My Hormone test Results (please read)

[ddaavviiddd]

quit chocking the chicken  so  much

[hungry.tides]

Hi Hypo-is-here,

what do u mean by this:

It is worth requesting a copy of your pathology results and reference ranges as you have correctly done so in the past. 

[Hypo-is-here]

You are going to see this endocrinologist; he will perform pathology and other tests.  When the endocrinologist gets the results of your tests you should request a paper copy of your results and the reference ranges for those results so you can view them at your leisure.  You obtained a paper copy or at least noted down your last set of results and reference ranges- just do the same thing as it is very useful.

[hungry.tides]

just do the same thing as it is very useful.

yes Hypo-is-here, i will do that, will let u know tommorrow how it all went

Ciao

[hungry.tides]

hey sorry for delay in my post,
I went to Dr Anand, First he asked me show me gynecomastia, then saw all the reports, He said your estradiol and prolactin are very near the max range, but the testosterone level is fine, He talked about receptors malfunctioning, He said even though the testosterone is produced well, but that alone is not sufficient, sometimes testosterone is converted to estradiol, that means receptors are not working well, He asked me to excercise, so that the fat is converted to muscle, asked me to eat more protein, also said that being Vegetarian is also a problem. he said dont go for surgery at all.

i have heard this excercise thing for such a long that i dont believe it works, have been let down with this discussion with Endo. My parents on the other had are asking me to go for surgery. I dont know what to do. I dont want this to come back after surgery.....

Can any one help me!!!!!

[Hypo-is-here]

If you can post your results and reference ranges I can view them alongside your prior results and look into your situation a little more with you.  I am not saying I can definitely help, but I might be able to.  I could for instance put together something of a case for your situation if it is warrented for another endocrinologist to view.  I can promise to try to help if that is what you want.  It would start with looking at your latest results.

[tony_ss]

Hi hungry.tides, if you could you post some pics, it will help ... but only if at all u want an opinion from others.. bcoz we don't know how severe your condition is. if it is a mild case, (good) doctors usually don't suggest surgery.. as it is a pain to go through.. but if u r below 25, and it is bothering u too much or if ppl are teasing u, then it will make sense to go for surgery.. .. don't make rash decisions.
Good luck,
Tony.

[hungry.tides]

quote]It would start with looking at your latest results.
[/quote]

I didnt take any new tests, the Endo no 2 suggested that excercise and convert your fat into muscle.

Now what, I'm again posting my results of Endo1 here:

Test          Result          Normal-Range
--------------------------------------
prolactin     18.61          (4.04-15.2) ------------->was rechecked to
                 16.2               

TSH            1.34            (0.49 - 4.67)

testosteron  507.7       (280 - 800)

estradiol      42.57        (7.63 - 42.6)---> its within the range

I had scrotal doppler and ultrasound, both were fine...

[Hypo-is-here]

hungry.tides,

I think you need to see another endocrinologist.  I just don't accept the explanations that have been handed to you.

A) The elevated prolactin level should be investigated with an MRI or CT scan, there is simply no excuse for not looking into this.

B) Given the gynecomastia and elevated estradiol, total testosterone alone is not sufficient in order to assess androgen status.  You require a free testosterone test or failing that a Calculated free Testosterone (CT) and that itself means you need SHBG to be tested.  It is simply diagnostically NOT useful to test testosterone without looking at SHBG and without having at least a calculated free testosterone level.

C) You should have LH tested to see if anything amiss is being indicated on a pituitary level, so far you have not had this tested.  Along with the above this is standard practice and there is not excuse for this not being tested.

D) Irrespective of anything turning up on an MRI or CT scan, or there being any problem with free testosterone, it could still be worthwhile having prolactin and estradiol lowered, particularly if you are looking towards a surgical removal of the gynecomastia.


Irrespective of the merits of the last point- it is not acceptable to not properly evaluate your situation in the manner that I have detailed as this is simply good standard practice.

There is nothing wrong with trying to adopt a healthier lifestyle, particularly so if you are carrying excess weight and certainly excess weight can cause pseudogynecomastia and elevate estradiol somewhat and in some men even cause some glandular gynecomastia.  

However!!

A) Exercise will not resolve glandular gynecomastia- It just wont.

B) It is worth noting that elevated estradiol levels actually help prevent weight loss, it literally helps you put on excess weight and it reduces both the effectiveness of testosterone and the actual amount of testosterone produced.  Also elevated prolactin also helps to reduce testosterone.  And testosterone actually help the body to burn fat and put on and retain muscle mass.

So excess weight can cause a type of gynecomastia and it can to a certain degree cause hormonal issues, but it is a chicken and egg scenario because hormonal problems cause gynecomastia and can often result in excess weight. 

That is why it is very important for men with gynecomastia to have a full endocrine evaluation, and this is irrespective of whether they are or are not carrying a little extra weight- because it is not possible to know what came first.

hungry.tides,

You need a competent endocrinologist- to my mind the doctor you saw was not competent, at least not in this instance.


All I can say is check out some of the doctors in the list I gave you and hopefully next time you will get a more competent evaluation…certainly I hope you do.

[hungry.tides]

I think you need to see another endocrinologist.

Yes i will, but the thing is i was almost ready for surgery, i started dreaming of living free, my first endo said go ahead, and now it came all crashing down...

I will have to look for another Endo.... Meanwhile i shud start taking protein rich diet, also excecise (easier said than done)

the next i call up an endo for appointment i will ask if he has a history of dealing with GYne.
Hypo you have been a great help.... thanx alot

Ciao

[Hypo-is-here]

hungry.tides,

I can understand your frustration about the surgery. 

The issue is that although you could have the surgery and the gynecomastia might not return with that pathology it is also very possible that it would.  That is why I think you would be far better having a full competant assesment first....ultimately it is your call and I wish you the best whatever you choose to do, I just wouldn't want you to end up with it re-developing post surgery.

If you get an endocrinologist who has a lot of experience in dealing with men who have gynecomastia and hypogonadism, you will have more chance of getting a proper evaluation.  You could ask questions of endocrinologists (list I gave you) even if it is via a secretary prior to making an appointment.  You could then simply pick the endocrinologist that seemed to best answer your questions and seemed most appropriate.

The sooner this can be checked out properly and if need be treated the sooner you can get surgery.

I wish this was more straightforward for you..



 

[hungry.tides]

Hi Hypo-is-here

I have been to an Andrologist,(Dr S S Vasan, Andrologist, NU Trust & Diacon Institute of Neurology & Andrology)

He was of the opinion that my gynecomastia is not beacause of harmonal problem. he said that if harmones were the problem then my other features would also have been effected (my moustache, beard) He saID SURGERY is the only option. He has even though asked me to get some tests done, they are:
Recheck of Prolactin & Estrogen, Semen Count

He wants to confirm that my sperms have ability to fertilize (OMG what am i getting into !!! )

So on one count this meeting has been good in one sense that i can go for surgery without a fear of recurrence of Gyne(Very little chance)
But then why all these tests again

One very important thing Dr Vasan said is that one you remove the glad there is no chance it can  come back....

So what is ur take Hypo?

- Ciao

[Hypo-is-here]

Hi Hypo-is-here
He was of the opinion that my gynecomastia is not beacause of harmonal problem. he said that if harmones were the problem then my other features would also have been effected (my moustache, beard)

Many men who have hormone imbalances do not have a problem with beard growth or have other physical features.  This is particularly true if the hormone condition is post puberty in origin and relates to SHBG, estradiol, prolactin etc.

 

He saID SURGERY is the only option. He has even though asked me to get some tests done, they are:
Recheck of Prolactin & Estrogen, Semen Count

If your prolactin is high on a second test he should book you an MRI or CT scan.   There is absolutely no excuse not to.  Your prolactin is above the normal range- what on earth does he think a prolactin level is if it is not normal?   If it isn’t normal then it must be abnormal and that means it needs further evaluation.

As for checking your semen level, he is losing the plot an indulging in investigations for his own interest.  Semen has absolutely nothing to do with gynecomastia, the likelihood of re-development or anything that would concern us in this regard..

Surgery certainly is NOT the only option given your situation, it may however be the only thing that he is willing to help you obtain. 

So on one count this meeting has been good in one sense that i can go for surgery without a fear of recurrence of Gyne(Very little chance)
But then why all these tests again

I hope if you do have surgery that it does not return- but I do not concur with him.  I think that elevated prolactin and estradiol could still be a problem.

One very important thing Dr Vasan said is that one you remove the glad there is no chance it can  come back....
 

Absolutely and utterly wrong.

A)   No surgeon will be able to be sure that they have removed all the glandular tissue,
 
B)   Most surgeons will not want to try and remove all the glandular tissue as to do so would often cause deformation of the chest. 

What happens is you have a certain amount of glandular mass removed via excision so that the chest looks natural.  Any tissue that is left behind can be acted upon by your hormones if they are not correctly balanced.

For this reason gynecomastia can re-develop in men post surgery if their hormones are not correctly balanced.


You absolutely need an MRI if that prolactin is above the normal range.  Your estardiol is also right at the top of the normal range and something that could very well be problematic.  A good andrologist in the US would be willing to medicate both that prolactin level and that estradiol level to try and ensure that gynecomastia does not re-develop post surgery.  It looks like you will just have to cross your fingers and take your chances with surgery.

[hungry.tides]

Hi Hypo,

what do i do now

1) this doc didnt talk anything abt Higher Prolactin levels
2) he asks me to go for semen count- which i clearly dont need- does he mean that i cud be impotent...

If your prolactin is high on a second test he should book you an MRI or CT scan.   There is absolutely no excuse not to.  Your prolactin is above the normal range- what on earth does he think a prolactin level is if it is not normal?   If it isn’t normal then it must be abnormal and that means it needs further evaluation

I'm contemplating going for a CT scan and MRI. But i dont have the exact tests that i shud go for.
Hypo-is-here  : can u let me know exact names of the tests.
Also do u suggest i go for 4rth opinion from an endo or a Andrologist?

Also i wud like to tell u that i have a problem in urinating, Tht is when im alone i do it peacefully, with out much delay, but when the urinal is crowded then i find it difficult to urinate. Is it because of any psychologial problem? I forgot to ask doctor yesterday.....

Ciao

[hungry.tides]

I have found this link http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/prolactin.html

at the bottom it says:

Common manifestations of hyperprolactinemia in women include amenorrhea (lack of menstrural cycles) and galactorrhea (excessive or spontaneous secretion of milk). Men with hyperprolactinemia typically show hypogonadism, with decreased sex drive, decreased sperm production and impotence. Such men also often show breast enlargement (gynecomastia), but very rarely produce milk.


so i think Dr Vasan was targetting the Sperm Count test because of the above reason.
what do u say Hypo?