Do I have to see an endocrinologist first or can I just go to Surgeon?

[charlie1821]

I have gynecomastia with lactation, not a joke. It's something I've had for a few years now and have been wearing compression vests to deal with. Obviously there is something wrong with my hormone levels, but do I really need to see an endocrinologist first? I don't really want to take testosterone or any other hormonal injections, because other than the gynecomastia and lack of a lot of facial hair, everything is fine.

For insurance purposes can the surgeon deem it a necessary surgery or do I need an endocrinologist for that?

I'm also looking at Bermant's office since he's closest to me (D.C.).

Thanks for any responses.

[Dr. Elliot Jacobs]

For most gyne that is stable and has been present for many years, I generally do not require an endo evaluation.  In your case, the presence of lactation should be investigated and evaluated by an endo.  There are circumstances in which a prolactinoma can be present and treatment can be in the form of a medication.

Dr Jacobs

[charlie1821]

Thanks for the prompt response Dr. Jacobs.  I've have large amounts of gland tissue which I can feel, and have had gynecomastia without lactation since I was 15, it wasn't until I was in college that lactation occured and the glands became increasing apparent. I'm 25 now.

Wouldn't removing the glands surgically negate the need for hormonal treatment since once they're removed they do not grow back?

Unless hormones also contribute to fat being stored in the chest and exercise wouldn't be enough to keep the fat away from my chest. I'm concerned about emotional changes coming from medication.

Basically I'm just really confused as to how to get from where I am now, to surgery and what to do.

[Grandpa Bambu]

Basically I'm just really confused as to how to get from where I am now, to surgery and what to do.

As Dr. Jacobs mentioned, see an Endo for the lactation issue.

Other than that, you have had your G for 10 years now and the chances of it clearing up on its own is slim-to-none. So... do some research on a few PS's. You say Dr. Bermant is closest to you.... see him first and if you get a good vibe from him, he's the man. He's one of the best PS's for Gynecomastic Correction in the US.

So... see an Endo, consult with Dr. Bermant, get surgery, recover, and be free!!! 

GB

[charlie1821]

Thanks a lot guys!

I've felt so lost for a while.

[Dr. Elliot Jacobs]

I am concerned that you had quiet gyne for a while, and then later it enlarged and you started to lactate.  That is a change that is worth investigating.  There are simple blood tests for prolactin levels -- do it!!

Surgical removal of gland is no guarantee that breast tissue would not re-grow if you have continued stimulation by out of whack hormones.  Remember, surgical removal is never complete -- there is always some amount of breast tissue left -- and it is that residual breast tissue which could begin to re-grow if hormonal stimulation were to continue.  If your homone levels check out fine, then go for surgery!

Best advice:  check it out before considering surgery.

Dr Jacobs

[DrBermant]

I have gynecomastia with lactation, not a joke. It's something I've had for a few years now and have been wearing compression vests to deal with. Obviously there is something wrong with my hormone levels, but do I really need to see an endocrinologist first? I don't really want to take testosterone or any other hormonal injections, because other than the gynecomastia and lack of a lot of facial hair, everything is fine.

For insurance purposes can the surgeon deem it a necessary surgery or do I need an endocrinologist for that?

I'm also looking at Bermant's office since he's closest to me (D.C.).

Thanks for any responses.

With the help of endocrinologists over the years, I have evolved a Red Flag system of Gynecomastia Symptoms.  This methodology was recieved well during my invited Gynecomastia lecture at the last American Association Of Clinical Endocrinologists national meeting.

There are many possible Causes of Gynecomastia that can cause male lactation that I have seen over the years  Male Nipple Discharge such as lactation, is a major red flag that should be evaluated by an endocrinologist first.  Endocrine treatment depends on the problem to be treated.

I prefer to sculpt a stable problem whenever possible before surgery.  That is how I am able to help my patients keeping risk of recurrence so low.

However, not all patients who thought they had "lactation" actually had problems.  Some actually were squeezing their nipples so hard that normal tissue fluid was coming out from the trauma.  We see many patients from DC and around the world who prefer my techniques and are glad to help explore your concerns.  Some patients start with our office first and have us work with a local endocrinologist.  Jane is my office manager and can explain the process.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.
 
Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[charlie1821]

Sounds like we have to see an endo to get hormone pills/injections in order to prevent reoccurence of gyne.

[Dr. Elliot Jacobs]

No, I do not operate on teens with actively growing gyne.  I only operate on them if their gyne has been stable for about two years.

Dr Jacobs

[headheldhigh01]

the drs can address whether it always happens and how it affects women by comparison, it's an interesting subject, but the fact that it's much more likely to happen is why their advice is sound.  your symptoms more than normally indicate an underlying issue that an endo would be qualified to look into.  there is always some residual tissue, even if it's minimal, so you don't want it acting up, and my non-professional guess is it just behaves differently in women because at some point it just peaks out, whereas the hormone irregularity was what caused gyne in the male anyway with extremely little to start with. 

[charlie1821]

Ugh, what a nightmare, the possibility of regrowth.

[Dr. Elliot Jacobs]

To answer a previous question, women who undergo breast reduction generally do not experience re-growth or enlargement of their  breasts after surgery, despite the fact that they still continue to produce their own estrogen.  And I have seen many post-menopausal women, who are making much less of their own estrogen, develop breast enlargement in their 60's or 70's.  Why?  We don't know. There are lots of things we do not know about breasts and hormones.  For example, why do women grow larger breasts (or smaller breasts) while most women have roughly the same levels of estrogen?  Obviously, there are genetic interactions as well.  The same is true for men.  Each of us undergoes tremendous hormonal fluctuations during puberty -- yet only some of us develop gyne.  The answer is that there is a genetic predisposition as well -- and to my knowledge, there are no blood tests to determine this.  Perhaps in the future, when each of us can have our own DNA analyzed for all possible diseases and conditions, we will be able to treat or prevent gyne from even starting in a young man.

But returning back to earth, it has been my experience that if you operate on stable gyne, the chance of re-growth is extremely rare.

Dr Jacobs

[Dr. Elliot Jacobs]

By the way, I forgot to mention an interesting case I did.  I operated on a teen for one sided gyne when he was 15.  the other side was absolutely perfect -- no evidence of any excess tissue, so I never touched it.

He returned 12 years later with gyne on the other side, while the previously operated upon side had remained perfect.  Now try to explain that one!

Dr Jacobs

[Prolactinoma]

Hi,

I was wondering if I cold get some advice. I have a endocrine issue as you can probably guess by my username it is a prolactinoma. I am desperate to get my gynecomastia removed but I am unsure on a few things.

1) When my hormones become normal (medication didn't work so i am having to have the prolactinoma operated on next week) then is it likely I will be able to get gynecomastia surgery without any issues i.e. surgeon refusing?

2) I know blood tests are needed prior to an operation. What do these usually include?

3) Is there a time period I am likely to have to wait after normalisation of hormones prior to getting surgery i.e. hormones normal for 2 months can now have surgery?

Many thanks,

Prolactinoma

[Dr. Elliot Jacobs]

Once the prolactinoma is removed successfully, I would recommend waiting at least three months or more before considering gyne surgery.  You would probably want clearance from your endo as well as confirming endo blood tests, that total removal of the prolactinoma has been accomplished and your prolactin blood levels are normal.

Once your blood prolactin levels are normal, you should be a candidate for gyne surgery.  The normal blood tests of gyne surgery are a CBC (blood count), blood chemistry, urinalysis, and perhaps some other blood tests as requested by your surgeon.

I have operated on several patients with active prolactinomas who have had blood levels stabilized with medication.  Their gyne has not returned after surgery.

Dr Jacobs