Want to point something out about gynecomastia surgery

[cpa5oh]

I saw two plastic surgeons within the last two months to discuss gynecomastia surgery for a lump on my chest (left side only) and excess fat in my chest (I'm not an extreme case, but it's a problem).  I explained to both that this just became a problem in the three or four months previous to my consultations.  Neither prescribed any kind of testing to try and determine the cause: we went from a brief examination to discussing price and payment arrangements.
I held off with the surgery for two reasons: 1) both were giving me a lipo-only vibe and 2) because this was sort of a developing situation that I didn't know the cause of, I didn't know what that meant for likelihood of recurrence.  So I figured I'd spend the summer trying to get it at least stabilized which would require figuring out the root cause (if possible).  
Had a blood test done last week and got the results today - estrogen is 220 where the normal range is 60-190.  (And that process with the medical doc was disheartening.  He acted like I was crazy for worrying about a quarter diameter sized round ball lump on my chest - no concern over whether it could be malignant.  I had to beg for the blood test and promise to pay out of pocket if insurance didn't cover it.  And then I got a call from his office and was told "everything came back normal" only to actually see the results from the lab which were "flagged" as "high".)
So there's a high probability that my cause has been revealed: it can't be said that this is idiopathic when my estrogen level is above normal.  Had I not done some homework and demanded testing before going under the knife and opening myself up to the inherent risk of this operation, I'd have spent $5,000 and had the surgery and the cause would not have been addressed.  Leave a little gland behind with the surgery with the cause still there and, probably, I'd have had another lump.  Now, I've got a chance to eliminate the cause and maybe resolve the issue without surgery.  And while I'll have the surgery if the problem doesn't reverse itself, there's a great chance that I'll have the cause eliminated BEFORE having the surgery which should go a long way toward eliminating the possibility of recurrence.  
Point of this post: if you are considering surgery, it only makes sense to try and pin down the cause BEFORE you have the surgery done.  I've read MANY stories of guys who had the surgery and everything was great and then three months later they're noticing another lump or puffy nipples again.  It seems logical that they got the symptoms resolved but, by not resolving the issue that caused the symptoms, recurrence was almost destined to happen.

[rrr]

Point of this post: if you are considering surgery, it only makes sense to try and pin down the cause BEFORE you have the surgery done.  I've read MANY stories of guys who had the surgery and everything was great and then three months later they're noticing another lump or puffy nipples again.  It seems logical that they got the symptoms resolved but, by not resolving the issue that caused the symptoms, recurrence was almost destined to happen.

Definitely good advice for those that don't know the cause. Many (if not most) of the folks here know the cause of theirs - whether it be medications, HRT, testosterone issues, or steroids.

I am in the lucky idiopathetic category. No doctor has been able to explain to me why I have it, and every single test I've had is perfectly normal. I don't think there's a blood test out there that I DIDN'T have done.

To begin with, my T was on the low side but not out of range. I tried Androgel for a while, but it seemed to lower it even further after 6 months or so. I will say though, that it had ZERO effect on my gyno - it still keot slowly growing.

I am now on Clomid, and my T is perfectly in the middle of the normal range. Since this is not exogynous T, it should have zero chance of aromatasing, but my gyno seems to have gotten a bit worse - firmer, growing more than it has in the past.

Based on my previous 2 years, it makes no sense whatsoever.

Why can't a doctor actually find the problem? Surgery is totally out unless a cause is found, because I wouldn't want to have it return.

How can a person have a medical condition that is abnormal, yet there is no reason?

Bummed

[TigerPaws]

Point of this post: if you are considering surgery, it only makes sense to try and pin down the cause BEFORE you have the surgery done.  I've read MANY stories of guys who had the surgery and everything was great and then three months later they're noticing another lump or puffy nipples again.  It seems logical that they got the symptoms resolved but, by not resolving the issue that caused the symptoms, recurrence was almost destined to happen.

Definitely good advice for those that don't know the cause. Many (if not most) of the folks here know the cause of theirs - whether it be medications, HRT, testosterone issues, or steroids.

I am in the lucky idiopathetic category. No doctor has been able to explain to me why I have it, and every single test I've had is perfectly normal. I don't think there's a blood test out there that I DIDN'T have done.

To begin with, my T was on the low side but not out of range. I tried Androgel for a while, but it seemed to lower it even further after 6 months or so. I will say though, that it had ZERO effect on my gyno - it still keot slowly growing.

I am now on Clomid, and my T is perfectly in the middle of the normal range. Since this is not exogynous T, it should have zero chance of aromatasing, but my gyno seems to have gotten a bit worse - firmer, growing more than it has in the past.

Based on my previous 2 years, it makes no sense whatsoever.

Why can't a doctor actually find the problem? Surgery is totally out unless a cause is found, because I wouldn't want to have it return.

How can a person have a medical condition that is abnormal, yet there is no reason?

Bummed

There is always a reason, the issue is finding it. While I am only guessing your hormone issues could be transitory and short lived. Typically the three primary hormones are relatively short lived in the blood stream, so in the time you feel the growth to setting an appointment to actually sampling your blood the hormones might have returned to normal.

It is just a possibility.

You may also be highly susceptible to breast development, this is genetic and there is nothing that can be done about it. Many girls do not actually feel their breasts growing, they simply discover their development when it becomes noticeable. You could be in this category along with being predisposed to developing breasts from very small quantities of the offending hormones.

There is no way to know.

[cpa5oh]

Point of this post: if you are considering surgery, it only makes sense to try and pin down the cause BEFORE you have the surgery done.  I've read MANY stories of guys who had the surgery and everything was great and then three months later they're noticing another lump or puffy nipples again.  It seems logical that they got the symptoms resolved but, by not resolving the issue that caused the symptoms, recurrence was almost destined to happen.

Definitely good advice for those that don't know the cause. Many (if not most) of the folks here know the cause of theirs - whether it be medications, HRT, testosterone issues, or steroids.

I am in the lucky idiopathetic category. No doctor has been able to explain to me why I have it, and every single test I've had is perfectly normal. I don't think there's a blood test out there that I DIDN'T have done.

To begin with, my T was on the low side but not out of range. I tried Androgel for a while, but it seemed to lower it even further after 6 months or so. I will say though, that it had ZERO effect on my gyno - it still keot slowly growing.

I am now on Clomid, and my T is perfectly in the middle of the normal range. Since this is not exogynous T, it should have zero chance of aromatasing, but my gyno seems to have gotten a bit worse - firmer, growing more than it has in the past.

Based on my previous 2 years, it makes no sense whatsoever.

Why can't a doctor actually find the problem? Surgery is totally out unless a cause is found, because I wouldn't want to have it return.

How can a person have a medical condition that is abnormal, yet there is no reason?

Bummed

I'm no doctor, but I think the statement "since this is not exogenous T, it should have zero chance of aromatizing" is totally wrong.  I think any increase in testosterone, especially if you're carrying a decent amount of body fat, is almost definitely going to bring with it an increase in estrogen.  If I were you I'd get that estrogen/estradiol level tested now.  

[rrr]

I appreciate the advice, but I am not, nor have I ever been, carrying extra fat. I wear the same size clothing in my fifties as I did in my twenties.

I will ask that an estrogen test be done along with my next lipid profile. Even if it's high, WTF am I supposed to do? I had gyno when my T normal, I had gyno when my T was low, and I still have gyno when my T is back to normal.

Bummed

[TigerPaws]

I appreciate the advice, but I am not, nor have I ever been, carrying extra fat. I wear the same size clothing in my fifties as I did in my twenties.

I will ask that an estrogen test be done along with my next lipid profile. Even if it's high, WTF am I supposed to do? I had gyno when my T normal, I had gyno when my T was low, and I still have gyno when my T is back to normal.

Bummed

You may also be highly susceptible to breast development, this is genetic and there is nothing that can be done about it. Many girls do not actually feel their breasts growing, they simply discover their development when it becomes noticeable. You could be in this category along with being predisposed to developing breasts from very small quantities of the offending hormones.

There is no way to know.

[cpa5oh]

I appreciate the advice, but I am not, nor have I ever been, carrying extra fat. I wear the same size clothing in my fifties as I did in my twenties.

I will ask that an estrogen test be done along with my next lipid profile. Even if it's high, WTF am I supposed to do? I had gyno when my T normal, I had gyno when my T was low, and I still have gyno when my T is back to normal.

Bummed

Body fat causes an increase in aromatization, and I don't know you from Adam, so that's why I mentioned that.  No matter, aromatization of testosterone increases as you get older.  If estrogen is high, you have to get it down.  TigerPaws is right: you may be susceptible to more breast growth than the average man (some guys go on steroids and don't take an anti-estrogen and have no issues with breast growth...some guys have to be on an anti-estrogen throughout...I know you aren't taking steroids, but the aromatization of your natural testosterone and the aromatization of exogenous testosterone is the same).  There's still got to be a cause and the most obvious answer (high estrogen) needs to get ruled out.  The relationship between estrogen and testosterone is complex: high estrogen can cause low testosterone, which you'd think would be a means to an end, but it doesn't sound like it is and I think the number of doctors that really know what's going on is low (because they don't care, really).  My opinion is guys like us need to have our testosterone and estrogen levels monitored continually: an anti-aromatase drug like Arimidex should bring estrogen levels right down.  Clomid is a SERM (won't lower overall estrogen levels) and I've never read anyone use it for gynecomastia related issues: the SERMS that occupy the estrogen receptors in breast tissue are tamoxifen and raloxifine...again, I'm not a doctor, but it seems to me that the SERM you're taking could be a contributor to the problem.

[rrr]

[font="Open Sans", Helvetica, Arial, sans-serif]My opinion is guys like us need to have our testosterone and estrogen levels monitored continually: an anti-aromatase drug like Arimidex should bring estrogen levels right down.  Clomid is a SERM (won't lower overall estrogen levels) and I've never read anyone use it for gynecomastia related issues: the SERMS that occupy the estrogen receptors in breast tissue are tamoxifen and raloxifine...again, I'm not a doctor, but it seems to me that the SERM you're taking could be a contributor to the problem.[/font][/color]

I will take the advice and have estrogen checked again. However, if it is high, I don't have any good options. Stopping Clomid means my testosterone will go back to low levels. Taking an estrogen blocker brings other health risks and side effects, and it is a lifelong process. Either way, my gyno started before my low T problem (at least before low T was discovered), and if that is what triggered the gyno, there appears to be nothing I can do.

Low T causes gyno?
Normal T causes gyno?
High T causes gyno?

Sheesh

[TigerPaws]

Overall you may simply have a predisposition to developing breasts. While this was not the case for me, when my Testosterone was fully suppressed and replaced with Estrogen my breasts developed quickly and fully into a natural female form.


There is not way to know as it is the luck of the genetic draw. Rather than dwelling on the why me consider moving on with your life. Looking back is self destructive, moving forward is the only reasonable option.


How or if you deal with the hand you have been dealt is up to you.  

[rrr]

There is not way to know as it is the luck of the genetic draw. Rather than dwelling on the why me consider moving on with your life. Looking back is self destructive, moving forward is the only reasonable option.

Well, since it is still in progress, the why could help stop it. As it is an ongoing situation, it's kinda hard to be moving forward when the present is still very much in play.

If I was a couple years past when the growth stopped, yes, it's done, it's in the past, let's move forward. Right now, all forward means is more growth...

Bummed

[TigerPaws]

There is not way to know as it is the luck of the genetic draw. Rather than dwelling on the why me consider moving on with your life. Looking back is self destructive, moving forward is the only reasonable option.

Well, since it is still in progress, the why could help stop it. As it is an ongoing situation, it's kinda hard to be moving forward when the present is still very much in play.

If I was a couple years past when the growth stopped, yes, it's done, it's in the past, let's move forward. Right now, all forward means is more growth...

Bummed

Ok and what? There is nothing that can be done, your growth could go on for years, what are you going to do gripe and complain?

Time to accept who and what you are or simply end yourself.

[cpa5oh]

My opinion is guys like us need to have our testosterone and estrogen levels monitored continually: an anti-aromatase drug like Arimidex should bring estrogen levels right down.  Clomid is a SERM (won't lower overall estrogen levels) and I've never read anyone use it for gynecomastia related issues: the SERMS that occupy the estrogen receptors in breast tissue are tamoxifen and raloxifine...again, I'm not a doctor, but it seems to me that the SERM you're taking could be a contributor to the problem.

I will take the advice and have estrogen checked again. However, if it is high, I don't have any good options. Stopping Clomid means my testosterone will go back to low levels. Taking an estrogen blocker brings other health risks and side effects, and it is a lifelong process. Either way, my gyno started before my low T problem (at least before low T was discovered), and if that is what triggered the gyno, there appears to be nothing I can do.

Low T causes gyno?
Normal T causes gyno?
High T causes gyno?

Sheesh

I think (and I'm just trying to help so take whatever you want from this) that T level is a factor but you can't draw any conclusions from T level alone because it isn't the direct cause - aromatization of that testosterone into estrogen is the direct cause.  Both the level of aromatization (amount of aromatase enzyme your body produces) and the testosterone level (more testosterone to aromatize) are factors and different combinations can lead to high estrogen: low T with lots of aromatase enzyme could equal high estrogen...high T with normal amounts of aromatase could equal high estrogen...high T with low aromatase could equal low estrogen...etc.  And Tiger Paws is right: one guy could have high estrogen and never have a gynecomastia issue...another guy could have lower estrogen than the first guy and have a gynecomastia issue.  Sounds confusing but it really isn't: you and I are the guys that, if we have high estrogen, we're going to have gynecomastia issues (and we might be in the majority because I see lots of guys with chest growth).  If our estrogen level is high, it's because we're aromatizing a lot of testosterone into estrogen.  That could be because we produce more aromatase enzyme or because we have a lot of testosterone to aromatize (the latter is me: testosterone level 781 and estrogen 220).

You do have options if your estrogen level is high.  You are using a SERM right now which has no effect on global estrogen level.  All that does is block estrogen receptors in tissues.  And as far as I know, it isn't as effective as Tamoxifen in blocking estrogen receptors in breast tissue (don't think it's used at all in female breast cancer treatment, but I could be wrong).  Clomid does raise testosterone levels by blocking the receptors that can get occupied by estrogen to cause the body to think that testosterone is high when it is not.  Tamoxifen does the same thing and it seems to be preferred by drug using bodybuilders (and frankly, I trust their collective knowledge more than doctors who don't care about the issue).  

You also have the option of using an aromatase inhibitor: this blocks the production of the aromatase enzyme (no aromatase enzyme, no estrogen).  Drug using bodybuilders don't use it post drug use to restart their testosterone levels because a total crash in global estrogen isn't desirable (they do use aromatase inhibitors while using drugs to keep estrogen levels in check).  But that wouldn't be your purpose for using it: your purpose for using it would be to get your estrogen level into the normal range.  Unfortunately, the only way to know how a dosage effects your estrogen level is to have blood tests for estrogen level frequently...I'm using anastrozole (arimidex) at .5 mg every other day and I'll have an estrogen only blood test done in two months: if estrogen isn't low-normal, I'll up the dosage (most likely, it's going to be too low and I'm going to have to reduce the dosage...but we'll see what happens).  If you think taking an anti-estrogen for an extended period is a health issue, I'd submit that high estrogen levels pose health risks too.

Lastly, I don't believe that if you get estrogen from high to normal that you'd be stuck on anti-aromatase drugs for the rest of your life.  I think hormone levels can get out of whack, need to be brought back normal, and can be maintained (and should be monitored) going forward.  All kinds of things can cause hormones to get out of whack: stress, lack of sleep, training (or not training), environmental factors, etc. which means all kinds of things can be done to maintain normal hormone levels once they are achieved.

This is really the last thing: surgery.  If you get a bunch of the breast tissue/gland removed through surgery, you may be less susceptible to estrogen induced gynecomastia going forward.  There are bodybuilders who developed gynecomastia, had the surgery, and then continued their drug use without recurrence.  I think that this is where having an excellent surgeon comes in: there's a balance they have to contend with, which is taking too much gland material and you having cavity deformation or not taking enough and, if you get into high estrogen again (or never get it under control), you've got a lump and growth again.  

I think you've got tons of options.  

[TigerPaws]

Hence the age old saying "You pay your money and you take your chances".

The is only one guarantee in life, eventually you will die. Beyond that everything else is up to you.

Gynecomastia will not kill you, it is a best an inconvenience. If you believe that a surgical procedure will help then pay your money and take your chances. If you get the results that you want, good for you, if things go badly or terribly wrong then you only have yourself to blame.

There is a reason for your (and every others man) breast development, the question is always what and that can be difficult. If a cause cannot be found then a man may need to make whatever decision may work best for him.

[rrr]

(and we might be in the majority because I see lots of guys with chest growth)

This keeps being mentioned in this forum, and I really wonder what crowds you are mingling with.

I have seen 2 or 3 guys with any breast that could be seen through clothing and I've never seen a guy wearing a bra. And no, I do not live in the boonies, nor am I a hermit. And yes, I do look. I have looked for nearly 2 years.

Of course I'm not counting the 2/3 that are overweight or obese, since they can have mostly moobs and it just blends with the rest of the rolls.

I live in a small city (a bit over 100k population), it's diverse and a major college town. Where are all these guys with gyno living? It doesn't seem to be in my area.

I think if I saw significant numbers of guys with boobs, some even wearing bras, I would not be so insecure about it.

Bummed

[hammer]

Bummed, you are a moron!

You say you live in a small city 100k! I reiterate, you are a moron! As I said in another post I live in a suburb of Saint Paul a population of 22,000! Different country thank God! I even maintain the secondary backup radios for my Police Department! The state of Minnesota is on the 800mhz system but I provide a VHF backup radio system for my Police Department. And I live in a relatively small town of 22K

And I'm known by a ton of people who live here because I grew up here, I live here, I provide the radio system for the city,ect...

I should add that I did the same thing for the country Sheriff's office for 12 years!