Hello and Help! - Recent onset Gyne

[fguss01]

Hello All,

Sorry to ask for help/advice on my first post but here goes.

Took Domperidone for 5 days a couple of months ago for gastric symptoms and within 2 weeks noticed significant female pattern weight gain (belly and hips) and the start of Gynecomastia. Age 51, 6'3" tall, 175lbs, slim build and physically fit, swim ~2miles/week.

Now 8 weeks after finishing the meds the Gyne is still developing. Not sure why this is as my levels are not so far out of whack?

Test is 14nmol/l (low normal) = 403 ng/dl
Prolactin is 223 mu/l (middle of normal)
Estradiol is 157 pmol/l (just above normal) = 42.8 ng/dl

Had difficulty convincing my endo that I had gyne, it is still fairly subtle but ultrasound today has confirmed galndular tissue below both nipples in excess of the norm for a male with excess adipose (fat) tissue surrounding it.

I am terrified that the longer this goes on the less chance I will have of getting rid of it and want to go to my next appt with a point of view on meds.

From my research I think that the two best options are likely to be either a SERM (Nolvadex/Tamoxifen) or an AI (Anastrazole/Arimidex)to address estrogen execess.

Anyone have any experiences/views as to whether these meds will help?

No-one seems to have a clear point of view on whether or not the glandular tissue under the nipple will recede - depends on fibrosis but when this occurrs seems to be a mystery.

Any advice gratefully received, this site is a godsend - I cannot believe how badly this medically benign condition is impacting my life - I can think of nothing else right now :-(

Many thanks.

[xelnaga13]

It's difficult to imagine that many bodily changes in such a short period of time,  specially from the use of a medication for a short period of time.

Im assuming that because your hormones are within the acceptable ranges your doctor will not assist you with medication?

Based on your hormone levels (IMO) the culprit is the combination of estrogen/prolactin and the absence of enough testosterone (and DHT) to off set their impact on your physiology.

Nolvadex is not the preferred option here. Primarily because it does not clear estrogen from your system, it merely blocks estrogen from your bodies E receptors. Additionally, it will superficially raise your testosterone, so when you stop you will have to deal with estrogen rebound and worsening of your gyne symptoms.

Self administration of arimidex is a last resort when your exhausted your medically supervised options. If you find yourself in that position feel free to private message me. There are many sites/forums that deal specifically with the male endocrine system.

[fguss01]

Xelnaga,
Many thanks for the reasoned response.

I am not through with the Endo yet, I see him again next week but given that he initially denied my Gyne (hence the ultrasound) I want to go in with a clear viewpoint on where I want to get when I see him, sounds like Arimidex could be the way forward.

What is killing me is the waiting, my gyne is not severe yet but every day I am putting on more breast mass.

As for the levels, Nobody really knows how Domperidone (Motilium) causes gyne, it raises Prolcatin but I have also seen comments that it may intefere with the Aromatase enzyme and therefore screw up the relative ratios between Test and Estrad, sadly having no benchmark for these pre-Domperidone I will never really know.

I will resist the urge to self medicate and hold out for another week.....

Thanks again, being able to "talk" really helps, my wife didnt "get it" at all until I asked her how she would feel about a pair of budding testis :-)

Best regards.

[fguss01]

Sorry, forgot to ask - is there a rough timeline beyond which drugs are useless or is this genuinely variable from person to person - what I'm really asking is do I have days, weeks or months to try and get on meds before the gyne becomes permanent?

[xelnaga13]

Okay- I wasnt clear on where you were with your endo. If you are still working with him it is absolutely CRITICAL that you do NOT self medicate. Doing so will make his job impossible.


Btw- your when your estrodial/prolactin are addressed successfully, your natural testosterone levels wont be suppressed and will rise. Then it would just be a matter of time and patience for your fat to redistribute itself. I know this from experience.

[xelnaga13]

Sorry, forgot to ask - is there a rough timeline beyond which drugs are useless or is this genuinely variable from person to person - what I'm really asking is do I have days, weeks or months to try and get on meds before the gyne becomes permanent?

While no one can give you a specific timeline, reversing it is time sensitive. The sooner you can remove the physiological support for the growth the higher the chances of your body catabolizing it. 

In the mean time I would do the following:

supplement fiber into your diet... doing so will help clear the body of estrogen
take zinc... zinc is a natural inhibitor of estrogen conversion
drink lots of water... it will help get rid of toxins and estrogen
stay away from drugs/booze... they clog up your liver and lead to build up of estrogen...


Also are you taking any medications for depression, anxiety etc?

[fguss01]

Thanks for the info, doing most of this except for drinking red wine! I am super clean and take no meds or any other drugs - luckily in good health generally.

I am too stubborn to take any anti-depression meds :-)

I am also hopeful that the adipose (fat) will redistribute itself I guess the unknown is whether or not the glandular element of the tissue behind the nipple (will also regress with the meds - this is dependent on whether "fibrosis" has occurred I believe, the timing of which does not seem to be an exact science....

Glad for your support, the self imposed pressure to buy some Adex over the web and self medicate is huge given that every day I'm getting bigger.

Only eight days and counting, will post back after my next visit to the endo.

Best regards.

[xelnaga13]

Okay great!

[fguss01]

Update, have an appt with the endo late this week, he has called and indicated that he will probably be recommending drug treatment when I see him once he has reviewed my case again but would not be drawn in specifics.

So, looking at the options the UK General Practitioner notebook lists the following possible treatments;

SERMS - Nolvadex or Raloxifene
DHT - assume topical
Danazol
Clomiphene
AI - Arimidex or Testolactone

From having a dig on the net Nolvadex or Arimidex seem most popular - the only studies I can find seem to place Nolvadex (Tamoxifen) above Arimidex in terms of clearing Gyne but these studies were done on guys who were also receiving therapy for prostate cancer - not sure if this is significant?

The studies on Arimidex alone appear to have been done on pubescent gyne which does not apply in my case.

Any opinions out there as to efficacy of Nolva vs Arimidex?

Can they be given as a combined therapy?

Thanks as always.

[xelnaga13]

Ive seen every protocol and combination under the sun.

A three pronged approach would be an estrogen blocker ( nolva), an aromtaste inhibitor ( armi), and an estrogen antagonist (dht cream). Ive seen this combination used with success in treatment of early onset gyne induced by exogenous testosterone/hgh use.

You will most likely find your endo is inflexible with compounds, and has his own ideas of how to remedy your gyne. I doubt he will take out his rx pad and give you a script for everything we are discussing. But being prepared with information never hurts, and can force a doc. to actually spend time thinking critically about your options.

[fguss01]

Thanks for the reply, typing on the move so apols for any errors.

Looks like these therapies can clinically be run in parallel then? Take your point on the endos view I am sure he will have his own ideas.

Do you have a point of view on Nolva vs. Clomid, to mu untrained eye they seem similar but I know they are sometimes run together by bodybuilders for gyne avoidance\resolution.

Thanks again, will post at the end of th week - my latest bloods - LH, FSH, PRL and total Test all came bacl in normal range altho I suspect the test will be at the low end.

[xelnaga13]

Clomid uses the same mechanism of action as nolvadex. However, clomid carries many more side effects. Some of which include eye sight issues, emotional problems , and cancer. Ive also read research that suggests that while clomid is not capable on activating breast tissue receptors it is capable of being recognized as actual estrogen in other tissues.

Ill be very curious to know what approach your endo will take considering your hormones are all within acceptable ranges. Any treatment will result in hormonal changes, and I wonder if he will be willing to rock the boat.

You are correct that bodybuilders looking to stop steroid use and restart their natural testosterone production typically look to a combination of nolva/clo. Since they essentially rely on the same mechanism of action, I suspect the combo is more about cautious overkill than any possible synergistic effects. 

[fguss01]

I am also keen to hear his thoughts, and get started as my gyne (especially lhs) is still sore and, I think, still putting on mass.

Since I have seen female pattern weight gain (hips and stomach) in addition to the Gyne despite now being lighter than I have ever been - trying to eat well (lots of broccoli, fruit etc.) and limit the booze, I suspect a shift in the E/T balance somehow caused by the Domperidone, my wife also thinks I am more emotional of late which could indicate a kick up in E.

I have tried to draw out the endo process to include PRL and the Hypo-Pituitary-Test-Aromatase-E2 process to reason out how Domp might have affected me but I dont know enough to do this and I am sure better minds have tried and failed.

So, I will report back after seeing the endo.

Thx again.

PS Not sure if I said but I am located in the UK, not sure if this makes a difference either way in approach the endo may take?

[xelnaga13]

I did some reading on Domperidone and it's direct effects on dopamine and indirect effects on other hormones. Im not familiar with gastrointestinal issues... but it does seem like a drastic choice.

[Paa_Paw]

Domperidone is sometime used to stimulate adoptive lactation in the case of newborn adoptions Where the adoptive mother wishes to breast feed the infant. For this use the medication is only one of several used and advanced planning is required as the required course of treatment takes months.

An early response indicated surprise that use of this kink of drug might cause significant breast growth in a matter of only a few weeks. I too find this difficult to accept. I think a more likely scenario would be that the breast enlargement already existed but went un-noticed until this medication caused increased tenderness of the nipples which focused attention on the breasts.

Several years ago, a young man related that his doctor asked if his enlarged breasts were a source of embarrassment. Until the Doctor asked that question, the young man had not even noticed his breasts. Now that the breast enlargement had been brought to his attention, He quickly became obsessive about it.

I wonder how many of us are in the same situation. How many young men would not especially aware of their breasts except for someone or something that focused attention on them.