Endocrinologist appointment. What should I ask?

[enquirer]

Hi, I will be seeing an endocrinologist next week. Since there is only one Endocrinologist in my town (and she may be a new doctor), I want to make sure that I ask the right questions related to my case so I get some useful answers.

Here is a brief history about myself:

I am 28. I have had gynecomastia since I was 13~14. The hard lumps in my chest measure around 2.5 inches in diameter. When kids started making fun of me in middle school, my dad took me to an endocrinologist. I don’t think that doctor requested any lab tests of me. He seemed to be interested in finding out if I had an erection or not. I don’t know what that had to do with Gynecomastia but I was too young to ask and my dad didn’t know any better. I have had a complex all my life due to this sh*t and it has affected my personality a lot.

I saw a documentary on BBC about this a few months ago where I learned the term Gynecomastia. Since then I’ve made it my mission to get rid of this stuff. Had I known about this term earlier, I would have taken care of it long time ago.

A doctor friend recommended that I see an endocrinologist before I visit a Plastic Surgeon to rule out any medical condition that might cause this thing to redevelop. Furthermore if the endocrinologist does find some medical condition then the insurance company will have to cover the Gynecomastia surgery.

I hope the above information helps. I look forward to your suggestions.

[hypo]

Hi enquirer,

You should make it plain how much the gynecomastia affects you and you should say that you want to rule out any underlying conditions given that you are looking towards a surgical procedure.

Let him run the consultation but make it clear you want pathology investigations into your hormonal status that includes testing androgens, estrogens, pituitary and thyroid hormones.

If he/she is any good they will take it from there, if they are not, no amount of talking will change the fact that you'd have to get another endocrinologist.

You should get a copy of your pathology investigations for your own records including the lab ranges for the tests- very important!

If you pm me or post your results here I can help you interpret them.  That way you would have the best of both worlds, you would have the perspective/opinion of an endocrinologist and of a person who has a hormone problem who has seen many pathology investigations and has an understanding of the issues at hand.

[jc71]

enquirer.
Good advice by your dr.  Yes. make sure the endo knows that you know it has a name...GYNECOMASTIA.  Make sure he knows that you know what you're talking about.  Not in a obnoxious way but in a respectful way. Do some hunting on these boards for other endocrinology threads and educate yourself. You'll be that much more confident with your appointment and the dr will probably respect you more because of it.  

[enquirer]

Hi enquirer,

You should make it plain how much the gynecomastia affects you and you should say that you want to rule out any underlying conditions given that you are looking towards a surgical procedure.

Let him run the consultation but make it clear you want pathology investigations into your hormonal status that includes testing androgens, estrogens, pituitary and thyroid hormones.

If he/she is any good they will take it from there, if they are not, no amount of talking will change the fact that you'd have to get another endocrinologist.

You should get a copy of your pathology investigations for your own records including the lab ranges for the tests- very important!

If you pm me or post your results here I can help you interpret them.  That way you would have the best of both worlds, you would have the perspective/opinion of an endocrinologist and of a person who has a hormone problem who has seen many pathology investigations and has an understanding of the issues at hand.

Okay, I got the results today from my endocrinologist. She is forwarding my case to another endocrinologist who specializes in Diabetes Mellitus, General Endocrinology and Metabolism, and Lipid Disorders. Anyway, here are the results:

ESTROGEN, TOTAL: 153, Ref: 130 or less
TESTOSTERONE TOTAL: 200, Ref: 189 to 1111
PROLACTIN: 9.0, Ref: 2.1 to 17.7
THYROXINE FREE: 1.2, Ref: 0.8-1.5
THYROID STIM HORMONE: 2.08 , Ref: 0.4-5.5
FSH: 1.3, Ref: 1.4-18.1
LUTEINIZING HORMONE: 6.5, Ref: 1.5-9.3
TESTOSTERONE, FREE: 35.9, Ref: 40.0-150.0

She indicated that I might have secondary hypogonadism. What do you think hypo?

[Paa_Paw]

Hypo is in London for a few days, and I am not nearly the Expert he is.

That said: Total Estrogen is above normal, while Total Testosterone and FSH are in the low end of normal, and Free Testosterone is below normal.  Sounds like you have a good doctor who is passing your case on to with someone with nore expertise in this area.  Go with the referral.

I suspect that the Gynecomastia is merely a symptom of a larger problem, but you are on a path to competent diagnosis and treatment.  Keep a good attitude and stay in touch.

Good Luck

[Gine2D]

Your hormone are way out of balance.  Estrogen too high, testosterone too low.

You probably have low muscle mass, low endurance, & boobs.

I hope the endo also knows something about hormones.
He will probably do the FSH again & add a couple more tests like SHBG & HCG. This will help determine why the hormones are out of balance before he can correct them.

If he is just out of med school you have a better chance of him knowing something or willing to learn.  

Most prefer diabete treatment & just guess at hormones.

With those levels of hormones & if you have surgery now the boobs would probably just grow back.

Good luck