gyno and TRT Did I cause my Gyno by taking testosterone replacement?

[Chicago Cop]

Life has been pretty rough these past ten years.  Severe ED, fairly severe depression, dramatic weight gain, and Moobs!  My Primary Care Doctor has been my friend since the 7th grade.  He is a good man and good doctor, but he is ultra-conservative in all aspects of life.

My doctor treats me for high blood pressure, GERD and depression but has always rejected any treatment for ED.  He says that men over 50 shouldn't expect much of a sex life. 

Recently I have started seeking help from other doctors.  My endocrinologist put me on Androgel 7g per day.  I can't say that this made much of a difference.

I sought help for removal of my Moobs - and I found it!  A caring and affordable surgeon right here in Chicago; Dr. Pensler.  Dr. P performed my Gyno surgery about 6 weeks ago and found "gargantuan" pieces of breast tissue. 

I also sought help from an ED specialist.  He has shown me how I can use Tri-mix to once again have a normal sexual function BUT - he also thinks that my testosterone level is still way to low.  He increased the dosage and switched me over to an injectable form of Testosterone.  Man do I feel better! I am no longer suicidal.  I see that there might actually be life after age 50!

But, I am afraid. Will taking the testosterone cause my Moobs to come back?  Will taking the testosterone cause any other life threatening illness?

When I told my Primary Care doctor that I had had my Moobs removed he was very dismissive and said that he couldn't believe that I would let a purely cosmetic issue drive me to such lengths.

When I told him about the testosterone replacement he left the exam room and told me that he would not be responsible for that aspect of my health anymore -that he would only monitor my high blood pressure from now on and that was it!

So now I feel really conflicted.  what have I don't?  What should I do?

[Litlriki]

Properly administered, hormone replacement therapy in men will not cause gynecomastia.  Indeed, it may serve to prevent it by maintaining normal levels of testosterone and controlling for excess estrogens (estradiol).  This is very different from "performance enhancing" steroid use, which is cyclical and goes to excesses in hormone levels. This results in fluctuating levels of testosterone and estradiol, which can stimulate breast tissue growth leading to gynecomastia. 

Ideally, your hormonal management would be monitored by your primary care doctor, who could watch for things like heart disease or prostate disease, things that are associated with HRT.  If he's not comfortable with prescribing the medication, and you have a specialist doing that and monitoring your hormone levels, your PCP should at least be aware of your regimen and able to answer your questions.  If you share with him what you've shared here ("Man do I feel better! I am no longer suicidal."), he might rethink his judgmental attitude toward HRT. 

Good luck,

Rick Silverman

[Dr. Elliot Jacobs]

Agree with Dr. Silverman.  One more item, however. Whenever you tinker with your very delicately balanced hormones, you should check estrogen levels as well.  Sometimes your testosterone may change (aromatize) to estrogen, which in turn could possibly stimulate breast growth.  Should you begin to develop elevated estrogens, your physician might prescribe an estrogen blocker while still allowing you to continue on the testosterone replacement.

Dr Jacobs