and discomfort? Can surgery even correct this kind of sensation problem? I have spoken with two general practitioners and three plastic surgeons and no one seems to understand what has happened to me or be able to give me clear advice. It seems that this kind of persistent pain and hyper-sensitivity is very unusual. I've been told that I should wait for six months before I do surgery, because often the condition corrects itself, but all the doctors I spoke with said they have no idea if this waiting will help with the pain and sensitivity. They also seem uncertain if the surgery will correct it.

Can anyone please advise me? I am unable to live my life due to this unmanageable discomfort. I feel worried to do cosmetic surgery because my appearance is acceptable to me, and I have been warned it can sometimes make things worse. What should I do?

[Dr. Elliot Jacobs]

I have had a few patients who had a similar history.  The presence of pain/tenderness is due to the growth of breast tissue and oftentimes treatment with Tamox can be helpful if it is taken early in the process.  However, I have found that eventually, every patient needed surgery to remove that extra breast tissue and most patients had relief of their pain problems as well.  These observations are based based anecdotally on just a few patients -- there are no scientific studies to back this up.

Would recommend observation as long as you can tolerate it -- and if the pain still persists and the nipples remain enlarged, then you might consider surgery.  Good luck!

Elliot Jacobs, MD, FACS
Boca Raton, Florida