Quesition for Dr Bermant (endocrinology)

[MisterPeepers]

Dr. Bermant, I have a consultation with you in a few weeks, but want to know if I should see an indocrinologist first to rule out hormune induced gyno. Also do I go to a general one or one of the specific specialty indocriniologists, thanks..

I am 24, 170 lb, fit. Got a little chubby at age 13 (was only chubby for a year or two) and also developed puffy nipsat that time, and its been there since. It has gotten slightly better over time (probably less fat), but the glands there havent really changed in size at all. It is mostly gland and just a tad bit of fat in front of the glands.

[MisterPeepers]

BTW i do not currently have insurance so it would be out of pocket. Is this test expensive 

[Hypo-is-here]

If you are not bothered about the potential risk of gynecomastia returning post surgery and wasting thousands of dollars, time and pain- then forget the endocrine testing.

If you want to stay gynecomastia free, correctly diagnose any potential causative condition and look out for your own health in a proper and diligent manner then you ensure that you vistit an endocrinologist before surgery irrespective of cost.

It's your call..

[DrBermant]

Dr. Bermant, I have a consultation with you in a few weeks, but want to know if I should see an indocrinologist first to rule out hormune induced gyno. Also do I go to a general one or one of the specific specialty indocriniologists, thanks..

I am 24, 170 lb, fit. Got a little chubby at age 13 (was only chubby for a year or two) and also developed puffy nipsat that time, and its been there since. It has gotten slightly better over time (probably less fat), but the glands there havent really changed in size at all. It is mostly gland and just a tad bit of fat in front of the glands.

I prefer to individually evaluate each patient before making a recommendation about other testing.  Gynecomastia by itself is not sufficient to warrant an endocrinology evaluation.  Considering that over 60% of the male population has gynecomastia to one degree or another, forcing all into testing just does not make sense.  I am sure if we did total body CAT scans of every person every let us say 10 years, we would be picking up all sorts of disease that has gone missing.  But who is going to pay for this testing?  Why not increase this testing to every year?  No, clinical judgment is a very powerful tool when put to use by good physicians licensed to practice medicine.

My plastic surgery practice brings me patients from around the world giving me a very nice exposure to a wide range of Endocrinologists.  My lectures about gynecomastia also gives me the opportunity to discuss this condition with many Endocrinologists specializing in the treatment of gynecomastia.  I have been speaking with Endocrinologists about gynecomastia for over 30 years.  Almost all have told me that good screening by history and physical examination is the standard of care for a gynecomastia patient considering surgery. I recently polled 15 Endocrinologists on this matter.  14 out of the 15 said that automatic endocrinology referrals for gynecomastia patients was not warranted.  A number of Endocrinologists specializing in the treatment of gynecomastia helped me set up a series of red flags for evaluation instead of automatically sending each gynecomastia patient for testing.  For some, an endocrinology evaluation helps set their mind at ease and is a great idea.  For others I mandate the endocrinology consultation before surgery because of my findings during my evaluation of the patient.

Negative endocrinology evaluations do not prevent breast regrowth.   I have seen one patient who had 3 prior operations by other doctors for gynecomastia.  The patient brought a nicely documented series of images showing breast regrowth after each surgery.  The amount of tissue removed on each operation was substantial, so I doubted it was a case of inadequate removal.  I sent that patient for an Endocrinologist evaluation which came back negative.  After talking with his endocrinologist, further endocrinologists were consulted and further testing was done.  These tests were negative.  There was quite a bit of money spent on these endocrinology evaluations, yet no cause was found.  Of the large number of gynecomastia patients I have sent for Endocrinology evaluations, only a few have ever come back with an actual condition that needed treatment before surgery.

Cost for testing varies on the problems found.  We are glad to help our patients explore their concerns during their consultations.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[Grandpa Bambu]

"Gynecomastia by itself is not sufficient to warrant an endocrinology evaluation".

"I have been speaking with Endocrinologists about gynecomastia for over 30 years.  Almost all have told me that good screening by history and physical examination is the standard of care for a gynecomastia patient considering surgery. I recently polled 15 Endocrinologists on this matter.  14 out of the 15 said that automatic endocrinology referrals for gynecomastia patients was not warranted.  A number of Endocrinologists specializing in the treatment of gynecomastia helped me set up a series of red flags for evaluation instead of automatically sending each gynecomastia patient for testing.  For some, an endocrinology evaluation helps set their mind at ease and is a great idea.  For others I mandate the endocrinology consultation before surgery because of my findings during my evaluation of the patient."

So.... the preaching of 'Go see an Endocrinologist first' is redundent then?

GB

[DrBermant]

"Gynecomastia by itself is not sufficient to warrant an endocrinology evaluation".

"I have been speaking with Endocrinologists about gynecomastia for over 30 years.  Almost all have told me that good screening by history and physical examination is the standard of care for a gynecomastia patient considering surgery. I recently polled 15 Endocrinologists on this matter.  14 out of the 15 said that automatic endocrinology referrals for gynecomastia patients was not warranted.  A number of Endocrinologists specializing in the treatment of gynecomastia helped me set up a series of red flags for evaluation instead of automatically sending each gynecomastia patient for testing.  For some, an endocrinology evaluation helps set their mind at ease and is a great idea.  For others I mandate the endocrinology consultation before surgery because of my findings during my evaluation of the patient."

So.... the preaching of 'Go see an Endocrinologist first' is redundent then?

GB

If you mean by preaching, one solution fits all, then no.  I know of no medical authority that will recommend that everyone with gynecomastia see an endocrinologist.  Just image the number of evaluations that would bring for all the teenagers with the problem or aging men with sagging chests with gland components.

However, if you mean should all patients with

tender breasts, breasts that are still growing, nipple discharge, small testicle size, abnormal body fat distribution, abnormal hair distribution, or other red flags that we have evolved over the years

get an endocrinology evaluation before surgery, the answer is definitely YES!  At least I advise my patients that they will need that evaluation before I can continue to help them with surgery.  Have I seen patients with recurrences from other doctors' surgery that I would not have done until an endocrinology evaluation?  Yes, and when I sent them for that evaluation and was able to help stabilize the underlying problem, my revision surgery had a much better chance of not recurring.

Good doctors try to solve problems.  Competent pediatricians, family practice doctors, internists, and surgeons all should be able to examine a patient and determine which ones need further evaluations. Some patients under the care of an endocrinologist have been referred by their endocrinologist to specialist endocrinologists for unusual problems.  Clinical judgment is the key.  I see many patients for evaluations that I do not recommend surgery until their problem has been stabilized.  Patience can be very important.

My frustration in watching patients trying to deal with stabilization before surgery (i.e. losing weight or endocrine stabilization) led me to develope the section on my website:

Non-Surgical Body Shaping

and it has been very rewarding watching the emotion of those realizing they can put the emotional band-aide of a garment on what getting the original problem stabilized before surgery.


Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[Grandpa Bambu]

If you mean by preaching, one solution fits all, then no.  I know of no medical authority that will recommend that everyone with gynecomastia see an endocrinologist.  Just image the number of evaluations that would bring for all the teenagers with the problem or aging men with sagging chests with gland components.

However, if you mean should all patients with tender breasts, breasts that are still growing, nipple discharge, small testicle size, abnormal body fat distribution, abnormal hair distribution, or other red flags that we have evolved over the years get an endocrinology evaluation before surgery, the answer is definitely YES!

I have small testicles, have some feminine body characteristics and gain fat tissue in the areas that most women do, thighs, butt and trunk. Also, prior to my GRS, I had huge 'D' cup breasts. I have seen several different GP's over the years and not one of them mentioned to me that I should have Endocrinology testing. It disappoints me that having tiny testicles and the 'D' cup m(o)(o)bs, not one of my GP's bothered to investigate my 'Red Flags'.   

So what you are saying is that the gynecomastic victim is relying on his GP and/or PS prior to GRS , to make the decision on Endo testing? As I mentioned above, none of my GP's took interest. My PS did not indicate that there may be an underlaying problem for my gynecomastia and that Endo testing was an option. I was very new to this Site when I had my GRS and was unaware of Endocrinology testing.

GB

[Grandpa Bambu]

Dr. Bermant....

I had to remove your post with the link to the Klinefelter patient video. I must have clicked on 'Modify' rather than 'Quote' and messed it all up.  So I had to trash it altogether. Sorry dude....

Did you say in that post that if the condition is corrected, the patients thought process would be greatly improved? Or did I misinterpret what you were meaning?

The video audio is very difficult to listen to. The Klinefelter patient's voice is very low and there is a somewhat loud humming in the background.   

Having very small testicles, am I a candidate for Testosterone shots? What health improvements would be attained with testosterone shots/meds?

GB

[DrBermant]

If you mean by preaching, one solution fits all, then no.  I know of no medical authority that will recommend that everyone with gynecomastia see an endocrinologist.  Just image the number of evaluations that would bring for all the teenagers with the problem or aging men with sagging chests with gland components.

However, if you mean should all patients with tender breasts, breasts that are still growing, nipple discharge, small testicle size, abnormal body fat distribution, abnormal hair distribution, or other red flags that we have evolved over the years get an endocrinology evaluation before surgery, the answer is definitely YES!

I have small testicles, have some feminine body characteristics and gain fat tissue in the areas that most women do, thighs, butt and trunk. Also, prior to my GRS, I had huge 'D' cup breasts. I have seen several different GP's over the years and not one of them mentioned to me that I should have Endocrinology testing. It disappoints me that having tiny testicles and the 'D' cup m(o)(o)bs, not one of my GP's bothered to investigate my 'Red Flags'.   

So what you are saying is that the gynecomastic victim is relying on his GP and/or PS prior to GRS , to make the decision on Endo testing? As I mentioned above, none of my GP's took interest. My PS did not indicate that there may be an underlaying problem for my gynecomastia and that Endo testing was an option. I was very new to this Site when I had my GRS and was unaware of Endocrinology testing.

GB

There are good doctors and there are others that just are not as good.  Not all doctors have the same skills.  I have seen many patients who have red flags of endocrine problems that have been ignored by other doctors.  With these Red Flags , I stop a consultation or preliminary remote discussion for an endocrinology evaluation. 

Here is a Klinefelter Syndrome patient who had many doctors miss the diagnosis.. Listen to the video and the emotion behind his missed diagnosis.  This patient used the Internet and friends and eventually got doctors to perform the appropriate evaluations.  That the diagnosis had to wait so long is really a tragedy.  Without Testosterone, a Klinefelter patient has, among other things, a hindered thought process.  When the testosterone, it is like a switch turning on in the brain.  Something rather remarkable when you hear patients who experience the effects of getting a normal level of this important hormone.

Dr. Bermant....

I had to remove your post with the link to the Klinefelter patient video. I must have clicked on 'Modify' rather than 'Quote' and messed it all up.  So I had to trash it altogether. Sorry dude....

Did you say in that post that if the condition is corrected, the patients thought process would be greatly improved? Or did I misinterpret what you were meaning?

Yes, it is rather remarkable how Testosterone can turn on parts of the brain on those suffering from low levels.  Many described the experience as a "switch being turned on," or "wires getting connected."  I have on tape such revelations of patients talking about how they had different perspective reading, watching movies, talking with others, listening to music, and just walking outdoors.  There was some variation on the individual experience, but there was great commonality.

The video audio is very difficult to listen to. The Klinefelter patient's voice is very low and there is a somewhat loud humming in the background.   

Sorry, the interview was done during a National Klinefelter meeting and I did not get to choose the room we were able to get to document these patients' stories.  A nasty ballast transformer made the recording a mess.  However, the emotion was so powerful, I felt it was worth keeping and sharing.

Having very small testicles, am I a candidate for Testosterone shots? What health improvements would be attained with testosterone shots/meds?

GB

The purpose of the Red Flags is for when I stop and get an endocrinologist involved.  That is who patients considering problems of possible low Testosterone need to go for an evaluation.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture