Does the gland produce fat?

[MonarchX]

The gland is a hard material, but what makes me wonder is why its always surrounded by fat EVEn in body-builders who are ripped and have VERY low body fat.  I would think that the fat around the gland would go away and just the gland would stuck out.  However, the gland is ALWAYS covered in some fat.

Does it produce it?

[ireallyhatemyself]

yes, and that fat is controlled by the (usually) now inactive gland so it never goes away

[lopher]

Complete nonsense  

I've never seen a competitive bodybuilder at a show compete with anything BUT gland.

The gland does not 'make' fat, nor controls it. What a stupid thing to say. The gland is simply stimulated to grow by an excess amount of estrogen, and in turn an excess of estrogen will often produce fat deposits on your body in a feminine like way including the breast area.

Fat and gland are both completely seperate, but spurred on to grow by the same thing, estrogen.

Here's a good example of a competitive bodybuilder with gland only:

http://www.plasticsurgery4u.com/procedure_folder/male_breast/gyno_bodybuilding.html

Taken from Dr B's very own site,

See if you can find any fat on his chest...


lopher

[MonarchX]

Yeah...there is fat between the nipple and the gland.  There is no way the gland extends in such a way and such a shape.

[lopher]

Yeah...there is fat between the nipple and the gland.  There is no way the gland extends in such a way and such a shape.

Well there's always going to be some fat remaining. Competitive bodybuilders go down to maybe 4% bodyfat, not 0%.

If you look at the shape of the gland removed in that picture I think it all makes sense:

http://www.plasticsurgery4u.com/procedure_folder/male_breast/gynecomastia_bodybuilder.html


lopher

[Drew]

This is a better example of 'fat-free' breast tissue.
(graphic)
http://www.plasticsurgery4u.com/puffy_nipples/bodybuilder_puffed_nipples.htm

[supaaman]

Complete nonsense  

I've never seen a competitive bodybuilder at a show compete with anything BUT gland.

The gland does not 'make' fat, nor controls it. What a stupid thing to say. The gland is simply stimulated to grow by an excess amount of estrogen, and in turn an excess of estrogen will often produce fat deposits on your body in a feminine like way including the breast area.

Fat and gland are both completely seperate, but spurred on to grow by the same thing, estrogen.

Here's a good example of a competitive bodybuilder with gland only:

http://www.plasticsurgery4u.com/procedure_folder/male_breast/gyno_bodybuilding.html

Taken from Dr B's very own site,

See if you can find any fat on his chest...


lopher

Not exactly true.  I have had a reknown PS tell me differently.  Not much is known about gyne or why it develops.  Studies show that with the majority of cases (onset at puberty) that there is usually not higher estrogen than normal.  The feeling is that somehow testosterone is interpreted incorrectly for a short time during puberty.  As a result, the glands (that are present in every male) develop more.  When the gland is mixed with the fat (fingers of gland) it becomes very stubborn to lose.  One would have to get down below the 5% bf, or so, to finally eat away at that fat.  That's why some body builders get pretty close to getting rid of gyne.  I think many of us gyne sufferers turn to body building to hide and minimize our gyne as best we can.

I am obviously not an expert either (although he is), but the explanation sounds plausible.  However, I think gyne is not well understood at present and most explanations are not based on highly empirical evidence.  I think we will find out much more as the body of knowledge grows in relation to gyne.

[snugs]

Not exactly true.  I have had a reknown PS tell me differently.  Not much is known about gyne or why it develops.  Studies show that with the majority of cases (onset at puberty) that there is usually not higher estrogen than normal.  The feeling is that somehow testosterone is interpreted incorrectly for a short time during puberty.  As a result, the glands (that are present in every male) develop more.  When the gland is mixed with the fat (fingers of gland) it becomes very stubborn to lose.  One would have to get down below the 5% bf, or so, to finally eat away at that fat.  That's why some body builders get pretty close to getting rid of gyne.  I think many of us gyne sufferers turn to body building to hide and minimize our gyne as best we can.

I am obviously not an expert either (although he is), but the explanation sounds plausible.  However, I think gyne is not well understood at present and most explanations are not based on highly empirical evidence.  I think we will find out much more as the body of knowledge grows in relation to gyne.

Do you know of any literature to back up that 5% figure? I'm not challenging it, justcurious.

[supaaman]

Hey Snugs,

When I spoke to the "expert" he did actually say "about 5% bf" - I don't think he meant literally/exactly 5%.  I think his point was that it is stubborn fat, like in the female breast, where it would be the last place you lose it... obviously it would vary from person to person, to some degree, but probably close to the 5% mark.  So, the gland, from what he said, is finger-like and mixes in with the tissue (fat).  I think he said it actually mixes in and "swirls" - I can't recall exactly how he described it.  The gland, therefore... I am assuming somewhat... makes it difficult for the fat to shrink as it might in other areas of the body.   I think my explanation (and his) is oversimplified to some degree.  But, he illustrated the point in a good way for the layman to understand, I think.  Again, I don't think there is a lot of empircal knowledge and solid understanding, unfortunately... but it was good to get a basic understanding.

[Hypo-is-here]

This is a very pinickity discussion.

I think the important point is that an excess amount of estrogen can stimulates the increase of glandular mass and it also can lead to a Gynecoid body shape, with an excess amount of visceral fat that accumalates on the chest, hips and thighs.

[billybob2]

also if you do go to working out a lot--kinda like I did--you'll lose sag in that area. I got to the point where basically you see a pec, and then a puffy nipple (I've had surgery now tho). And my body fat is around 20%. But I guess all people will react differently.

[supaaman]

Yeah, I'm in the same boat as you... approx 20% fat, but I have been much lower (~12%) and the problem still existed to some extent.  I have been reading "Hypo" here for a while and he is probably the most knowledgable person posting here.  I respect his expertise, but the doctor I talked to is a reknown expert too and he definitely said that studies show that in most cases that there is not excess estrogen.  He said it is not well understood why the body builds excess gland in that are, but a theory was that during puberty, testosterone is actually interpreted incorrectly.  I'm sure he broke this down as simply as he could for the layman and "Hypo" would find these generalizations not very empirical or valuable, but basically I don't believe the assertion that there is excess estrogen necessarily.  

As for a gynecoid body shape, that's defintely not my case and from what I have seen here it far more rare than guys with just puffy nips and some excess in the chest only.  From photos here, I see most guys with normal male physiques, with some level of gyne in the chest.  I think this condition tends to get guys working out a lot to try to correct their condition and so I see many with great phyiques, and highly "male" physiques, posting here.  That was the most suprising thing for me when I started visiting here.  I thought I would be rare.  I expected it to be mainly really "fat" guys and guys with major hormone problems with really large breasts.  I found that most are just like me, good male builds, etc. but " subtly imperfect" chests that they would love to correct.

So, I think Hypo's suggestion of a "gynecoid body shape" is, by far and away, more the exception than the rule.

[ireallyhatemyself]

Complete nonsense  

I've never seen a competitive bodybuilder at a show compete with anything BUT gland.

The gland does not 'make' fat, nor controls it. What a stupid thing to say. The gland is simply stimulated to grow by an excess amount of estrogen, and in turn an excess of estrogen will often produce fat deposits on your body in a feminine like way including the breast area.

Fat and gland are both completely seperate, but spurred on to grow by the same thing, estrogen.

Here's a good example of a competitive bodybuilder with gland only:

http://www.plasticsurgery4u.com/procedure_folder/male_breast/gyno_bodybuilding.html

Taken from Dr B's very own site,

See if you can find any fat on his chest...


lopher

I guess you know more than Dr Fielding then when he told me verbatim the fat around mantits is gland operated and is the reason it never goes away, my bad.

[Hypo-is-here]

the doctor I talked to is a reknown expert too and he definitely said that studies show that in most cases that there is not excess estrogen.  
.

Ah yes however….

Most men who have estradiol levels high enough to cause gynecomastia are within the normal male reference range.  Which makes you wonder somewhat, what is the point of a supposedly normal male reference range if it doesn’t confer or imply the notion of well-being?

You see there are many problems with reference ranges and abstract cut-off points.

First of all we have the fact that there is no age range, no differentiation between the normal reference range of the hormones of a 17 year old and those of a 90 year old!

Heart function, vascular health, liver function, renal function, immune system etc etc etc, you name it everything deteriorates with age.  You would never expect the heart function, hearing, eyesight etc of a 90 year old to be the same as that of a 17 year old, what is acceptable for a 90 year old , what is normal for an elderly man is highly unlikely to be normal for a young man.  But because we have no differentiation in the normal range between elderly men and young men, the elderly men statistically greatly reduce the lower end of the reference range of testosterone and greatly increase the upper level of the reference range for estradiol.  So young men with low levels of testosterone are often told they are normal, despite the fact that they are not remotely normal for their age and the same is so when it comes to estradiol levels.

The above fact has been taken on board by some endocrinologists that specialize in reproductive endocrinology, which is why many of these experts are coming round to the fact that symptoms and physical presentation are of equal importance as blood results.  These experts who are in the vanguard of hormonal male health are much more skilled at interpretation of blood results in the context of the overall clinical picture than your bog standard endocrinologist or gp who very often incorrectly views hormonal pathology within strict/straightjacket definitions as exacted by the reference ranges..

Many forward thinking endocrinologists in this field are looking at testosterone levels around the 5th percentile for age alongside symptoms, they also look far greater into symphony/synergistics of hormonal health whether that is looking at the SHBG, Estradiol etc.

Again looking at the limitations of abstract cut off points within hormonal assays;

Let’s say patient A has an estradiol level of 51pg/ml.  Now suppose we take 1000 men of seemingly good health and from this number of men we obtain our reference range, let’s call it reference range X.  Let us say that reference range X dictates that the normal male range reaches 55pg/ml. Now we can see that according to reference range X, man A is normal.  Now let’s say that we go ahead and obtain a new reference range following the same protocol, we obtain our reference range, let’s call it reference range Y.
Now due to the differing human statistical presentation, let us say that reference range X dictates that the normal male range reaches 50pg/ml.  Now can you see our problem?

According to reference range X patient A has a normal estradiol level, but according to reference range Y patient A has an abnormal estradiol level.  Both reference ranges were obtained following the same protocol, so which one do we believe to be correct?

I would suggest that the problem lies with abstract cut-off points and strict interpretation of pathology data rather than a flaw with reference ranges.  It is about understanding the whole clinical picture and realizing that the blood pathology does not exist in isolation/a vacuum….interpretation is the key IMHO.

Again the point being I think your doctor is totally wrong and his definition of excess estradiol almost certainly too strict and incorrect.

I could go on and detail the problems that exist with testing estradiol in men because of the fact that equipment is very often calibrated around female reference values, the fact that estradiol tests themselves are very often lacking accuracy, with a view to again disputing the idea that excess estrogen is not an issue in the development of gynecomastia…..don’t worry I wont, neither shall I talk about issues relating to lognormal transformations of reference values.

What I will go onto talk about is the importance of relative excess estrogen;

Most doctors including many endocrinologist fail to understand what represents excess estrogen.  This is because many doctors fail to understand that the crucial factor in the development of gynecomastia is often a relative excess or imbalance of estrogens to androgens, basically if the endocrine balance or ratio favours estrogens then gynecomastia is likely to develop.

This means that SHBG is an important factor as 98 percent of serum testrosterone is bound to this protein and rendered inactive in the body.  SHBG binds estrogens as well as testosterone, however it binds to estrogens with less affinity, this means subtle increases/elevations of SHBG can radically alter the endocrine balance so that it favors estrogens and produces a “crucial relative excess of estrogens”.  Very often estrogen or rather the potent estradiol which is what is measured is not overtly elevated, but due to the actions of SHBG, the individual can still have a “crucial relative excess of estrogens”. A highly skilled reproductive endocrinologist will be able to correctly interpret this from correct hormonal assays and take further action, whereas general endocrinologists or gps will fail to grasp the issue at hand.

Of course SHBG isn’t the only factor here.  When considering the crucial androgen to estrogen ratio it is important to look at many factors.
The testosterone to estradiol relationship is crucial, irrespective of SHBG.  If a man has a testosterone level of 800ng/dl and an estradiol level of 40pg/ml then he will be within the normal range of both reference ranges and he may well be well with those sort of levels, however if a man with 400ng/dl has the same estradiol level of 40pg/ml his testosterone to estradiol level is FAR less than that seen in the man above and despite not having an absolute lack of testosterone or an absolute excess of estradiol his testosterone to estradiol ratio and androgen to estrogen ratio maybe quite poor and favor estrogens and in so doing produce gynecomastia.

So again the issue can and often is one of a relative excess of estrogen.  

Other issues;

Men who have taken Proscar, Propecia or other treatments that contain finasteride or anti dihydrotestosterone (DHT) medications often end up with gynecomastia, this happens because the androgen to estrogen ratio ends up favoring estrogens over androgens because DHT has been reduced.  Some information is coming to light that these medications are also raising estrogens and/or SHBG, if this is true then these medications produce a double whammy effect on the male endocrine system.  But again, If a bog standard endocrinologist or gp was to take a look at hormonal pathology they would probably only test testosterone and ancillary hormones.  In doing this they would fail to test the crucial DHT which has been lowered and possibly miss out on SHBG or fail to understand that subtle increases in estradiol coupled with a lowered DHT could have quite substantial effects one of course being the development of gynecomastia.

Men with Klinefelter syndrome have often been found to have testosterone levels well within the normal range, in such cases their bodies are predisposed genetically to favor estraogens hence the fact that gynecomastia is common in men with Klinefelter Syndrome.  There are many but admittedly rarer conditions or drugs that lead to enhanced uptake/sensitivity to estrogens or decreased uptake or sensitivity to androgens, everything from inherited issues of aromatase excess to problems in the coding of the androgen receptor and problems of CAG repeats.

So the bottom line.


I think your doctor is talking out of his hat.

He said it is not well understood why the body builds excess gland in that are, but a theory was that during puberty, testosterone is actually interpreted incorrectly.  I'm sure he broke this down as simply as he could for the layman and "Hypo" would find these generalizations not very empirical or valuable, but basically I don't believe the assertion that there is excess estrogen necessarily.  

You don’t have to agree with me, it is your prerogative to agree or disagree.  In all honesty I don’t think it sounds as though your doctor is simplifying things for you.  It sounds as though he has little understanding of the facts.

The hypothalamus/pituitary factually cannot distinguish between testosterone and estradiol in terms of its negative feedback system, it only sees the overall/total hormonal level of the sex steroids combined.  This is why estradiol and or DHT lowers luteinizing hormone and subsequently testosterone levels even if the individual has insufficient testosterone and fully functional testicle and hypothalamic/pituitary axis.

As for a gynecoid body shape, that's defintely not my case and from what I have seen here it far more rare than guys with just puffy nips and some excess in the chest only.  From photos here, I see most guys with normal male physiques, with some level of gyne in the chest.  I think this condition tends to get guys working out a lot to try to correct their condition and so I see many with great phyiques,
.

First of all I have seen a lot of guys here with a gynecoid body shape, but it is not necessarily an easy thing to spot if you are not aware of it.  Secondly you would be very unlikely see a gynecoid body shape if the individual managed to get to a low body weight.

I found that most are just like me, good male builds, etc. but " subtly imperfect" chests that they would love to correct.

So, I think Hypo's suggestion of a "gynecoid body shape" is, by far and away, more the exception than the rule.

With 10% of typical gynecomastia sufferers having a hypogonadism and upto 25% suffering having an underlying medical condition I would doubt that is typically the case on these boards, though of course it maybe that way at the currect time....who knows?

 

[plato]

Ah yes however….

Most men who have estradiol levels high enough to cause gynecomastia are within the normal male reference range.  Which makes you wonder somewhat, what is the point of a supposedly normal male reference range if it doesn’t confer or imply the notion of well-being?

You see there are many problems with reference ranges and abstract cut-off points.

First of all we have the fact that there is no age range, no differentiation between the normal reference range of the hormones of a 17 year old and those of a 90 year old!

Heart function, vascular health, liver function, renal function, immune system etc etc etc, you name it everything deteriorates with age.  You would never expect the heart function, hearing, eyesight etc of a 90 year old to be the same as that of a 17 year old, what is acceptable for a 90 year old , what is normal for an elderly man is highly unlikely to be normal for a young man.  But because we have no differentiation in the normal range between elderly men and young men, the elderly men statistically greatly reduce the lower end of the reference range of testosterone and greatly increase the upper level of the reference range for estradiol.  So young men with low levels of testosterone are often told they are normal, despite the fact that they are not remotely normal for their age and the same is so when it comes to estradiol levels.

The above fact has been taken on board by some endocrinologists that specialize in reproductive endocrinology, which is why many of these experts are coming round to the fact that symptoms and physical presentation are of equal importance as blood results.  These experts who are in the vanguard of hormonal male health are much more skilled at interpretation of blood results in the context of the overall clinical picture than your bog standard endocrinologist or gp who very often incorrectly views hormonal pathology within strict/straightjacket definitions as exacted by the reference ranges..

Many forward thinking endocrinologists in this field are looking at testosterone levels around the 5th percentile for age alongside symptoms, they also look far greater into symphony/synergistics of hormonal health whether that is looking at the SHBG, Estradiol etc.

Again looking at the limitations of abstract cut off points within hormonal assays;

Let’s say patient A has an estradiol level of 51pg/ml.  Now suppose we take 1000 men of seemingly good health and from this number of men we obtain our reference range, let’s call it reference range X.  Let us say that reference range X dictates that the normal male range reaches 55pg/ml. Now we can see that according to reference range X, man A is normal.  Now let’s say that we go ahead and obtain a new reference range following the same protocol, we obtain our reference range, let’s call it reference range Y.
Now due to the differing human statistical presentation, let us say that reference range X dictates that the normal male range reaches 50pg/ml.  Now can you see our problem?

According to reference range X patient A has a normal estradiol level, but according to reference range Y patient A has an abnormal estradiol level.  Both reference ranges were obtained following the same protocol, so which one do we believe to be correct?

I would suggest that the problem lies with abstract cut-off points and strict interpretation of pathology data rather than a flaw with reference ranges.  It is about understanding the whole clinical picture and realizing that the blood pathology does not exist in isolation/a vacuum….interpretation is the key IMHO.

Again the point being I think your doctor is totally wrong and his definition of excess estradiol almost certainly too strict and incorrect.

I could go on and detail the problems that exist with testing estradiol in men because of the fact that equipment is very often calibrated around female reference values, the fact that estradiol tests themselves are very often lacking accuracy, with a view to again disputing the idea that excess estrogen is not an issue in the development of gynecomastia…..don’t worry I wont, neither shall I talk about issues relating to lognormal transformations of reference values.

What I will go onto talk about is the importance of relative excess estrogen;

Most doctors including many endocrinologist fail to understand what represents excess estrogen.  This is because many doctors fail to understand that the crucial factor in the development of gynecomastia is often a relative excess or imbalance of estrogens to androgens, basically if the endocrine balance or ratio favours estrogens then gynecomastia is likely to develop.

This means that SHBG is an important factor as 98 percent of serum testrosterone is bound to this protein and rendered inactive in the body.  SHBG binds estrogens as well as testosterone, however it binds to estrogens with less affinity, this means subtle increases/elevations of SHBG can radically alter the endocrine balance so that it favors estrogens and produces a “crucial relative excess of estrogens”.  Very often estrogen or rather the potent estradiol which is what is measured is not overtly elevated, but due to the actions of SHBG, the individual can still have a “crucial relative excess of estrogens”. A highly skilled reproductive endocrinologist will be able to correctly interpret this from correct hormonal assays and take further action, whereas general endocrinologists or gps will fail to grasp the issue at hand.

Of course SHBG isn’t the only factor here.  When considering the crucial androgen to estrogen ratio it is important to look at many factors.
The testosterone to estradiol relationship is crucial, irrespective of SHBG.  If a man has a testosterone level of 800ng/dl and an estradiol level of 40pg/ml then he will be within the normal range of both reference ranges and he may well be well with those sort of levels, however if a man with 400ng/dl has the same estradiol level of 40pg/ml his testosterone to estradiol level is FAR less than that seen in the man above and despite not having an absolute lack of testosterone or an absolute excess of estradiol his testosterone to estradiol ratio and androgen to estrogen ratio maybe quite poor and favor estrogens and in so doing produce gynecomastia.

So again the issue can and often is one of a relative excess of estrogen.  

Other issues;

Men who have taken Proscar, Propecia or other treatments that contain finasteride or anti dihydrotestosterone (DHT) medications often end up with gynecomastia, this happens because the androgen to estrogen ratio ends up favoring estrogens over androgens because DHT has been reduced.  Some information is coming to light that these medications are also raising estrogens and/or SHBG, if this is true then these medications produce a double whammy effect on the male endocrine system.  But again, If a bog standard endocrinologist or gp was to take a look at hormonal pathology they would probably only test testosterone and ancillary hormones.  In doing this they would fail to test the crucial DHT which has been lowered and possibly miss out on SHBG or fail to understand that subtle increases in estradiol coupled with a lowered DHT could have quite substantial effects one of course being the development of gynecomastia.

Men with Klinefelter syndrome have often been found to have testosterone levels well within the normal range, in such cases their bodies are predisposed genetically to favor estraogens hence the fact that gynecomastia is common in men with Klinefelter Syndrome.  There are many but admittedly rarer conditions or drugs that lead to enhanced uptake/sensitivity to estrogens or decreased uptake or sensitivity to androgens, everything from inherited issues of aromatase excess to problems in the coding of the androgen receptor and problems of CAG repeats.

So the bottom line.


I think your doctor is talking out of his hat.


You don’t have to agree with me, it is your prerogative to agree or disagree.  In all honesty I don’t think it sounds as though your doctor is simplifying things for you.  It sounds as though he has little understanding of the facts.

The hypothalamus/pituitary factually cannot distinguish between testosterone and estradiol in terms of its negative feedback system, it only sees the overall/total hormonal level of the sex steroids combined.  This is why estradiol and or DHT lowers luteinizing hormone and subsequently testosterone levels even if the individual has insufficient testosterone and fully functional testicle and hypothalamic/pituitary axis.


First of all I have seen a lot of guys here with a gynecoid body shape, but it is not necessarily an easy thing to spot if you are not aware of it.  Secondly you would be very unlikely see a gynecoid body shape if the individual managed to get to a low body weight.



With 10% of typical gynecomastia sufferers having a hypogonadism and upto 25% suffering having an underlying medical condition I would doubt that is typically the case on these boards, though of course it maybe that way at the currect time....who knows?

Superb post; you are extremely knowledgeable about this issue, and I completely agree with your assessment. However, once hormone levels reach a favorable ration, how likely is it that gynecomastia will recline? For instance, as cells die, would gynecomastia gland cells reproduce themselves at a lower rate due to a suppression of the hormones it takes to produce them, or is rehabilitation of a cell dependent on another catalyst? Thanks.