If this is gyno, what caused it?

[ducky]

Hi there. I suspect I have gynecomastia. However,if I do, I don't understand what caused it.


I'm a 2nd year medical student and interested going into endocrinology, so I've been trying to figure it out. Also, I don't want to get the surgery done unless I know what I did to cause it, otherwise I fear I'll develop it again and require a 2nd surgery.


Here are some pictures.












About me:
- Did not have gynecomastia/puffy nipples/anything irregular until about age 24 (well past puberty)

- Have never used anabolic steroids or anything else that would provoke hormone levels to my knowledge.

- Aside from my suspect gyne, I am in perfect health. A few pounds overweight.

-No definite "hard" feeling around my nipple, but when I press into it, I do feel something, like a group of tiny round balls. Is this breast tissue?



- I began to notice puffyness of the nipple very gradually. First at the age of 24, and at around age 26 it was very noticeable to me.

During this time period I was trying to pack on muscle, and taking about 6-7 protein shakes a day.

Also around ages 21-23 I was on low-dose Accutane.

I also put on weight during ages 22-25, I went from about 140lbs to 170lbs. Obviously not all muscle and much of it is fat, however my abs still show and I dont even think I can consider myself overweight, though for my specific frame I do have some extra pounds.


Questions
Has there been any association with gynecomastia and Accutane?

Is it possible a component in protein powder (possibly phytoestrogens?) could have caused gynecomastia?


Is it possible that it is just fat and I'm just being a paranoid med student? lol.

Thanks.

[Dr. Elliot Jacobs]

Yes, medical students tend to over-diagnose (I did it myself when in medical school).

Most gyne starts in puberty or in older age.  Onset in one's 20's might be due to exogenous causes (perhaps something in the protein shakes you are taking) or it could be hormonal (check your prolactin levels).  Or, it could be associated with weight gain (exercising during med school is tough to do when time is spent studying so much).

good luck!

Dr Jacobs

[DrPensler]

Steroid use or ingestion can result in gynecomastia. You have gynecomastia. Many plants produce chemicals that mimic or interact with hormone signals in animals. At least 20 such phytohormones have been identified in at least 300 plants from more than 16 different plant families . The estrogen-like phytoestrogens are the most studied of all the phytochemicals. In general, phytoestrogens are weaker than the natural estrogen hormones (such as estradiol) found in humans and animals or the very potent synthetic estrogens used in birth control pills and other drugs but there are reports of biologic effects from them.