Author Topic: Gynecomastia Starting at older age  (Read 4901 times)

Offline l0410z

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I am fifty years old and just developed Gynecomastia.  It started on the right side with pain and tenderness, the breast got larger.  Now both breats are tender and I would say painful.  I have had a Sonograms, Breast MRI, Mamogram. The right side is glandular.   I have seen 2 surgeons...one said cut it out if it bothers you... the other said leave it alone.   My primary doctor has checked hormones levles of Estrogen, Testerone (though at the low end of the range) they are within normal....I am going to a specialist in a few weeks.   I trust my doctor (of 25 years) so I am following his lead.  

Any older people who have developed this later in life share if they have pain or tender breasts.    

I feel for those who have this from a younger age....from what I can read,  the younger you are the more the problem moves from concern for a problem to appearance.   I can afford to lose a few pounds but i am not heavy.  I have been running for 25 years.  I say this because while I think my right breast is huge.....my wife thinks one could only tell if you point it out.   If you are thinking she is your wife, what do you expect her to say.....trust me....she would say what she thinks.  ??? ??? ???

Offline Grandpa Bambu

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  • 31 Year Gynecomastia Victim...
Post some pics Dude....

Yeah, my wife prior to my surgery said that I was obsessing and that the operation wasn't necessary. However, after having the moobs removed, looking at my before and after pics, she agreed that surgery was the right course of action.....

John.
Surgery: February 16, 2005. - Toronto, Ontario Canada.
Surgeon: Dr. John Craig Fielding   M.D.   F.R.C.S. (C) (416.766.8890)
Pre-Op/Post-Op Pics

Offline Hypo-is-here

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Quote
I am fifty years old and just developed Gynecomastia.  It started on the right side with pain and tenderness, the breast got larger.  Now both breats are tender and I would say painful.  I have had a Sonograms, Breast MRI, Mamogram. The right side is glandular.   I have seen 2 surgeons...one said cut it out if it bothers you... the other said leave it alone.   My primary doctor has checked hormones levles of Estrogen, Testerone (though at the low end of the range) they are within normal....I am going to a specialist in a few weeks.   I trust my doctor (of 25 years) so I am following his lead.  

Any older people who have developed this later in life share if they have pain or tender breasts.    

I feel for those who have this from a younger age....from what I can read,  the younger you are the more the problem moves from concern for a problem to appearance.   I can afford to lose a few pounds but i am not heavy.  I have been running for 25 years.  I say this because while I think my right breast is huge.....my wife thinks one could only tell if you point it out.   If you are thinking she is your wife, what do you expect her to say.....trust me....she would say what she thinks.  ??? ??? ???


Take a look at this site it will help you understand from a laymans point of view what is required in order to correctly evaluate your situation.

http://www.androids.org.uk/

And this site is a forum where you can ask related questions should you feel the need.

http://www.andropause.org.uk/newforum/forum_frameset.htm

Given your age I would say you very much need to have your SHBG level checked and prolactin as well as your testosterone and estradiol levels.

It would also be wise to have a thyroid panel and renal and hepatic function tests.

If you should wish to ask me a question on any of this, please feel free either here or via pm.

I have have low testosterone (hypogonadism as it is termed) and help people out with hormone related matters across a number of web sites.

I am UK based but if you are in the US I would also like to help you with contact details for endocrinologists (specialist doctors who deal with such matters).

If you tell were to tell me what city and state you live in I could get you these details.

All the best.







« Last Edit: December 30, 2005, 03:21:25 AM by Hypo-is-here »

Offline TOLDFT

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I first noticed my breast growth last year at the age of 55.  To answer your question, I do have pain and tenderness at times, usually associated with an intense physical workout.  What I have more often is a burning sensation around the nipples.

Using a link from this web site, I found a reproductive Endo and had all the lab work done last summer.  Like yourself, my testosterone (and free testosterone) were on the low side of average and estradiol in the upper.  Keep in mind that average is for males age 18 to 70.  Articles I have found say the balance should be the opposite and if not, testosterone replacement may be necessary.  Since I suffered from prostate cancer and had surgery in 1998, I cannot use TRT myself.

My wife also has been supportive and has no objection to reduction surgery.  Since the cause of my problem cannot be addressed, I'm afraid it would just return.

Good luck.

Offline l0410z

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Hypo is Here.... Couple of questions since you seem to be in the know
First... thanks for the suggestion...
The prolactin  and Estradiol levels are normal... the  testosterone is at the low end of normal... (270).  Thank you for the offer of finding an endo doctor. My Doctor gave me the same of one when he saw the low end of normal telling me he could tell me if this was an issue.

Q1 My doctor also said that since the blood test was taken in the afternoon (around 3:30 or 16:30), this could be the reason for the low normal... the AM is the best time for this test.... he is correct...

Q2 Medication induced Gynecomastia.... tenderness in the right breast started in July.  I visited my doctor who said it could be a muscle pull.  My doctor didn't notice the enlarged right breast until October.  I was put on High Blood pressure medication (August),  take Zocor (2 years) and on occassion take Xanax.  He looked up the Blood pressure medicine and Gynecomastia was not  listed as a side effect.   He said we will try changing medication after the endo does an evaluation... your thougths please

Q3 Should I have my doctor run tests that you suggest  SHBG level, redo the  testosterone, a thyroid panel and renal and hepatic function tests)  in prep for the endo so the endo has the results

Thank you for your help in advance.... you provide a great value in an area that while much is know, little is understood.  

Offline Hypo-is-here

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Toldft,

Low serum testosterone and elevated estrogen creates even lower free testosterone.

This condition can be exacerbated also by elevations in SHBG.

As we age SHBG naturally often increases along with estradiol (the most potent estrogen).

This condition is known in forward thinking endocrine circles as “metabolic andropause”.

You have mentioned that testosterone replacement is out of the question given your previous diagnosis.  Some endocrinologists advocate testosterone replacement therapy in certain instances (only when no cancer is currently present), so I would not rule out TRT altogether.
 
It is also worth knowing that elevated estrogen is thought to be a factor in the aetiology of prostate cancer by many endocrinologists.

It might be possible, with “might” being the operative word for an endocrinologist to treat you with an anti estrogen or aromatase inhibitor, or possibly TRT.  If TRT is out of the question the other options may still be viable and correctly dosed could improve your androgen to estrogen ratio and improve your overall well-being.

Certainly these are matters you should enquire about.

In order to consider such matters you would require an endocrinologist who deals with hypogonadism as an area of interest otherwise I think ignorance and a fear of the unknown would ensure that these matters were not properly investigated given your circumstances and medical history.


I0410z,

It is worth knowing that the normal range for testosterone and estrogen has no reference relating to age.  The low end of the spectrum for testosterone also takes into account men in their nineties!

Likewise the high end of the estrogen spectrum takes into account men in their nineties!

A typical estradiol level for healthy men is typically between 17.3pg/ml and 26pg/ml (differing assays may present exceptions).  But the supposed normal reference range is sometimes quoted as high as 60pg/ml, something that is downright unhealthy and a level at which many men would develop gynecomastia and suffer from erection difficulties and even BPH Benign Prostate Hyperplasia.

A good guide with estrogen is to say that you would probably not want to be in the upper third of the normal range, never mind over it

So what is presented as normal is often anything but.

Also many endocrinologists/doctors fail to understand what the normal reference ranges mean and how they should be considered.

By normal what is meant is that 95% of men will be found to have values between the values expressed.  However some men require high levels of testosterone, some men medium levels and other men function quite adequately on fairly low levels of testosterone.

What we know for sure is this;

All men, ALL of us will have differing levels of testosterone.  If a healthy man has a natural level of testosterone of 500ng/dl and another healthy man has a testosterone level of 800ng/dl say, presumably each man has these respective values because his body requires that given level in order to function correctly.

If either of these men has a drop in testosterone production because of testicular or pituitary damage or because of metabolic factors they may suffer from the symptoms of hypogonadism but still be within the normal reference range (which at its bottom is usually quoted as 300ng/dl)..

They may suffer from hypogonadism despite a testosterone level that is technically within the normal range.

(Note: The differing array of testosterone levels that are required by men to be healthy relate to differing  SHBG levels, differing estrogens levels, and alterations in androgen receptors and genetic factors regarding androgen uptake).

So when they are at odds, what is correct the body or pathology reference ranges?

Science, or rather those that apply it can be guilty of arrogance, of thinking that new technologies are the be all and the end all.

But it is woeful in such instances if we presume that we have learnt so much, that we are saying we know more than the greatest diagnostic tool in the world- the human body.

Is it correct to stick rigidly to the reference ranges or should we be using the reference ranges as a loose guide or tool to help us in combination with symptomotology in order to reach a correct diagnosis?

The best endocrinologists in this field have already reached a conclusion here and it is that hypogonadism should be diagnosed on the basis of symptoms in combination with blood pathology and reference ranges, that hypogonadism should not be excluded on the basis of blood and reference ranges alone.


I hope I have explained how the reference ranges alone should not be used to exclude a diagnosis or treatment of hypogonadism.

If I have gone into too much detail; my apologies.




Quote
Hypo is Here.... Couple of questions since you seem to be in the know
First... thanks for the suggestion...
The prolactin  and Estradiol levels are normal... the  testosterone is at the low end of normal... (270).
.  


I would rather that you tell me that you do not have symptoms of hypogonadism, than simply your testosterone has come back as supposedly being within the normal reference range.  Please view the sites I have posted in my last mail and see if you have many symptoms of the condition.  

If you do, then I would suggest obtaining a second opinion, something I would be glad to help you with.

Quote

Q1 My doctor also said that since the blood test was taken in the afternoon (around 3:30 or 16:30), this could be the reason for the low normal... the AM is the best time for this test.... he is correct...
.  


Yes he is correct.

You should only have pathology undertaken between 9 and 11am in line with your bodies circadian hormonal pattern.  But I would also say that unless your assay/test was quite u7nusual your testosterone level would be regarded as being below the bottom of the normal range and hypogonadal.

But again- we are getting, like your doctor stuck on viewing the bloods in isolation and the fact is it is more important to consider your well-being and symptoms first and foremost and only use the bloods and reference ranges as a tool to help understand what is going on.

Quote

Q2 Medication induced Gynecomastia.... tenderness in the right breast started in July.  I visited my doctor who said it could be a muscle pull.  My doctor didn't notice the enlarged right breast until October.  I was put on High Blood pressure medication (August),  take Zocor (2 years) and on occassion take Xanax.  He looked up the Blood pressure medicine and Gynecomastia was not  listed as a side effect.   He said we will try changing medication after the endo does an evaluation... your thougths please


Many medications are known to adversely alter the androgen to estrogen balance/ratio and it is possible that these drugs may be exerting such an effect.  I think this is certainly something to consider with your doctor.

Quote

Q3 Should I have my doctor run tests that you suggest  SHBG level, redo the  testosterone, a thyroid panel and renal and hepatic function tests)  in prep for the endo so the endo has the results

Thank you for your help in advance.... you provide a great value in an area that while much is know, little is understood.  


My honest opinion is that in your shoes I would search for a doctor who specializes in treating men with hypogonadism, who has depth of knowledge and understanding in this particular area of medicine.  That way you would be able to obtain the best care.


I hope that helps a bit.
« Last Edit: January 02, 2006, 06:24:30 AM by Hypo-is-here »

Offline l0410z

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<My honest opinion is that in your shoes I would search for a doctor who specializes in treating men with hypogonadism, who has depth of knowledge and understanding in this particular area of medicine.  That way you would be able to obtain the best care.>

I  live in NY (Long Isand). Please if you can recommend  a doctor who specializes in hypogonadism.  My zip code is 11710 if that helps.... NYC is 30 minutes away if the best is found there.


<If either of these men has a drop in testosterone production because of testicular or pituitary damage or because of metabolic factors they may suffer from the symptoms of hypogonadism but still be within the normal reference range >

My only symptom is Gnynecomastia...... my estrodial is 32...... proiactin 10.6 ....  until 3 weeks ago I run 3 ot 4 miles (have a pulled muscle now) a day three times a week.  I do not have a lack of energy though I do have insomia every so often that gets me tired by days end.   I do not have erection problems though after 25 years of marriage, a job that is like s pressure cooker, my kids spending habits that are faster then my earnings, my desires are not as strong as they once were.....I used the above as an excuse though it could be medically induced.

I guess bottom line what I am hearing is that the range is so braod that a total picture must be looked at and not just levels by themselves.  

I thank you once gain for your help.....I do have one last question.....your information has been invaluable.... Can I make a small donation in your name to a charity or how else can I  show my appreciation for your help.  

<Gyneco

Offline Hypo-is-here

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l0410z,

I am going to put out a message, a request to people with hypogonadism in the New York area and see if they can come back with a personal recommendation for an endocrinologist for you.

Hopefully I can have a name/contact details of someone that comes recommended.

Give me a day or two and I will get back to you.

If I cannot get a personal recommendation, I will obtain the contact details of as many endocrinologists in the New York/Long Island area that have an active interest in reproductive endocrinology whom you can speak with, with a view to making an appointment.

Given what you have subsequently told me I suspect that you are either eugonadal (normal/healthy to you and me) or at worst suffering from PADAM (Partial Androgen Deficiency of the Ageing Male).

Hopefully you have no problem at all, but it is certainly wise to check these things out.

I am only too pleased to help, your thanks for which is more than enough.

Speak soon.














« Last Edit: January 02, 2006, 10:00:32 AM by Hypo-is-here »

Offline Hypo-is-here

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Hi l0410z,

A guy in one of the forums told me that there is a endocrinologist that he saw that he was very pleased with.

He said quote

NJ, Barry Klyde was an excellant endo...I believe he's
on 70th. and York in Manhattan.

Unfortunately he did not have any contact details.

I did a seach and came up with this.

Endocrinologist 614 Madison Ave, Albany, NY 12208 518 436-4991
Manhattan. Dr. Barry J. Klyde, Endocrinology/ Thyroid, 520 East 72nd Street ...

This may or may not be his correct current contact address/details.

I wanted to include his details for you as he is the only one that comes personally recommended by someone.

Every endocrinologist below has a stated interest in reproductive endocrinology.

If I were you I would ring a few of these doctors, perhaps the one above also and I would settle with an appointment with the one I felt most comfortable with.

I hope this helps.


Alkmini Anastasiadou, MD
133 E 73rd St # 401
New York, NY 10021-3556
Directions to Office
Phone: (212) 717-8800
Interest Areas:
   Diabetes Mellitus
   General Endocrinology and Metabolism
   Lipid Disorders
   Obesity
   Nutrition
   Reproductive Endocrinology
   Thyroid Dysfunction
   Osteoporosis
   PCOS
   
Donald A. Bergman, MD, FACE
1199 Park Ave Suite 1F
New York, NY 10128-1713
Directions to Office
Phone: (212) 876-7333
Interest Areas:
   Diabetes Mellitus
   General Endocrinology and Metabolism
   Metabolic Bone Disorders
   Parathyroid Disorders
   Reproductive Endocrinology
   Thyroid Dysfunction
   
Romy Jill Block, MD
Endoc. Fellowship Program, New Bellevue 16512
NYU Medical Center 550 1st Ave
New York, NY 10016
Directions to Office
Phone: (212) 263-8060
Interest Areas:
   Diabetes Mellitus
   Obesity
   Reproductive Endocrinology
   Thyroid Dysfunction
   
Terry F. Davies, MD, FRCP, FACE
Mt Sinai Medical Center, School Of Med
1 Gustave L Levy Pl # 1055
New York, NY 10029-6500
Directions to Office
Phone: (212) 241-6627
Interest Areas:
   Disease of Pregnancy
   General Endocrinology and Metabolism
   Parathyroid Disorders
   Reproductive Endocrinology
   Thyroid Dysfunction
   Osteoporosis
   
Rebecca Fenichel, MD
1 Gustave 1 Levy Place
New York, NY 10029
Directions to Office
Phone: (212) 241-1500
Interest Areas:
   Disease of Pregnancy
   Reproductive Endocrinology
   Endocrine Surgery
   Osteoporosis
   Menopause
   
Walter Futterweit, MD, FACP, FACE
1172 Park Ave
New York, NY 10128-1213
Directions to Office
Phone: (212) 876-6400
Visit Dr. Futterweit at AACEHost

Interest Areas:
   Adrenal Disorders
   General Endocrinology and Metabolism
   Reproductive Endocrinology
   PCOS
   
Eliza B Geer, MD
Mt. Sinai Hospital, Div. of Endocrinology
One Gustave L Levy Place, Annenberg 23-70
New York, NY 10029
Directions to Office
Phone: (646) 522-6964
Interest Areas:
   Adrenal Disorders
   General Endocrinology and Metabolism
   Obesity
   Pituitary Disorders
   Reproductive Endocrinology
   
Samara Beth Ginzburg, MD
Mt. Sinai Hospital
One Gustave Levy Place
New York, NY 10029
Directions to Office
Phone: (917) 377-7988
Interest Areas:
   Reproductive Endocrinology
   Osteoporosis
   PCOS
   
Harry Gruenspan, MD, PhD, FACE
79 E 79th St
New York, NY 10021-0202
Directions to Office
Phone: (212) 794-2900
Interest Areas:
   Hypertension
   Reproductive Endocrinology
   Osteoporosis
   
Spyros G.E. Mezitis, MD, PhD
220 E 69th St
New York, NY 10021-5737
Directions to Office
Phone: (212) 288-6661
Interest Areas:
   Diabetes Mellitus
   General Endocrinology and Metabolism
   Nutrition
   Parathyroid Disorders
   Pituitary Disorders
   Reproductive Endocrinology
   Thyroid Dysfunction
   Other
   Osteoporosis
   
Lila E. Nachtigall, MD
251 E 33rd St
New York, NY 10016-4804
Directions to Office
Phone: (212) 779-8353
Interest Areas:
   Reproductive Endocrinology
   
Marie Pulini, MD, FACP
60 Gramercy Park N
New York, NY 10010-5423
Directions to Office
Phone: (212) 475-7109
Interest Areas:
   Diabetes Mellitus
   Disease of Pregnancy
   General Endocrinology and Metabolism
   Lipid Disorders
   Metabolic Bone Disorders
   Parathyroid Disorders
   Reproductive Endocrinology
   Thyroid Dysfunction
   Other
   Osteoporosis
   
Robert Rapaport, MD
Mount Sinai School Of Medicine, Div. Of Pediatric Endo & Dia
1 Gustave L Levy Pl # 1616
New York, NY 10029-6500
Directions to Office
Phone: (212) 241-8487
Interest Areas:
   Adrenal Disorders
   Diabetes Mellitus
   Growth Disorders/Growth Hormone
   Pediatric Endocrinology
   Reproductive Endocrinology
   Thyroid Dysfunction
   Other
   
Geoffrey P Redmond, MD, FACE
Hormone Center of New York
133 E 73rd St
New York, NY 10021-3556
Directions to Office
Phone: (212) 861-9000
Interest Areas:
   General Endocrinology and Metabolism
   Reproductive Endocrinology
   Other
   
Ronald Tamler, MD
1 Gustave L Levy Pl
New York, NY 10029
Directions to Office
Phone: (212) 241-1500
Interest Areas:
   Adrenal Disorders
   Diabetes Mellitus
   General Endocrinology and Metabolism
   Metabolic Bone Disorders
   Reproductive Endocrinology
   
Rhonda Kay Trousdale, MD
Columbia University Medical Center
630 West 168th Street PH 8 West, Rm 864
New York, NY 10025
Directions to Office
Phone: (212) 531-1837
Interest Areas:
   General Endocrinology and Metabolism
   Reproductive Endocrinology
   
Andrew Joseph Werner, MD, FACE
1112 Park Ave
New York, NY 10128-1235
Directions to Office
Phone: (212) 534-3500
Interest Areas:
   Adrenal Disorders
   Diabetes Mellitus
   General Endocrinology and Metabolism
   Parathyroid Disorders
   Pituitary Disorders
   Reproductive Endocrinology
   Thyroid Dysfunction
   Osteoporosis
« Last Edit: January 03, 2006, 01:51:16 PM by Hypo-is-here »

Offline l0410z

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Thank you for the doctors.  My one Primary Doctor gave me a doctor in a group of  doctors (all Endobrinologists).  The one he suggested I see does not have an appointment open until mid march but one of the other doctors has  a cancellation for tomorrow so I notified my primary and took it at his suggestion.   My concern is the doctor I am going to see doesn't appear to have a speciality in the Reproductive area but that is okay for now.   I will most likely get a second opinion anyway (from your list).  

You have educated me to the point where I can asked questions instead fo getting information and then trying to understand what was said and done.   Knowing more about  boold work ups, the different blood tests,  hypogonadism and testosterone deficiency will malke the visit more productive.  

Thanks again

Offline Hypo-is-here

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That's great, all the best.
« Last Edit: January 04, 2006, 10:05:04 AM by Hypo-is-here »

Offline l0410z

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Went to the endo today.  This website helped me ask good questions.  It was late afternoon and he wanted blood tests taken in the morning so I have to come back.

Interesting... his thoughts were that since I had grandular tissue on only one side, it was unlikely to be hormonal.  In addition, my lack of symptoms also pointed to that direction.   The low end of the scale testosterone by itself is not a problem but until the complete blood work was done,  he is not ruling anyhting out.

If the blood work comes out fine Iand I hope so), after having a mamogram, sonagram, breast mri, ... seeing a surgeon, an endo... I am no closer to knowing the cause and this is important to me......

Getting it later is life is not fun... and having it only on one side makes it seem worse but  I feel for many of you who have had this problem all your lives

Offline Hypo-is-here

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I think a lack of symptoms point to things being well, and hopefully that is so.

If that is the case he will say the gynecomastia is idiopathic.  Basically of unknown aetiology.

Request a copy of your results and reference ranges for your own records.  Also pay particular attention to your SHBG level given your age.  Whilst not being ill, if elevated it (something that often happens with age)  may be worth lowering.

Anyway your in a good situation, I hope the appointment goes well.

P.S

Your endocrinologist was perfectly right to tell you to come back in the morning.  That is the only way you could have had reliable pathology as it is in line with your circadian hormonal rhythm and in line with the hormone pathology test reference ranges.

 
« Last Edit: January 06, 2006, 02:34:07 AM by Hypo-is-here »

Offline l0410z

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one quick question... here are the tests he asked for.. did he forget anything...(SHGB),

Testosterone, free testosteroen, LH, FSH, TSH, Estradiol, HCG(qualitative) nd Proactin.....

thanks... you do not know how helpful you have been,...

BTW.. "at your Age"... ouch.. still adjusting to being 50... anyone that tells you they feel the same at 50 as 40 is not truthful.... I slowed down in my running and my legs hurt more..... that all being said... I hope I can say the same at 60, 70,  80 and 90... will take the pains anyday.


Offline Hypo-is-here

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A good Free Testosterone test reduces the importance of an SHBG test.  

The main reason to test SHBG is because it is possible to have an adequate level of total/serum testosterone but a low level of free testosterone thanks to elevated SHBG.  But you know if you have a low free testosterone level of course when you test for it directly.

If it turned out that you had a low normal/normal total/serum testosterone level, but a low free testosterone level then you would want to know why that was.

If this was the case you would then want an SHBG test.

If it was then shown that SHBG was causing low free testosterone it would be wise to treat the high SHBG and in doing so increase the free testosterone- this would be preferable to simply increasing total/serum testosterone via TRT.

So SHBG still has its value, in certain circumstances/cases but your endocrinologist can work around it if needs must- and for the most part the free testosterone test will tell all that is required (making this explanation long-winded and pointless- Oh well  :D

SHBG is very important when you only have a total/serum testosterone test.

Your endocrinologist is testing correctly.

If you felt ill or had dramatic significant symptoms of ill health then a larger panel of tests would be advisable, but I see nothing wrong in what he/she is doing.

The only thing that you could maybe say might be worth adding would be a liver function test- given 8% of all gynecomastia sufferers have an underlying hepatic problem, but even there it can be argued otherwise as you have no apparent symptoms of ill health from what I gather.

If you had any of the following;

Fatigue, jaundice, yellowing of the eyes, history of liver disease/liver surgery, sudden unexplainable weight loss, nausea, pain in the upper right quadrant of the stomach then you would definitely want a liver function test.  As it is its worth is arguable.







 





 

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