Testosterone treatment

[jdb]

Hi, I have had severe gynecomastia for about 7 years now, originally caused by bilateral orchitis destroying the function of my testes.  I am in my fifties and not particularly overweight but have breasts that any young woman would be proud of.  I have recently been complaining of being very tired and a hormone test showed almost zero testosterone.  The doctor has prescribed Testim, a testosterone gel.  The trouble is one of the more common side effects of this treatment appears to be gynecomastia! It says to be used with caution when the patient has existing gynecomastia. Is there anything I can take to minimise this side effect?  I have learnt to live with this deformity and have an understanding wife but for heavens sake, the last thing I want is for them to grow even bigger!

Thanks.

[Litlriki]

Gynecomastia develops because of an imbalance in the relationship of estrogens to testosterone, in your case resulting from low testosterone after orchitis.  While testosterone administered  in excess can lead to gynecomastia, in your case, the treatment is designed to restore your level to a normal one. That could actually be required to manage your gynecomastia and prevent it from worsening.  Should you decide to have the condition treated surgically, you should be sure to have your hormone levels under control beforehand--with testosterone replacement--otherwise, you're likely to have recurrence.

I hope that's helpful.

Rick Silverman

[jdb]

Thanks for your advice.  That is a relief.  The trouble with some medicines is that they give so little information.  In this case, as far as gyno is concerned, it just gives a "may cause breast enlargement in men". Not very helpful!
I probably will not have surgery, I am nearly sixty, I have had my family and am not the type to sit in the sun with my top off. My condition is bad enough to warrant skin removal so scarring would be inevitable.
Thanks again,  JDB

[Dr. Elliot Jacobs]

There are certain levels of testosterone that are appropriate for men at various ages.  If your testosterone is low for your age, then certainly supplementation should be considered.  Any doctor prescribing hormones should constantly monitor your hormone levels -- all of them.  That means your levels of estrogen as well.  Sometimes testosterone can change (technically, it is called aromatization) to estrogen -- which can then stimulate any breast tissue you have to grow larger.  But there are estrogen blocking medications available -- just ask your endocrinologist.  If this is necessary, you might be able to have your testosterone supplementation and at the same time avoid stimulation of breast growth.

Would hold off on any gyne surgery until your hormone treatment is in a stable state -- then go for it!!

Dr Jacobs

[DrBermant]

Hi, I have had severe gynecomastia for about 7 years now, originally caused by bilateral orchitis destroying the function of my testes.  I am in my fifties and not particularly overweight but have breasts that any young woman would be proud of.  I have recently been complaining of being very tired and a hormone test showed almost zero testosterone.  The doctor has prescribed Testim, a testosterone gel.  The trouble is one of the more common side effects of this treatment appears to be gynecomastia! It says to be used with caution when the patient has existing gynecomastia. Is there anything I can take to minimise this side effect?  I have learnt to live with this deformity and have an understanding wife but for heavens sake, the last thing I want is for them to grow even bigger!

Thanks.

Natural testosterone levels are a dynamic condition in the male. They change with the interplay of the pituitary gland and testicles. Blood tests of testosterone levels will vary from hour to hour and throughout the day.  Any exogenous source of testosterone can never duplicate this delicate balance act. The worst used to be injection once a week or two testosterone. There is a horrible extreme level followed by a prolonged period that varies from too much finally ending up as too low a level. The body is exposed to way to much, just the right amount, and too low a level over this course. Male breast gland tissue bathed in such high levels tends to be stimulated and grows.  The newer gels, patches, intraoral options are much better. However, they should never be applied to the breasts nor to the groin. The peaks are not as high, the lows not as low but still this is not a delicate as real working testicles. Constant monitoring of blood levels of hormones is just not practical at present.  Antiestrogens and other such options have their own risks.  Such issues are best explored with an experienced endocrinologist who will take the time for good patient education. That can be a challenge in itself.

Perhaps one day someone will evolve an implantable pump activated by the body's own demands. Until then, we are stuck with the imperfect system we have so far.

Hope this helps,

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

[jdb]

Thanks for all your replies, it seems nothing is simple in life.  It seems to be like a conspiracy, a catch 22. You get gynecomastia if your testosterone levels drop and you get it worse if you have it replaced! I will talk to my doctor about monitoring my estrogen levels and perhaps being referred to an endocrinologist.