True Gynecomastia Gone But Symptoms Remain?

[John86]

(I posted this in the "puffy nipples" section a week ago to no avail and was recommended to re-post here.)

Last September I underwent a lumbar discectomy, before that I was very active physically, but afterwards I went through a period of inactivity where I gained weight and also, to my surprise, two hard, painful lumps growing under my nipples.  My nipples also seemed to have gotten larger and "puffier", which is particularly noticable when I'm warm.  Eventually I went and saw an endocrinologist who confirmed it was gynecomastia and sent me for some blood tests.

When I saw him again in January, the lumps had practically gone (which he guessed they would have before I told him as much, presumably based on my test results).  I was so relieved when he told me within a month or two they'd be gone entirely that I forgot to ask any further questions.

Unfortunately I still have the unsightly, puffy nipples despite the fact the hard lumps have gone entirely along with the pain.  If the gynecomastia goes away on it's own with no treatment do the pseudogynecomastia symptoms soon follow it, or can they be permanent?  Worthy of note that I had hoped losing my weight would rid me of them but it hasn't; I'm at 11-13% (calipers) bodyfat at the minute so if it's a contributing factor I can't imagine it's a large one (I was able to resume exercising in January).

I mention the exercise only because the endocrinologist was never 100% sure what caused this in the first place, but it seems to be too much of a coincidence that it happened at exactly the same time I was laid up due to surgery.

Any information would be deeply appreciated, I've been going nuts trying to separate fact from fiction online.

Edit:  Should probably have also mentioned my age as it's relevant.  I'm 26.

[Litlriki]

Gynecomastia has various stages, and the florid phase is characterized by swelling, sensitivity or pain in the nipple-areolar region, may include some nipple discharge, and a lump and puffiness may be present.  Over time, particularly as the stimulus causing the gynecomastia resolves, it moves into the fibrous phase.  This is still gynecomastia, and that may be where you are now.  I'm not really able to address the cause of your condition from the events you've described.

Rick Silverman

[John86]

Thank you for the reply Dr. Silverman,

My endocrinologist originally suspected a medication I was taking (Mirtazapine) was raising my prolactin levels, but after ruling that out he just said that "sometimes the cause is unclear".

If the stimulus has been resolved and that is why I've moved from the florid phase into the fibrous phase as you've described, are there cases where this regression has continued until the symptoms are gone entirely, or are the majority of people left at this stage?  I've read that teenager's symptoms often go away entirely on their own, but that adult men usually have to opt for surgery, though this could be misinformation.

[Dr. Elliot Jacobs]

In many cases of gynecomastia, the exact cause cannot be determined.  Doctors call this "idiopathic" -- ie we just don't know.

Your history is complicated and there may have been some possible causes buried in your medications, hormones, etc.  But that is all past and you are now dealing with the resultant breast tissue.

There is absolutely no harm in waiting and observing -- sometimes for 6-12 months, until your chest has stabilized.  Then, assuming there is still some tissue present,  do some thinking as to whether it is something you can live with or wish to remove.  If you wish to have it removed, then do your research and find an experienced gyne surgeon.

Dr Jacobs

[John86]

Thank you for the information Dr. Jacobs,

I realise it's still early days, I think it will be easier to wait and see because now the lumps have gone it doesn't show as obviously through a shirt as it used to, and I'm no longer flinching away in pain when my wife or daughter hug me.  I'll take a view to it in another 6-12 months as suggested.  Thanks again.