Important information for gynecomastia

[Kevin]

I am going to have a blood work measuring my testosterone level. Which type of test is best to take? I have read that measuring "Free Testosterone" is a must, besides that what else should I tell my endocrinologist to test for?

[hypo]

What country do you live in?

[Kevin]

I live in the Philippines. The last time I did a test for my testosterone levels I was very young like 16 and I forgot the results. The endocrinologist who ordered the test said that my testosterone levels is in the lower end of the normal range. Maybe i have testosterone resistence which ledme to develop bilateral gynecomastia.

[hypo]

Kevin,

The thread below should tell you what you need to know.

I'm not sure of the specific tests used in the Philippines, but I have included all the tests used in the US and Europe.  I would imagine that the Philippines uses one system or the other.

http://www.gynecomastia.org/cgi-bin/gyne_yabb/YaBB.cgi?board=1;action=display;num=1105543515

Make sure that when you get your results that you are given a copy of the actual results and not just told normal or not normal.  Make sure that on your results you are given the relevant lab reference ranges.

I hope that helps.  If it isn't quite what you were looking for private message me and i'll try and answer any further questions that you may have.

[whatswrongwithme]

HELP ME! i need to get rid of this. im not sure if its gyno but its the worst thing that has ever happened to me.
i think i started geting it when i started puberty. i cant remember but at first it was like a hard lump under my nipple, but it later (maybe a year after i noticed it) it went away but left my nipple still puffy looking. i hate it im 17 yrs old, 5'11", 160 pounds, good shape. i mean my nipples do not have any kind of hard gland or anything behide it, but there puffy, they stick out! they are soft. please what should i do to get rid of it. its so embarassing. it is messing up my life.

[hypo]

whatswrongwithme,

I think the best thing you can do is post your pictures on the site so that people can have a better idea of your issue and advise you accordingly.

Your story is a common one and you have reached a place where people feel much the same as yourself and try and help.

[hypo]

When referring to testosterone deficiency or hypogonadism I am referring to those who have absolute/outright unhealthy levels of the male androgen testosterone.  People whom if left will have a higher incidence of suffering from Cardio Vascular Disease, strokes Alzheimer’s, depression, life long fatigue, osteoporosis, diabetes, obesity etc etc.

And those people who have clear symptoms of testosterone deficiency in the presence of biochemical markers that show this to be a problem.

I am not talking about men who only have low levels of serum testosterone and that are asymptomatic.

In most men about 98% of testosterone is bound in the blood and cannot be used.  So it is the much smaller free/bioavailable freaction of testosterone that matters.  Changes in other hormones such as SHBG and estradiol can greatly affect this free fraction, so much so that some men operate quite healthily on lower amounts of serum testosterone because they still have an adequate level of the free fraction of testosterone.

You may be one of those men that has a good healthy level of free testosterone thanks to low levels of SHBG and estradiol, alternatively your endocrinologist maybe stringing you along with a load of hogwash and not be to good at his job.

To decide for yourself which one of the two is most likely, I am including a symptomatic test for you to try at your own leisure.  The test is not a replacement for pathology but is very important in its own right.  The test was created by world leading endocrinologist Malcolm Carruthers M.D and is something he uses in consultations with new patients.  If the test shows that you have a problem, then you most probably do have a problem, in which case I would recommend getting a second opinion.  Hopefully the test will just confirm that you are indeed one of those men that has a low level of serum testosterone but a healthy level of bioavailable testosterone.  If it shows a problem and you are in the US, tell me where you are and I will help obtain the contact details of another endocrinologist.  If your from the UK i can help will some detail but would need to talk to you a little more.  


Checklist.  

Instructions
Rate all categories below as none, slight, medium, severe or extreme.  For each category None=0, slight=1, medium=2, severe=3 and extreme=4.  In the age category although a little awkward given your age think how bad you feel and go off that with 30s=0, 40s=1, 50s=2, 60s=3 and 70s=4.  

1 Fatigue, tiredness or loss of energy

2 Depression, low or negative mood

3 irritability, anger or bad temper

4 anxiety or nervousness

5 loss of memory or concentration

6 relationship problems with partner

7 loss of sex drive or libido

8 erection problems or potency problems

9 dry skin on face or hands

10 excessive sweating, day or night

11 backache, joint stiffness

12 heavy drinking past or present

13 loss of fitness

14 feeling overstressed

15 the age you feel 30s/40s/50s/60s/70s.


Having added up your total you need to add an additional 4 if there has been any case of adult mumps, orchitis or other testicular problems, persistent urinary infection or vasectomy.

Based upon symptoms Malcolm Caruthers M.D endocrinologists says that the odds of you having hypogonadism is;

0-9 unlikely, 10-19 possible, 20-29 likely, 30-39 very likely, 40+ severe


P.S  

The comment about manliness that was made by your endo is wholly inappropriate as it can be very misleading.  Hypogonadatropic Hypogonadism can occur post puberty and could happen to Mike Tyson, so manliness can sometimes have nothing to do with this condition.

The Robbie Williams quote is not appropriate for those that have this condition.  For those that just have low serum testosterone but a good level of bioavailable testosterone, then there is no pain or problem anyway.

All the best graham

[hypo]

Graham,

quote
Does this mean a man (with or without gyno, I presume) should look for treatment for this condition based on the following:
unquote

I'll stop you there for a moment.  Gynecomastia is often a symptom of hypogonadism.  Hypogonadism is an associated condition as is clearly indicated in almost every single medical white paper on the aetiology of gynecomastia.  Therefore it makes sense for people who have a much higher incidence of hypogonadism to have their hormones checked.

If you have gynecomastia, have your hormones checked.

This is backed up by the fact that 10% of all gynecomatsia sufferers have hypogonadism.

http://www.leeds.ac.uk/acb/annals/annals_pdf/Nov01/596.pdf

So that is the reason.

Quote
1. He is correctly diagnosed (this itself is quite subjective even if it's coming from an endochrinologist who might or might not know his job) to have this 'problem' which until now he didn't even know about.

2. Because he MIGHT suffer from the quoted diseases in the future.
unquote

I myself had gynecomastia, that was the first symptom I had of hypogonadism.  The very skeptical attitude you are exhibiting, is exactly what allowed my hypogonadism to go undiagnosed for 13 years and as a result I now have osteoporosis in my spine and another osteo condition in my arm.

IS THAT REAL ENOUGH FOR YOU? or would you just dismiss this as a possible future condition?

When I have stated the conditions above, I have stated them for a very good reason.  They are not hypothetical maybes.  About a third of all men with diabetes have hypogonadism.  Hypogonadism left untreated results in a much greater statistical risk of developing diabetes, not a slightly increased risk.

A recent study into Alzheimer’s found that for every 50 percent increase in the free testosterone index, there was about a 26 percent decrease in the risk of developing Alzheimer’s…..Does that make you readdress?

I could go on and on but I wont.

Many people do not add up what are often seen as unassociated symptoms when it comes to hypogonadism, That is why under diagnosis is rife.

Quote from the AACE (American Association of Clinical Endocrinologists) states quote

The recognition, evaluation, and treatment of Hypogonadism in the male patient are often dismissed by the patient and overlooked by the physician
unquote

3. And all this is worth the risk treatment for hypogonadism might bring with it.

Yes.  The overwhelming evidence is that returning hormone levels to optimum healthy levels significantly reduces the statistical incidence of the conditions mentioned above and it can significantly improve the quality of the lives of those treated.  The risks of not being treated are statistically fairly small and dramatically of less importance than the risks of not being treated.

you say quote
While we're at it, we might as well check every inch of our skin at the dermatologist to see if we might have melanomata - I think that's more of a health hazard than hypogonadism.
unquote

This is a totally inappropriate remark, because hypogonadism is an associated condition of gynecomastia and is known to be a significant cause of gynecomastia and the situation you point to has NO association whatsoever.

Quote
mountain out of a molehill
unquote

Well a mountain out of a molehill can be Alzheimer’s, diabetes, osteoporosis for me, CVD, strokes, obestity, depression etc!!

It definitely means a high chance of gynecomastia returning post surgery for those that do not correct the underlying hormonal imbalance.

So forget surgery then if you have gynecomastia, if you are not interested in considering hypogonadism

This is shown by the fact that the success rate of surgery in the long term in only 64% as stated by Merle Yost on the program Boys with Breasts

Need I go on?


quote
By the way, I took the test you have up there and guess what - it's "possible". For the record, my endochrinologist actually told me to come and see him again to take another testosterone level test after the story he handed me the last time. Maybe when I'm in the mood to see him again, I'll have him look into it.  
Unquote

That was a self test that I took the time to provide for you to try and help you.  I am not trying to sell you something and your attitude here just stinks I’m afraid.  I am not some used car dealer offering you a banger.  So frankly you can do what you like.  What on earth is with the tongue out gesture as well?  Do you believe you have proved some point or other, you certainly have not and when I have osteoporosis because of this and your sticking a tongue out an talking of molehills- I feel like hitting you never mind helping

You’ll deal with your health when you’re In the mood, ok off you go then, be as Blasé about your own health as you like.  

I have tried to help and that is all that anyone can do, I hope that you are a man with very low SHBG who has no testosterone problem at all for your sake, as I wouldn’t wish ill health on anyone.

[hypo]

Graham,  

I took some of what you said personally because it is precisely this laid back blasé attitude towards health that leads to under diagnosis of this condition and under diagnosis equals under treatment and under treatment equals a higher number of PEOPLE SUFFERING from VERY serious conditions.

It is precisely as the AACE (American Association of Clinical Endocrinologists) put it, so I will quote them again.

The recognition, evaluation, and treatment of Hypogonadism in the male patient are often dismissed by the patient and overlooked by the physician
unquote

You are sticking your head in the sand.


I am passionate about informing people so they can make informed decisions about their own health and avoid becoming a victim of long term untreated hypogonadism.

Something I myself have suffered from, due in no small part from attitudes just like yours.

quote
did you stop to think that you might be needlessly scaring the <excrement> out of some of the people here?
unquote

Needlessly?  

Well I have found many people with hormone problems and helped them get help, diagnosis and treatment.  Is that needless?

With 10% of all gynecomastia sufferers on this site likely to have hypogonadism, is it needless to raise awareness about this condition?

With approximately 10 people in every 100 gynecomastia sufferers who visit this site likely to have hypogonadism, but often not knowing it, is it needless to raise awareness?

If 5 people in every 100, half of those likely to have hypogonadism read my posts and start to think and get checked out, get diagnosed and treated so they do not have to suffer from osteoporosis like myself- is that needless?

If it encourages all people here to get hormone pathology and as a byproduct of the above pathology reveals the 8% of people with poor liver function, if it reveals the 1 in 500 with Klinefelter Syndrome or the 1 in 250 who have haemochromatosis, or it reveals some of the 16% of people who have testicular cancer who have gynecomastia....all needless?

quote
we know as gyno sufferers we have to get our hormones checked and many of us have
unquote

No.  That is simply not true.  Before I came to this site the % of people who got there hormones checked was quite low.  When people did it was almost always inadequately by an unqualified individual like a gp or a plastic surgeon.  

People had hardly heard of the word endocrinologist before I came here.  Now it is used often because it is something I have pushed for, so that people can make enlightened, informed choices.

You are assuming people know about hormones that come to this site which is a very poor assumption indeed.

quote
now we have to do it again because if our doctor didn't say anything about hypogonadism the first time, let's get a second opinion!
unquote

I am not saying that.  You came back with a specific comment that your testosterone was on the borderline of being low, low normal, so my comments in this  regard were aimed squarely at you.

I was speaking to you on this Graham not everybody else.

Your endocrinologist has said that you have no problem, yet you do have some symptoms of hypogonadism coupled with that low normal level.  For that reason I was simply saying he could be right, but he could be wrong, maybe get a second opinion.

And for this you shot the messenger and continue to stick your head in the sand.

Ok, that's your prerogative. But I champion informed choices Graham so I tried to help.

P.S



Do you know what your testosterone level actually was?  Do you know whether they tested for free or serum testosterone?  Do you know what your SHBG level was? or even if it was tested for?  Do you known what your estradiol level was?  Do you know what your LH level was?  Do you know what your Prolactin level was?  And for all of the above do you know what the lab reference ranges were?

Do you even have a copy of the pathology result detailing this information?

Or have you taken one opinion and just said that will do me.

A lot of people do that.  Most of the time that opinion is good and they have nothing to concern themselves with.  However you are aware that there is such a thing as a second opinion and you would think that given everything discussed you might have wanted to have obtained one but you don't so that is that.  Perhaps you'll be ok and perhaps you wont.  I hope it is the former.  I hope that the bizarre mind control stuff that you mentioned will control your gynecomastia, because with the endocrinology possibly being ambiguous an operation might not be successful and the gynecomastia could return.

[hypo]

If you are from the UK please view this site and you might see the problem at the moment.

You see the UK is about 6 years behind the United States when it comes to the treatment of hypogonadism and many, many people in the UK are being told they have no problem, when in fact they exhibit all the symptoms of hypogonadism.

Many of these people would in fact be diagnosed and treated for hypogonadism if they lived in the United States.  

It has been argued that the UK position on hypogonadism is due to the funding based restrictions of the NHS.

http://www.androids.org.uk/index.html

[hypo]

Graham,

You are trying to turn this into an argument over semantics and you have ignored almost every single vitally important point I have raised.

You are not helping here whatsoever, in fact you are doing quite the reverse because you are spreading ignorance with honey coated words and clouding the information that I have made available.

Quote
If you think you are helping everyone here, then by all means continue. You probably are to a certain extent. Personally, I feel you are at the same time, fuelling paranoia and casting a shadow of doubt on the trust people place in their physicians.
Unqoute

I am helping by my own definitions.  I have helped to get people with hormone problems diagnosed.  If that isn't helping I don't know what is.  I am also championing the need for pathology investigations for all gynecomastia sufferers to rule out health issues that are clearly associated with its aetiology, if you think that is not helping then I strongly disagree.  

I happen to think it is and when you are gone, I will be still here, putting in the time and the effort to help people and even putting in the time to argue against ignorance of the issues at hand, just like I am here with yourself.

Quote
How do we know an endochrinologist is doing his job or not? If he finds something wrong? Is that it? Why stop at a 2nd opinion? Why not get a third?  
unquote

My comments were directed squarely at you Graham, not everyone, you know this, because I told you as much in the last post.  So cut the semantics.  I stated that you might want to get a second opinion because I suspect that by US standards you might have hypogonadism.  This is not the issue you are trying to make of it.  I was polite in suggesting this course of action and you can of course decide to reject that advice.  You are shooting the messenger over and over again, when perhaps you should be pulling your head out of the sand.

Quote
I tried being a smart a*s myself with my doctors by telling them what I thought was wrong with me and 'educating' them on technical details I had read or what other doctors had told me. Most of the time, they didn't like it and I spent needless days (months even) worrying about something I actually didn't have.
unquote

I cannot comment on what you did Graham.  I can however tell you again what they AACE states for a third time in the hope it will hit home

The recognition, evaluation, and treatment of Hypogonadism in the male patient are often dismissed by the patient and overlooked by the physician  
unquote

Notice the end of that quote, often overlooked by the physician.  That is why I champion hormone pathology with an endocrinologist.

Perhaps you are one of the patients with hypogonadism that is speaks of in dismissing the condition?  Perhaps you are not and you don’t have hypogoandism.  Either way I am championing information rather than a lack of it.  

"being a smart a*se", nice language Graham.

Which by its very implication I infer that you mean "smart a*se" to be second guessing, paranoid and delusional or at the very least negative.  I can tell you that I am not paranoid, delusional or negative, I can also tell you that me "being a smart a*se" as you succinctly put it lead to my diagnosis and has probably stooped my spine from collapsing.  

There is a world of difference between being paranoid and delusional and thinking you can second guess every doctor and simply raising real issues with your doctor and if unhappy getting a second opinion.  Without patients ever raising their problems they are rarely sorted out.  On this note I quote Professor John Wass M.D endocrinologist from Oxford University "patients that  complain the most tend to survive the longest".
 
Also raising awareness of a very real condition and championing its cause is not in my opinion being your derogatory termed "smart a*se".

Quote
Don't try to judge me by thinking I take my health lightly just because I'm not flipping over hypogonadism.
Unquote

Really, well lets have a look at just two of your quotes that spring to mind

Referring to going to see you endocrinologist you said quote
Maybe when I'm in the mood to see him again, I'll have him look into it.  
Unquote

Yea Graham get round to it in your own good time, I mean that isn’t flippant and this statement isn’t sarcastic either is it:)

Second quote referring to hypogonadism

I'll tell you there are worse things out there

Well Graham I see that as flippant.  Who are you aiming your question at?

Are you telling ME, there are worse things out there, bare in mind it has caused my osteoporosis at the age of thirty?  

Perhaps I can introduce you to friends I know who have heart problems as a result, are you going to tell them it isn’t so bad that they went undiagnosed and untreated?  How about a friend of mine whose spinal column collapsed because of a lack of diagnosis?

Or is your question, as I suspect directed at nothing other than your thin air, your own misguided ideas as to what hypogonadism actually is as opposed to the realities?  

What about the people who have died due to the long term effects, were there worse things out there for them?

I should also tell you that I have had cancer twice and this ranks right up there in terms of how bad it is when untreated.  That is my long term experience, but tell me how you know better- I await with baited breath?  

Quote
I'll tell you there are worse things out there. And for the record, I don't plan to have surgery to remove my gyno. You can mock my mind control methods all you want but I believe the problem is at least 50% in my mind and if I can cure that much, it's more comforting than the expensive and depressing "maybes" I get from doctors.
Unquote

Graham you become more believable by the second.  Yes we should listen to you because you believe mind control can resolve gynecomastia.

Quote
In case you don't realize this; getting treatment for hypogonadism doesn't mean you're out of the woods as far as other equally ominous diseases are concerned.
Unquote

Thank you for the not so kind words.  Yes of course that is true but it is equally true that my statistical likelihood of developing many of them will be significantly reduced.  Stopping smoking doesn’t ensure that someone wont go on to develop lung cancer, but it certainly has a major impact on reducing the odds.  Your logic is akin to telling a smoker that they might as well carry on smoking because stopping wont necessarily prevent them from contracting lung cancer or heart disease.

Quote
And as far as I'm concerned, 9/10 gyno patients DON'T have hypogonadism and I hope I don't either. However, I can always find an endochrinologist who will tell me that I do, get 'treatment' and possibly screw up my body further.
unquote

Yes 9/10 people do not have hypogonadism.  Another way to put that is 10/100 do have hypogonadism.  That is a significant minority of people, worth addressing whether you realize it or not, a reason in many respects as to why I am here.  

Statistics are very useful in many ways in others they are not. On the personal front, it is all very well saying 9/10 do not have it as you do, but what if it is you?  Would you care one iota then about the fact that statistically the odds are not high, or would you be glad to see the information I have provided given that you could get diagnosed and treated and live a better longer life?  

You say something very interesting after that shows that I am 100% right about the fact that you are sticking your head in the sand and shooting the messenger.

You said quote 9/10 gyno patients DON'T have hypogonadism and I hope I don't either.

Why bring hope into it when you could get a second opinion and know if you have a problem or not?

Not to say you even do, just maybe, but your take on things is just all wrong.

quote
I hope the treatment YOU are getting is the right treatment and it actually helps you. Again, don't assume just because YOU were correctly diagnosed and are benefitting from your treatment, it will work out for everyone else. It could just as well be that we (or I) could be misdiagnosed and suffer from the consequences of increased testosterone due to the treatment.
Unquote

I have gone to the trouble of learning about the condition, studying it and seeking a number of opinions of expert on the matter from the US to Europe, Australia and beyond and I have had multiple opinions and pathology investigations into my own situation from differing endocrinologists.  I have made no assumptions.  To Assume is to make an a*s out of you and me, I don’t go in for assumptions.  Also I should state that the consequences of treatment are not something that we should be getting into because quite frankly you have no idea about the matter in hand.

quote
In all fairness, I have no argument with you. You just don't like my comments and I don't like yours. As far as everyone else is concerned, I'm sure they can decide what's best for themselves.  
Unquote

But you do have an argument with me hence the debate which you are ill equipped to be involved in.  I don’t like your comments because you make assumptions, you do not know anything about the matters involved, you are flippant with respect to your own health and the health of others and you promote ignorance by arguing against what I have been trying to achieve in terms of the promotion of awareness and pathology testing by endocrinologists.

Debate over from my point of view unless you wish to ask me anything constructive that can help you (although I suspect that you wont want to do that having snuffed out this debate), as I do not wish to forward this.  Doing that would just turn this whole thread into semantics and cloud the good work that has been done in it.

P.S

Take my advice or don’t the choice is yours.  This is one thread on a large site and people can read it and decide for themselves how important my information is.

[hypo]

Semantics Graham.  Nothing more nothing less.

Your not capable of answering any of the very serious points that I have raised in any of my correspondance with you and you have no understanding whatsoever of hypogonadism, its association with gynecomastia or in fact any of the endocrinology involved in any of this.

Like I said I wiil be here helping people and putting in the time and effort long after your gone.

Given you are not helping on this subject perhaps you would like to make yourself useful elsewhere on the site, because you are not helping here.

[hypo]

I have provided information, cold hard facts about gynecomstia and hypogonadism that can empower people.  You have the opinion that the information I have provided is scare tactics or misguided of me.  I have the opinion that you are the misguided one given your ignorance (in the dictionary literal sense, no offence intended) on the issues at hand and believe you are therefore incapable of seriously debating this topic.  You said yourself that your understanding of hypogonadism was poor, which makes the whole debate somewhat redundant.  

You articulate yourself very well which is why I think you thought you'd get involved in the way you have, but words without knowledge only get you so far.

The test that I provided for you, the one you mocked was actually created by one of the worlds leading endocrinologists who has specialised in this subject for 20 years.  

I think that was typical of the nature of our discourse.

Still, you have made your opinions clear and known and no doubt people will read them and give them there due weight and attention.

quote
I'll just leave you to your noble task
unquote

The tone is mocking Graham, but I do see the raising of awareness of this condition as noble.  What can be nobler than helping people for no other reason than it is the right thing to do?  I am not noble at all, but what I am trying to do certainly is.

quote
I just hope that at the end of the day, you've done more good than harm
unquote

This is dark foreboding language Graham.  As I said you are articulate and very good at building up a certain impression with your colorful use of language.  

But let’s look at what I am really doing.  

I am detailing the symptoms of an under diagnosed condition that is associated with gynecomastia as stated by the American Association of Clinical Endocrinologists and raising awareness of it.  

I am promoting the referral of people with gynecomastia to endocrinologists, given that gynecomastia is the result of a hormone imbalance whether that is temporary or underlying one and endocrinologists are hormone specialists.

I am promoting pathology investigations to ensure that people are in good health and can make informed decisions about their health; in particular the information lets people know whether or not they can proceed with a surgical procedure or whether they need to medicate an underlying problem first.

No doubt the thought of having to see an endocrinologist and giving blood bothers some people and may even scare them, that is the nature of some individuals.  But it does not make what I am promoting wrong or mean I am giving bad advice.

If I have taken some of the things you have said personally, it is because I am human and not a robot.  I am passionate about helping people and some of the things you have said have been akin to recommending smoking to a cancer support group.

P.S

No matter how much I have disliked what you have had to say, the one thing I do wish you is good health and I mean that with all sincerity- not lip service.

If you are in the UK please view this site again and make an informed decision as to whether or not you want to ever get that second opinion.  

http://www.androids.org.uk/index.html

You may say I am belligerent for mentioning this again, but you have to be in trying to promote awareness, taking the knocks comes with the territory.

You can contact the editor of the site and ask him any question you should wish.  He has had hypogonadism for 15 years and has experienced treatment in the US, Canada and the UK.  You may not have hypogonadism at all, but knowledge is power and it is better to know one way or the other, as opposed to being unsure.

   
 

[Gine2D]

Hypo;

I wish I could say all that.  But it is what I feel, know, believe, & but can not express in words.

Hypogonadism can be treated.  Hormone imbalance can be corrected.  Men do survive - thrive with gynecomastia & without surgery.

Treating a physical symptom does not cure something, the underlying cause has to be corrected first.


G

[John101]

Just adding a line of support for Hypo.

We should be very thankful for having such a knowledgeable person writing on this forum.

I personally am.