Sure I think we pretty much agree on the basics. Just the thing is not all gyne caused by medicine is 'self medicated'. Doctors have certainly prescribed a few medicines in their time that have made gyne worse.
Obviously, I never stated otherwise.
I think the whole problem is even the most competetent endocrinologist dosen't know exactly whats going to happen with any medicine that alters hormone levels.
That is factually incorrect. Competent endocrinologists know exactly what is going to happen with the use of certain medications, in terms of what hormones they are going to affect and how. The only question is one of the degree to which the medications work and this is something that differs person to person. They also know for sure what will not happen or is unlikely to happen with particular medications as a result of controlled studies.
Hormone levels can be extremely sensitive and in constant change. Hormone levels change by the day, hour and even the minute.
Yes but this means nothing. A competent endocrinologist medicates when he or she sees a medical need evidenced by symptomatology, pathology and physical examination.
Multiple pathology, sometimes pooled pathology and even highly specific evocative dynamic testing of the HPTA form part of the diagnosis that comes before any given treatment. If you were aware of the realities of this area of medicine you would not think the way you do at present.
All blood work does is give them a snap shot.
Again this is to completely misunderstand the medicine involved, it is true to a degree, but it is a generalization that implies far too much.
A competent endocrinologist will take into account the whole medical picture including physical examination, symptomatology and pathology. Primary testicular failure can often be evidenced via orchidometer measurement of the testis. Small testicles and symptoms of androgen deficiency coupled with high or low LH would offer a highly specific diagnosis for hypogonadism. Pre pubertal androgen deficiency of any origin is often evidenced by eunecoid body statue or a failure to go through puberty. If an individual has overtly high estradiol levels they very rarely change from one test to another as estradiol levels tend to take quite some time to fall if they are going to do that at all. So this snapshot doesn’t tend to alter very much at all as long as the individual is not going through puberty. In order to diagnose hypogonadism a minimum of two morning samples of testosterone would be taken along with ancillary hormones and very often LH values can easily point to the problem at hand. LH is of a pulsatile nature and can be different every time it is tested, however if it is low, inappropriately normal in the setting of low androgen levels or high in the setting of low androgen levels in multiple tests it gives a fairly strong indication of hypogonadism and that is before even considering symptoms. Men with longstanding low GH or testosterone deficiency also often have osteopenia or osteoporosis as evidenced via bone density scans, so again this is something that can aid the competent endocrinologist when considering the possibility of long term hypogonadism. When an individual has a more complicated case evocative dynamic testing of the HPTA is often used. A GnRH test can help an endocrinologist ascertain whether the hypothalmic pituitary axis is intact and can also help ascertain whether or not the individual is suffering from pituitary insufficiency. A high prolactin level or a poor GnRH response would prompt a MRI or CT scan of the pituitary another medical aid that enables the competent endocrinologist make a definitive diagnosis. Some men may have Insulin Tolerance tests to ascertain cortisol and Growth Hormone levels. These tests can conclusively follow up on pathology for definitive diagnosis for differing conditions or at least aid in the endocrinologist in ruling out or following up with further dynamic testing in order to again arrive at a definitive diagnosis. When it comes to TSH (Thyroid testing). TSH is a highly sensitive test that reveals over ninety percent of those suffering from thyroid problems. In those suspected of thyroid problems not evidenced by low or high TSH, further testing of freeT4, freeT3, thyroid antibodies, reverse T3 etc usually provides definitive diagnosis of deficiency or excess. I could go on but wont
Pathology alone or poorly interpreted pathology is the problem, but pathology in the right setting with appropriate weight and interpretation applied to it alongside other diagnostic aids make pathology an incredibly helpful tool in ascertaining the hormonal make-up and problems of any given individual.
Unless you had your hormones continually monitored 24/7 then maybe exasberating the gyne through medicines could be avoided, but there are too many factors that the endocrinologist just cannot calculate to a 100% accuracy or even close. Hormones are affected by too many things, physiological and psychological that no-one can calculate for.
It is highly unlikely that anyone would require their hormones to be monitored in the manner you have stated. In an extreme case where longer dynamic testing was conducted it would not increase gynecomastia. I think you have read far too much into whatever it is that you have read. Although stress can temporarily reduce testosterone levels, hormones are working in the body 24/7 and gynecomastia does not respond/increase to such small episodic increases or dips in endocrine function. Like I say if you knew this area of medicine then you would know that competent endocrinologists can very often know more than enough to allow for medical intervention when it is necessitated.
Bottom line, if a endocrinologist prescribes a medicine, then sure take it, but just be aware no medicine comes with a guarantee.
lopher
It depends what you mean here, because again this statement is a generalization.
If you are referring to medical/drug intervention in cases of gynecomastia, I agree that there are no guarantees in terms of how successful such intervention will be. However the efficacy of such treatment can pretty much be assured if prescribed by a competent endocrinologist and any potential side effects well explained. If you are meaning your statement on a more general level, as in medications for hormone problems then I would argue that you’re far too pessimistic as thyroid, androgen and adrenal problems are very often well treated with medication and the benefits usually far outweighing any drawbacks.
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