Hormone Levels ... mine ...

[danp46]

After three visits to my primary physician, I finally got him to agree that, yes, I do indeed have gynecomastia. No small accomplishment. I went in armed with research I have searched for on the web but still for me all the numbers are confusing. My doctor says all my blood work came back with numbers in the normal range and my reply was, in 25% of gynecomastia cases the cause is never determined. And, even though my numbers when isolated appear borderline normal, my research says that the real determining factor is the ratio of testosterone to estradiol.

By the way, I am 63 years old and with that said, here are my numbers:

Total Testosterone:  360      (Normal Range: 250 – 1100)
Testosterone % Free: 1.75      (Normal Range: 1.50 -2.20)
Testosterone Free: 63      (Normal Range: 35 – 155)
AST: 18            (Normal Range: 10 – 35)
ALT: 23             (Normal Range: 9 – 60)

All within the Quest Lab ranges for normal but all on the low end and I think probably well below average for my age range. So, estrogen results:

FSH: 3.9            (Normal Range: 1.6 – 8.0)
LH: 3.0            (Normal Range: 1.5 – 9.0)
Estradiol: 48         (Normal Range: 13 – 54)

I don’t have a clue as to how determine the ratio of testosterone to estradiol or what it would mean. But, according to one article I found …

Also noted is enlarged breasts, aging such as pear shaped obesity (estrogen promotes fat gain), and other feminine characteristics appearing in men may be an indicator of increasing higher levels of estrogen in men.  So if you are a male and you note you are unable to maintain muscle, your body looks more and more like a woman's body, you are gaining weight on your belly that gives you a pear shape, and other feminine characteristics, you probably need to get your estrogen levels checked immediately.

And, well, that sounds like they were describing me.

So, if anyone can shed any light on this I would be most appreciative. Any and all comments are welcomed.

Thanks,
Dan

[TOLDFT]

My condition is very similar to yours.  In 2005 used a link provided here to find an endocrinologist.  My results showed testosterone in the bottom 25%, free testosterone at the very bottom and estradiol in the upper 25%. Since all totals were within the "normal" range, she merely recommended seeing a surgeon.  This prompted a lot of web surfing on my part.  I found a number of articles since which stress it's the relation between the hormones, not the total.  Don't remember the exact figures, but testosterone/free testosterone should be in the upper 25%, estradiol in the lower 25%.  Armed with this information, I talked to my urologist but since I have had prostate cancer, he would not recommend testosterone replacement.  FYI, my current age is 60.

[Paa_Paw]

On the surface, it seems that your Testosterone is on the lower end of the normal scale while the Estrogen is in the upper end of the normal scale. The problem with such a supposition is that it does not take your age into account and the other hormones are ignored.

There is a very good and valid reason why we have specialists called Endocrinologists. You would be wise to see one and get a professional analysis of your hormone test results.

It should be remembered that the hormones do not function individually but they work together. The comparison being akin to comparing a solo musician to a full orchestra. Making sense of your test results really requires a professional specialist.

[kingboob]

On the surface, it seems that your Testosterone is on the lower end of the normal scale while the Estrogen is in the upper end of the normal scale. The problem with such a supposition is that it does not take your age into account and the other hormones are ignored.

There is a very good and valid reason why we have specialists called Endocrinologists. You would be wise to see one and get a professional analysis of your hormone test results.

It should be remembered that the hormones do not function individually but they work together. The comparison being akin to comparing a solo musician to a full orchestra. Making sense of your test results really requires a professional specialist.

The problem being that many endocrinologists are just not interested or able to treat testosterone / male hormone issues..... although if you have diabetes you are in good hands.

I had low testosterone that was ignored by an Endo, I eventually got treatment started by a Urologist and he sent me on to a well informed Endo who now manages all my issues together as you suggest.

In my experience Endocrinology get fixated on blood tests;  they are unwilling to listen the patient if the blood tests are within 'normal range', even if the tests are at the extreme low / high of normal and you are showing classic symptoms!

[Paa_Paw]

The problem is that over time the various specialists will sometimes find a sub specialty and thus you will find one Endocrinologist who may specialize in diabetes, another who is a real ace at liver disease and etc.

For our purposes, you would want to find an Endocrinologist who treats reproductive problems.

[danp46]

Thank you all for responding to my post. I think as it has been pointed out that of the most frustrating things about trying to deal with gyne is finding a physician who will not only recognize the problem(s) but one who will recommend corrective action.
 
In my own case, when I took my shirt off, the primary physician immediately said, “gynecomastia” and ordered a blood test for testosterone levels. But, he said to have it done before my next visit in four months. I did not wait but when my results came in, I was passed off to a Nurse Practitioner. She was very helpful. She did a thorough breast exam (yes, breasts not fat) and ordered the Estrogen blood work.  But, when my results came back within the normal range, it was wait four months (till my next appt.), test again and try to lose some weight and see what happens.

So, the process is a very frustrating one. I am noticing almost daily changes in my body but my doctor has taken a let’s wait and see philosophy. Thankfully, my wife is very understanding of my problem and provides an objective opinion about what is happening. In the meantime, I am shopping for an endocrinologist who will do more than simply look at the numbers.

Thanks again for your responses.

[Paa_Paw]

Remember what I previously said about the hormones not working alone. Even though the Testosterone and Estrogen levels are both within normal ranges, The testosterone level is in the lower end of "Normal" while the estrogen level is in the upper end of "normal." The levels individually are not a problem, but the relationship of the two with each other could still be a significant issue. I expect your Doctor will refer you to an Endocrinologist.