Causes usually labled as Idiopathc?

[Plarkin]

Been to three endos who all say pretty much the same thing. I am low normal hormonally -- but no HRT, and the cause of the gyne (since adolesence; I'm now 53) appears to be idiopathic. I've been tested for Kleinfelter's (neg) and researched a bunch of other things. I wonder, though, if four obscure causes could be possibly associated with my case:

Androgen Resistance Syndromes (cells are unable to respond adequately to circulating androgens)
Enzyme Defects of Testosterone Production
Increased Peripheral Tissue Aromatase
Hypogonadotropic Hypogonadism

Endos don't seem to want to spend their time on what may be a wild, theoretical, and possibly unanswerable, wild hormonal goose chase, especially I don't even have abnormal labs, at least not yet. I do have some other slight feminization characteristics, long thin legs and arms, wide hips, light beard, etc. that make me question the Gyne as a isolated idiopathic condition.)

Anyone know how to get tested for the above? Easy? Worth doing? Extreme long shot? Give up and just get the surgery, forget the hormones?

[monsterclean]

Hi Plarkin,
I'll attempt to address the 4 causes you listed:

Androgen Resistance Syndrome: this usually occurs when the testosterone receptor is not functioning properly.  If this were the case, you'd have female external genitalia (i.e. no penis, testicles), but male internal genitalia (vas deferans, seminal vesicles, prostate, etc).  Suffice it to say, I'm sure someone would've noticed this by now. 

There is an alternative, incomplete androgen insensitivity, where it's not as extreme as the aforementioned.  Again, there is likely to be ambiguous genitalia.

Enzyme Defects of Testosterone Production: Similar to the above, you'd exhibit the consequences of a mal-functioning testosterone pathway.  The fact that your hormone tests are in the normal range rule this out as a possibility.  You are producing testosterone, and therefore your enzymes are fine.  This is also evident in the fact that you have facial hair.  The thin facial hair can be attributed to other things such as your genetics, and ancestry.

Increased Peripheral Aromatase: This is definitely plausible, and moreso if you are overweight or obese.  However, the problem would be manifest from the testosterone being converted to excess estrogen by the aromatase enzyme.  In that case, the lab tests would have identified high estrogen levels.

Hypogonadotrophic Hypogonadism: This condition implies that there is low testosterone levels.  However, the cause is not in the testes.  Instead, either the hypothalamus or the pituitary are malfunctioning.  They are not providing the testes with the adequate signal to produce testosterone.  As a result, your testosterone levels would be low, and this would be found on the lab test.  Further, I'm not sure if you have access to this information, but one (or more) of the following hormones would also be low: GnRH (gonadotropic releasing hormone, if the hypothalamus is the problem) or LH/FSH (leutinizing hormone/ follicle-stimulating hormone if the pituitary is the problem).  A low testosterone level would be the first sign of problem in this case, and any endocrinologist would have immediately ordered an LH/FSH.  I doubt 3 different endos missed this diagnosis.

This brings us back to the possibility of 'idiopathic' gynecomastia.  Idiopathic simply means that the cause is unknown.  In the vast majority of gyne, this is the case.  It's probably due to the large variation in hormone levels at the onset of puberty.  Your estrogen levels were probably out of whack, but are now in check.  However, the breast tissue formed in that time out of excess estrogen.

Hope this message helps.

[Plarkin]

It did help. Thank you very much. My estrogen levels are actually a little low, so I doubt it is Number 3 on my list. I guess I can safely rule out these four things. I have been wondering about hypothyroidism and if that could cause gyne, and what causes the slight feminization here and there in stature, and hair? Heredity? I got to be on the absolute low end of normal, if all this is normal.

[Bob2000]

I think its possible that if one has accumulated adipose tissue in the chest region then the aromatase activity in that region is higher then if one did not. In my case, predinesone injections distributed abnormal amounts of fat in my chest, now the slightest shift in hormones can give me achy nipples and even increase the adipose tissue. Just my theory, having been labeled as "idiopathetic growth of adipose tissue", i am forced to tackle this on my own.

[Bob2000]

I think the term for it might be Local estrogen biosynthesis, but i am not sure.

[monsterclean]

If your estrogen levels are low, then it's unlikely to be a problem of estrogen.  Likely, your estrogen levels were out of whack during the puberty period, resulting in gynecomastia.

Hypothyroidism would cause your basal metabolic rate to decrease, which would result in you putting on fat all over your body.  If you're overweight, lethargic, often feeling cold, then perhaps you should get your thyroid hormone levels evaluated.

As for "local estrogen biosynthesis", estrogen and testosterone are hormones.  By definition, hormones exert their effects throughout the body.  Even if the fat accumulated on your chest is producing excess estrogen, it would be spread through the body - i.e. the estrogen wouldn't act ONLY on the chest.  Further, Plarkin mentioned that he has low estrogen levels, so that's an unlikely cause.

All signs point back to "idiopathic" being a correct label for his case.  It's pretty accurate for half of cases.  I mean think about it: prior to puberty, our estrogen and testosterone levels are extremely suppressed.  At puberty, the lid comes off, and these hormones go crazy.  If there is a period of time where you have unopposed estrogen, then you could have some feminizing characteristics.  However, this was a short period of time, and since then testosterone has kept estrogen levels in check.  HOwever, the damage has been done.

[Bob2000]

As for "local estrogen biosynthesis", estrogen and testosterone are hormones.  By definition, hormones exert their effects throughout the body.  Even if the fat accumulated on your chest is producing excess estrogen, it would be spread through the body - i.e. the estrogen wouldn't act ONLY on the chest.  Further, Plarkin mentioned that he has low estrogen levels, so that's an unlikely cause.

Neither of us have our degrees in endocrinology, so we should refrain from making statements that sound a bit too "matter of factly". I have been under the supervision of 3 different specialists since the onset of my "idiopathic growth of adipose tissue", and never has my hormone profile been anything but normal. i did blood work WHILE having "breast" tenderness and pain, and again with normal hormones. whenever i apply anything that affects the production of DHT (hair products) i develop pain around the nipple area, yet my hormones remain normal, and yes tissue specific excessive aromatisation IS possible. http://www.endocrine-abstracts.org/ea/0011/ea0011p435.htm

[monsterclean]

Hi Bob2000,

I'm not trying to sound "matter of factly".  As you can see from my posts through this site, I am an active contributor and have many questions for others.

Having said that, I have done a full course in endocrinology, and do know a thing or two.  That paper you poster does support the notion of excess aromatase activity in a fatty chest.  My previous post did not argue against that.  That makes complete sense.  If you have extra fat on the chest, and fat has the aromatase enzyme, then of course excess conversion will take place there.  I do argue that the excess estrogen will not be confined to the chest, though!  The excess estrogen will start at the chest, but will quickly disseminate through the body.  It is, after all, a hormone.

If you review that paper, they did not support the idea that excess estrogen biosynthesis in the chest affects the chest only.  Instead, the focus of the paper is on the idea that multiple alleles may be contributing to excess aromatise activity.  They also touch on the idea of environmental pollutants affecting aromatase activity.

I apologize if I come across "matter of factly".  However, I think we should also refrain from coming up with own hypotheses that are not supported by medical evidence.  If the medical community knew the cause or had an idea, they would not call it idiopathic.

[johnsmithreturns]

What is it called when you gain a lot of weight, develop these things then even if you drop the weight, the gynecomastia still remains?

[Plarkin]

If your estrogen levels are low, then it's unlikely to be a problem of estrogen.  Likely, your estrogen levels were out of whack during the puberty period, resulting in gynecomastia.

Hypothyroidism would cause your basal metabolic rate to decrease, which would result in you putting on fat all over your body.  If you're overweight, lethargic, often feeling cold, then perhaps you should get your thyroid hormone levels evaluated.

As for "local estrogen biosynthesis", estrogen and testosterone are hormones.  By definition, hormones exert their effects throughout the body.  Even if the fat accumulated on your chest is producing excess estrogen, it would be spread through the body - i.e. the estrogen wouldn't act ONLY on the chest.  Further, Plarkin mentioned that he has low estrogen levels, so that's an unlikely cause.

All signs point back to "idiopathic" being a correct label for his case.  It's pretty accurate for half of cases.  I mean think about it: prior to puberty, our estrogen and testosterone levels are extremely suppressed.  At puberty, the lid comes off, and these hormones go crazy.  If there is a period of time where you have unopposed estrogen, then you could have some feminizing characteristics.  However, this was a short period of time, and since then testosterone has kept estrogen levels in check.  HOwever, the damage has been done.

Monster. Thanks for your thoughts; you are mostly likely right. That's the conventional wisdom, or best guess, in other words. I do have the extreme aversion to cold, lethergy and if I didn't work out and watched what I ate, I'd easily be 30 pounds overweight, naturally. And even working out and watching what I eat, I have 23 percent body fat. Am going to check this out.

Regarding the low e2, it is low in isolation, barely in the normal range. It is actually more normal and less low when ratio-ed with my total T. I have had one of two low Free T readings in Australia, but oddly none in the United States.

If you or anyone has any further thoughts, plass them along,

Cheers,