String of lumps following 5 weeks of AAS use (testosterone)

[Kelp]

First of all , hello to everybody. I would like to write my quick and unfortunate story about steroid use and gynecomastia and ask for a medical oppinion regarding the outcome.

I started a cycle of Testosterone Enanthate , 400 mg / week , and in week 5 i just had an idea to check my pectorals for lumps after reading stuff on the web -> i had NO symptoms whatsoever around my nipples. I stopped the steroids the moment i discovered lumps. But here is the thing:

I only have 1 small (not even pea sized) lump under my areola, but i'm having strings of bigger lumps (1-2") just above and laterally of my nipples going up to the arm pits. I have them on the left AND right pectorals. They do not hurt and feel like strings. No changes in Areola/nipple area.

I am currently using Arimidex and Tamoxifen. I would prefer to postpone the doctor visit until my hormone levels are balanced again.

Do i have the chance of this lumps going away after stopping the substance and following tamoxifen?

Thank you in advance!

[DrBermant]

First of all , hello to everybody. I would like to write my quick and unfortunate story about steroid use and gynecomastia and ask for a medical oppinion regarding the outcome.

I started a cycle of Testosterone Enanthate , 400 mg / week , and in week 5 i just had an idea to check my pectorals for lumps after reading stuff on the web -> i had NO symptoms whatsoever around my nipples. I stopped the steroids the moment i discovered lumps. But here is the thing:

I only have 1 small (not even pea sized) lump under my areola, but i'm having strings of bigger lumps (1-2") just above and laterally of my nipples going up to the arm pits. I have them on the left AND right pectorals. They do not hurt and feel like strings. No changes in Areola/nipple area.

I am currently using Arimidex and Tamoxifen. I would prefer to postpone the doctor visit until my hormone levels are balanced again.

Do i have the chance of this lumps going away after stopping the substance and following tamoxifen?

Thank you in advance!

Anabolic steroids, as you found out, can cause an imbalance of hormones. Gland stimulated swells and enlarges. Once the stimulation stops, the swelling resolves but what gland has grown you may be stuck with. Antiestrogens will react and help only during the swelling phase and do not reverse actual gland growth. So any recommendation for something like Letrozole will be ineffective if the problem happened long in the past. If the tissues are still painful and tender, then getting the problem stabilized is the first step. If there has not been enough build up, then the problem may resolve without surgery. Antiestrogens and hormonal manipulation should only be done under the hands of an experienced endocrinologist.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[Litlriki]

I am curious if you ever checked your chest before you used steroids, since the bumps you feel might have been there all along.  In my experience, most of the patients who develop gynecomastia related to steroid use describe a variety of symptoms at the outset, including nipple sensitivity, itching, aching, and so on. I can't think of anyone who didn't have some sort of "feeling" associated with the onset of their gynecomastia, but it's possible. 

Nonetheless, at this point, you just need to give yourself time to see if the condition resolves.  If this is your first cycle and the lumps are very small, they may go away and not cause you any concern afterwards--as long as you avoid stimulation in the future.

Rick Silverman

[Dr. Elliot Jacobs]

Totally agree with Dr. Silverman -- watchful waiting is important.

Once your condition is stable (many months from now) and any odd feelings have disappeared, you should take another look at your chest.  If it looks good, then great.  If there is visible residual enlargement, then you have some decisions to make.  Would not opt for surgery just because you can feel something.

Dr Jacobs

[Kelp]

Thanks for the answers docs, and my respects for not being judgemental on the steroid use - which was obviously a bad idea.

Exactly, i cannot fully link the bumps to this cycle (it is my first one) because i never previously checked my chest. But starting this cycle made me a bit paranoid so i started checking for things.

My last shot of testosterone was exactly 1 week ago, i am currently using 0.5mg Arimidex Daily along with 20mg Tamoxifen, and in 1 week i will quit the Arimidex and continue with Tamoxifen and Clomid for 4-5 weeks.

Hopefully things will settle down in 2 months so i can undergo some other tests, i'm guessing, a mammography. Would a mammography be able to tell for sure if this mass is breast tissue or some other nature ? Could they just be veins/tendonds/muscle fibers running along?

Thank you.

[Dr. Elliot Jacobs]

A mammogram can tell if breast tissue is present.  An MRI would be necessary to look for other things -- but rest assured, there are no other things.  What you have is fat and breast tissue.

I reiterate what was earlier stated -- if your chest looks OK once it has settled down, then (as we say in Brooklyn) fugedaboutit!!

Dr Jacobs

[DrBermant]

Thanks for the answers docs, and my respects for not being judgemental on the steroid use - which was obviously a bad idea.

Exactly, i cannot fully link the bumps to this cycle (it is my first one) because i never previously checked my chest. But starting this cycle made me a bit paranoid so i started checking for things.

My last shot of testosterone was exactly 1 week ago, i am currently using 0.5mg Arimidex Daily along with 20mg Tamoxifen, and in 1 week i will quit the Arimidex and continue with Tamoxifen and Clomid for 4-5 weeks.

Hopefully things will settle down in 2 months so i can undergo some other tests, i'm guessing, a mammography. Would a mammography be able to tell for sure if this mass is breast tissue or some other nature ? Could they just be veins/tendonds/muscle fibers running along?

Thank you.

Testing without medical guidance makes little sense. Male mammogram can show fat vs gland but I rarely order such tests. This post discusses such testing for gynecomastia:

https://www.gynecomastia.org/smf/index.php?topic=13608.msg94835;topicseen#msg94835

Ordering a mammogram on tender hormone swollen breasts can be a false positive. When the stimulation is stopped and tissues stabilized, then the mammogram could possibly have value. Yet it is a waste of radiation just to prove the contour is gland if the patient does not like the contour and I am going in anyway to shape the chest.

The best sequence starts with an experienced Endocrinologist who will take a history, perform a clinical exam, and based on that consider what testing would be appropriate. Getting the problem stabilized first, in my opinion is the smarter way to get growing breasts under control. How soon the tests should be ordered will depend on that exam and evaluation but rarely are beneficial during the imbalance of hormones at the completion of a cycle unless you are looking to understand a window of altered state vs. the body's steady state condition.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[Litlriki]

Unless a test is going to influence your treatment action, it's a waste of time and money.  A mammogram will not show you anything useful, and I am always surprised when a young man with pubertal gynecomastia is referred to me and arrives with mammograms and ultrasounds that provide no useful information.  As for testing of hormonal balance, you're messing with your hormonal balance with exogenous hormones, so they're not going to be predictive of your normal levels until you have cleared everything from your system.  Again, testing at this point has little value. 

Finish your post-cycle treatment, if that's your plan, and then get off of everything.  Let things settle for up to six months, and if everything looks normal, it probably is normal.

RS