Testosterone gel -> gynecomastia

[lowt]

Hello all.

I'd never heard of gynecomastia until a few months ago.

I'm 30 now, and I've been tired for the last 5, 7, even 10 years of my life, and it got to the stage where life was getting to the stage where it wasn't really worth it.

I finally have discovered that I am hypogonadic (I don't produce enough testosterone naturally) - this is due to a torsion I had at the age of 14, I expect.

Anyway, I started taking testosterone gel, and I felt amazing. (Probably just like all men feel normally, but I'd not felt like that for a long time - if at all).
Anyway, after a month or two, I noticed that I was getting a bit flabby round the chest, and it looks like I'm developing breasts.

I spoke to my doctor about this. We think that my body is reacting to the testosterone, and is converting it to estrogen (how helpful). Now I am taking testosterone and Tamoxifen (an anti-estrogen which prevents estrogen uptake in the breast). It seems to have more or less stabilised at the moment.

The thing is, my growth doesn't look quite like the typical gynecomastia I have seen in pictures here. I don't have "puffy nipples", or enlarged nipples or whatever. I just have small breasts starting to grow. They're more spread out and less pointy.
It's amazing how much even a little growth has affected me mentally.

Anyway, I'd love to hear some advice about whether I should even be looking at surgery yet, if anyone else has had this happen to them due to testosterone therapy, or if it's possible that they might go away again when my body stops reacting to the new, higher (normal) levels of testosterone. (It's only 2-3 months since I started this - but they've grown fairly fast).
Also, when women have a breast removed, it doesn't grow back. When men have theirs removed, there is no chance that it will grow back again, is there?


And what kind of stupid idea does nature have to grow breasts on men when their testosterone level increases?

Thanks in advance.

[GuckFyno]

You won't need to have surgery most likely.  Usually when the gyne is a result of a product or a flare up in estrogen levels it can be cured through anti-estrogens like your taking, especially since you've caught it early.  

It's pretty common that at high testosterone levels the body will convert excess into estrogen.  I wouldn't even think about surgery at this point, give the tamoxifen some time.

[aux513s]

First of all you should NEVER let a general doctor prescribe hormones or medications that affect your endocrine system. You should have gone to an endocrinologist.

Here's whats going to happen to you if you stay on the testosterone gel and tamoxifen.

1. Your testicles are going to atrophy and will produce NO natural testosterone. After a while, you'll be forced to keep using the gel.

2. Tamoxifen was originally intended to be used as an anti cancer drug. It has SERIOUS side effects (fatal blood clots, also causes cateracts if used for more than a year). That's not something you want to be on.

Gynecomastia occurs when the males testosterone level is too high or too low. The fact that you didn't have gyno to begin with leads me to believe you didn't have abnormally low testosterone levels.

Here's what I recommend:

Stop taking the gel, but stay on the tamoxifen until your testicles start producing natural testosterone again. Then after your hormones are how they were before, get the surgery. Male gynecomastia will grow back if there's an underlying hormone imbalance.

Next, to increase your energy levels try eating right and drinking more water. Do anything, just don't take that gel or you'll have to get used to living with breasts.

[lowt]

aux513s

Hello, and thanks for your reply.

I have an appointment to see an endocrinologist sometime soon. However, here, you can't just go and see an endocrinologist instantly.

I am quite sure that I have had low (and lowering) testosterone levels all my life, or at least for the last 5-10 years.
My blood tests show this - I am below the bottom end of the acceptable range for men.

I have tried living well, eating well, excercising for the last few years, but I just don't have the energy. If you look at the link below, I suffer from most, if not all of this:
http://www.get-back-on-track.com/en/tools/fragebogen_aging_male.php
And as you can see, these are things that are usually attributed to older men.

You are right, my doctor can't answer all of my questions - but I was at the point of despair due to the tiredness - and for a couple of months the testosterone made me feel "normal" again.

I don't suppose there is an endocrinologist on this board, is there?

[olderguy]

You might want to consider treatment for depression with Prozac or another of the so-called SSRI drugs.  I have been on Prozac for ten years now.  I never felt "hopeless" or psychologically depressed, just exhausted at the end of the day and especially the end of the work week.  Prozac relieved those problems within a couple of weeks and I began to feel better than I ever had!  I take 40mg of Prozac (generic: fluoxetine) every morning and 50mg of Trazadone at night, which helps with restful sleep.

I am 64 now.  Recently I developed sore nipples and a small disk of tissue under the nipple on the right side.    My doctor tested me for testosterone and LH.  Testosterone was low (221), even for a man my age, and LH was elevated (16), which means that I don't produce enough  testosterone to turn off the LH switch.  MRI showed normal pituitary gland.

I would rather be on Prozac than testosterone replacement or Tamoxifen.  I have had no adverse side-effects.  When I first started taking Prozac, I had the well-documented problem of difficulty achieving sexual climax.  After a few months, my body adjusted to the new chemistry and that problem went away.

[lowt]

At first, the doctors thought it was depression, and I have had a course of SSRIs, and I went to counselling.
It didn't help. I'm not tired because I'm depressed.

However, when my beard started to stop growing, it was just another pointer towards low testosterone. (I know that other things can cause alopecia, but those have been ruled out.).

I think I'm going to be taking testosterone for the rest of my life - so I need to work out a way of making sure I don't convert it to estrogen. What is LH? Lutenizing Hormone?

[olderguy]

Sorry the SSRI's didn't work for you.  Yes, LH stands for Luteinizing hormone.  LH is secreted by the pituitary gland.  It signals the testes to produce testosterone.  When the testosterone level goes up, the pituitary turns off the secretion of LH.  Low testosterone and high LH is a sign of hypogonadism.  Many clinicians regard a level of total testoterone < 300 (or <200 for older men) as the biochemical definition of hypogonadism.  Do you know what your levels of LH and testosterone are?

I gather from my reading online that gynecomastia is a well known side-effect of testosterone replacement therapy.

[lowt]

Well, the SSRIs didn't work because I'm not depressed

I haven't had an LH test, but my testosterone is now down to 9nmol/L which for a 30 year old bloke is way, way down. (The acceptable range  is 10-35).
I don't know what this 200-300 units you're speaking about are.

I might ask for an LH test, but I need to get to see an endocrinologist first - I'm still waiting for an appointment.

[olderguy]

Testosterone in the 100's is a measurement of ng/dl.  To convert to nmol multiply by .0347.  Or to convert from nmol to ng, divide by .0347.  9 nmol would be the equivalent of 259 ng/dl, which is indeed low for your age-bracket.  

If the testosterone makes you feel better, don't give it up!  It is probably just a matter of titrating the dosage so you don't get an excess that can be converted to estradiols.

I have seen some recent studies that say tamoxifen is effective against recent-onset gynecomastia with no adverse affects.  My own doctor disapproves of it, however.

[bathroom]

If you're growing breasts isn't the first sign glands growing under the nipples?  Maybe you're growing muscle in your chest.

Look at taking a drug called arimidex.  It blocks the conversion of test to estrogen.  You only need to take a small amount to block most of it.  You need some estrogen, just excessive amounts have bad side effects.

[aux513s]

SSRI drugs also can cause gyno in some people because they affect the hypothalamus and pituitary gland.

If you really think you have hypogonadism, there are some forms of testosterone, like DHT, that can't be converted into estrogen. However some people still feel tired on DHT and it increases the risk of prostate cancer moreso than if you took regular testosterone.

One thing you might want to look into is the delivery method of the testosterone. Maybe you'd have more success using a patch, or getting a subdermal implant since that would mimic a natural production of testosterone better than absorbing it into your bloodstream all at once.

[lowt]

If you're growing breasts isn't the first sign glands growing under the nipples?  Maybe you're growing muscle in your chest.

Look at taking a drug called arimidex.  It blocks the conversion of test to estrogen.  You only need to take a small amount to block most of it.  You need some estrogen, just excessive amounts have bad side effects.

Heh - for the first few weeks, I **did**think it might be muscles. But after a few more weeks, it definitely isn't. I've got my doctor to have a feel, and an ex nurse, and they both can feel definite female tissue there.

Heard of Arimidex, but at the time I was freaking out about my breasts, so the doctor gave me Tamoxifen, and will let the endocrinologist work out the longer term treatment.

[lowt]

Testosterone in the 100's is a measurement of ng/dl.  To convert to nmol multiply by .0347.  Or to convert from nmol to ng, divide by .0347.  9 nmol would be the equivalent of 259 ng/dl, which is indeed low for your age-bracket.  

If the testosterone makes you feel better, don't give it up!  It is probably just a matter of titrating the dosage so you don't get an excess that can be converted to estradiols.

I have seen some recent studies that say tamoxifen is effective against recent-onset gynecomastia with no adverse affects.  My own doctor disapproves of it, however.

Thanks for explaining the difference in measurements. 259 does seem a little low for a fit healthy 30 year old My estrogen is 113, (since I've been taking testosterone, anyway. No idea what it was before).

The testosterone made me feel great for a month or so, but the effects have tailed off. My theory is that my body is being swamped by it, and is converting it all to estrogen, which in turn is causing my breasts to grow.
I'm taking 1/2 a gel packet each day now, as I think that my body is trying to regulate the amount of testosterone in my body, but as it's not being produced naturally, it's unable to control it.