Reoccuring Gyne, after two surgeries many years apart

[fieldofsun]

I'm a very fit 28 year old. I did a cycle of steroids during college 2005, my hair also started thinning so I started taking propecia. Gyne developed and got it surgically removed in 2008 by a very good plastic surgeon.  It came back a year or so later and I got it removed again in 2012 by another plastic surgeon in NYC and took almost all of it out. It's been almost a year and it came back suddenly in the last week. I have not taken any propecia for the last year because I thought that's what was causing it.  Before both surgeries I went to endocrinologists, did lab tests, and they said everything was normal and approved me for surgery.   A more detailed version of my story is under the topic for user stories, I just posted it so it's at the top. 

Doctors, I am desperate to find the underlying cause of this gyne. I have done a lot of research in the last 8 years and I have never heard of someone getting it removed twice and it coming back. The last two times I have had it, it has been very painful and of course making me very unhappy. Do I have any other options other than surgery?

Thank you in advance

[DrPensler]

I would generally  classify recurrences like yours into two categories. The first  type , which is the most common,  is due to ingestion of a causative agent.This can result from prescribed drugs , anabolic steroids for muscle enhancement or unknown ingestion via a supplement often from China.I would recommend you systematically review your intake.
 The second reason for recurrence is most commonly an underlying medical condition. I would recommend a review of your prior endocrine and medical evaluations and a supplemental evaluation.
I am answering this with the assumption that the surgery was adequate for tissue resection which is characteristically not the case.

[fieldofsun]

Thank you for your prompt response Dr. Pensler.  That makes sense however I do not take anything regularly other than using rogaine for my hair.  In the last couple of weeks I have been working out a lot and drinking whey protein. Could that be causing it? I am in Bangkok and my friend also says the food could cause it but he is no expert or Dr.   

[DrPensler]

Whey protein has bovine albumin in it which may contain small amounts of impurities depending on the origin.What do you take not regularly? Ingestion would be the leading cause from what you have indicated , however this assumes the surgery removed adequate tissue which is usually not the case.

[fieldofsun]

Nothing, I've been very careful since I really didn't want this to come back again. I don't smoke, I don't take vitamins, I don't even drink that much. I went to a endrocrinoligist today in Bangkok to get my blood done, unfortunately they hit me with a $300 bill at the end of a dr visit and a blood test. I will find out tomorrow what my hormone levels are looking at.  Please stay with me.  The last year without it has been heavenly, now that it's coming back I am already less happy all the time.

[Litlriki]

Recurrence after adequate resection isn't common, but it can occur.  I've found, as Dr. Pensler indicated, that recurrence is more often the result of inadequate initial resection.  Alternatively, in patients who use nutritional supplements, contaminants and "stealth" ingredients (hidden under the heading of "proprietary blend") can be responsible for recurrence.  We aren't really able to comment on the adequacy of your previous surgery, and it sounds like you're not taking anything at this point, so your hormonal assessment will be informative.  Hopefully, you had an estradiol checked as well as testosterone levels, since this can be elevated and stimulate recurrence even in the face of normal testosterone levels.  Depending on the nature of your recurrence--namely, if it's slight and mostly under the nipple--it's possible that a Kenalog injection can give you improvement, suggesting that it may be related to scar tissue.  I've seen this in patients in a late setting.  Another issue in individuals who use anabolic steroids at an early age is hypogonadism, but this would show up with the hormone testing.

Rick Silverman