Important information for gynecomastia

[hypo]

All those who suffer from gynecomastia should be tested for kow testosterone (hypogonadism as it is termed).

Gynecomastia is often caused by a low testosterone production that sees estrogen taking too prominent a role in the male homonal system.

Low testosterone can cause serious long term health problems (increased risk of osteoporosis, increased risk of diabetes, increased risk of stroke and cardiac disease).  

Its symptoms are numerous but usually are;

low stamina eaily fatigued (similar to chronic fatige syndrome)
Poor concentration
Sparse body hair particularly underarms
erection problems/low libido
Difficulty losing weight/excess weight on the stomach and chest but no excess weight on arms or legs.

A blood test can be taken to confirm whether or not you have this condition.  

If your testosterone level is not low, the problem may be caused by the body converting (aromatase) your testosterone into estrogen.  Again this can be checked out by the blood test checking your estrogen/estraidol level.

Many people can see a reduction of gynecomastia from estrogen affecting medication Arimadex and Tamoxifen.

Below are links to low testosterone sites, the second of which is a forum where people are discussing gynecomastia medication.

http://www.androids.org.uk/index.html

http://www.globalandropause.com/forum/disc6_frm.htm


I also have gynecomastia, I am seeing an endcrinologist next week where I will be asking to be prescribed Arimadex in the short term and put on a waiting list for an operation on the NHS (uk health system).

I suffer from (low testosterone) Hypogonadism for which I am being treated with testosterone gel.

On Last thing thats very important!!

I have seen people suggesting on the forums to use testosterone gel to combat gynecomastia.  

Do not do this unless instructed to use such gel by a doctor!!!  

Doing so will significantly worsen your condition if it is caused by your own body converting testosterone into estrogen as opposed to simply producing too little testosterone.

[Jeff123]

Good info man, I recently went to an endo who checked me naked from head to toe...So get ready to drop the boxers lol

He said everything was looking normal but I got a blood test just to be sure, it also came out normal, or so he said. I really have no idea what the cause of my gyno is but it's definitely worth getting the levels checked.

[hypo]

Testosterone levels deemed to be within the normal physiological range are 300-1100ng/dL on the USA scale or 11-35nmol on the UK scale.

This scale is used by all the expert consultants (endcrinologists).  

Unfortunately it isn't a very sophisticated way of measuring testosterone deficiency (bizarrely), as there is no mean average given for what testosterone levels should be and the scale does not differentiate between a 90yr old and 17yr old men.

I personally would consider testosterone lower than 432ng/dL or 15mnol to be a potential problem and a likely cause for gynocomastia for any man.

Although of course this may not be an issue if you are over 70.

Anyone who has testosterone levels lower than the normal physiological range has testosterone deficiency and should seek treatment.  

Obtaining treatment for inadequate levels (previously stated above) above this range sometimes (termed low normal) is difficult but important enough to warrant/demand.  

Once testosterone deficiency is diagnosed by an endocrinologist treatment may begin and the gynocomastia, which is often an accompanying symptom can be investigated and treated appropriately.

Simply put gynecomastia is often a symptom of a wider hormonal problem that should be investgated.

Treating symptoms is less preferable than treating the cause of such symptoms.  

So i must reiterate;  ALL men suffering from gynecomastia should have a full hormonal investigation.

Why?

Because surgery for gynecomastia may only work in the short term and the problem may return if there is a underlying hormone problem that is left untreated!

If you have testosterone deficiency or your body is converting testosterone to estrogen, then you could very well require surgery and additional medication to ensure the condition does not return.


I would also wonder whether or not it would it would be a good idea for those looking at surgery to consider arimadex or tamoxifen prior medication prior to sugery to reduce the condition in order to lessen the scale and invasiveness of a surgical procedure (doing so may also lead to greater post operative results).

[karl2me]

Would it have been detected with any blood test?  I've never been told anything so I dunno but

low stamina eaily fatigued (similar to chronic fatige syndrome)  (not sure if I have this or not)
Poor concentration (sometimes)
Sparse body hair particularly underarms (Barely anythihng on underarms)
erection problems/low libido (no problem)
Difficulty losing weight/excess weight on the stomach and chest but no excess weight on arms or legs. (I have this)

[hypo]

You require a specific blood test to find if this is a problem or not.

The list of symptoms do not occur in all individuals who  have low testosterone, a condition called hypogonadism.

You have gynecomastia, little body hair and weight distribution suggestive of the condition, however you may have no problem at all.

Life has so many variables.

What I would say is go to your doctor and ask/demand to have your testosterone level tested.

Once you have found out what it is post it here.

I will tell you what your level means and if need be what the American Guidlines for endocrinology state and also what levels are widely regarded as a problem.

Regards

[benz]

hey, does anyone know anything about how well this testosterone gel would work on puffy nipples? i do not have huge breasts or anything like that.. my only problem is the puffiness. i'm pretty sure i don't have low testosterone levels due to my amount of hair.. but i should probably get it checked anyway. any info someone has would be greatly appreciated

thanks, -ben

[DavidVenice]

Interesting stuff and a good synopsis compared to all the medical papers I've been perusing. I am particularly interested in whether the line for low testosterone is too low. I went to a endo about 9 years ago at age 38 and he said I was ok, except my testosterone (in the morning) was like 310 and low started at 300. He wasn't concerned, didn't think it was the cause of gyne. My GP, at my request, again tested my testosterone about two-three years ago and it was like 305. And I got the same response from him. Basically, the gyno was ideo. (They all ruled out Klienfelter because I wasn't sterile; they did not chronosone-type, however.) So maybee many of us who are boarderline "not hypogonadism" cases really are and the gyne is a symptom! I have some of the other symptoms, too. Sure would be great if this was the known cause -- and even better if like Tamoxofin treated it long-term, although I sense that's not the case and too new a use for the drug.

[hypo]

David from what you have told me I believe you do have hypogonadism.  Although I of course cannot diagnose the condition as I am not an endocrinologist.

Your low total testosterone plus a raised shbg would lead to low free or bioactive testosterone.

You need a referal to see an endocrinologist and a more sophisticated testosterone test.

The test should be for total testosterone and shbg.  Prolactin and estrogen levels would also be useful.

hypogonadism is diagnosed in men who often appear to have boarderline and even totally normal levels of total testosterone.

I have left posts for you in another thread that we have previously conversed in to explain this is in greater detail.  

I have posted a symptomatic test that is used by endocrinologists, that may give you a good indication as to your situation.

If you want to converse in a more private setting then
e-mail Merle (moderator) and ask if he can pass on my e-mail address and say I said it was ok.

I'll do anything I can to help  

[DavidVenice]

Yes, hypogonadism, or a slight/borderline case of it, is a leading suspicion with me, too, so far, ahead of familiar, Klienfelter and even ideopathic. (I've also been slightly anemic for years; I wonder if that plays into anything.) These things don't have to be black and white, do they? 300 testosterone you aren't hypo and 299 you are, except in the UK, where it might be 400 and 399. Weird.

What is the sghg again? I plan to hit an endo as soon as I get back to the states in mid-August. Quick question: Is there a good endo list, like this board/webpage has of surgeons? One with expertese in hypo and gynecomastia? I do recall, though, that the endo I saw in '95, one I didn't carefor very much but was highy respected, say all my hormones, including estrogins, estradoil, etc., were normal. I went initially to an endo because I had been freaked by an study that linked gynecomastia to high estradoil and heart attacks among relatively young men. (I wonder whatever happened to that study, circa 93, I think.)

Secondly, should I assume that if I had surgery without treating the hypo, there could be a regrowth?

And would the treatments for hypo themselves do anything to the gyno that might not necessitate survery?

Cheers,

[hypo]

Quite a lot of questions, where to start?

shbg is sex hormone binding globuin, it is vital that, that is checked in conjunction with your total testosterone level.

Please read the other thread where i posted a reply for you for more details.

The thread was titled "looking for experts on gynecomastia".

I included a symptomatic test in there that endocrinologists use to help test for hypogonadism, it may be VERY helpful for you, take the test!!!!!!!!!!!!!

It is vital that you see an endocrinologist (just as vital that you are comfortable with him and have faith in him as with any other doctor).

Hypogonadism isn't simply defined by low total testosterone as I said.

The AACE (American Assosiation of Clinical Endocrinologists) guidlines were updated in 2002 to detail this.

I feel your additional questions, would be better answered by an endocrinologist as I have only read one book on the subject and studied it for about 6 months.

Last thing the US scale is different to the one used in Europe.  US is measured in ng/dl and Europe in nmol/l

To convert the US scale to Europe you divide total testosterone by 28.8 and therefore multiple if you are converting the European measures to US.

Your level even without taking shbg into question and the problems that that could mean is 10.5 on the European scale.

This is almost the same as mine and I am being treated for the condition!!!!

If you e-mail me privately, I can give you further assistance with websites and published advice from some of the more eminent endocrinologists.

I can also pass you a link to the AACE guidelines that you can read to ensure that any endocrinologist you see is treating you in accordance with the best clinical practice.

I hope that helps David

[uk2000]

i have my surgery booked for the 1st of july throught a private P.S   who did not make any tests for hormones.

so from reading this info i have decided to book a Hormone health screening which i have for next week.  they will test for testerone etc.  they said they will test for a total of 18 things,  im not sure what.   however i will let u guys know.
its not a endocrinologist i am seeing but a private medical centre who tests hormone levels.

my question is that if it is a hormone that is causing the gyn,  after surgery do u have to take drugs to control the hormone balance  in order to prevent regrowth of breasts.

they guy on here who breasts regrew after having surgery with Dr Bermant,   he said after having surgery again it sorted the problem out,  i take it he had to take drugs to control the hormone balance in his body???

[hypo]

Good on you!!!!!

You may have no problem at all, I hope you don't!!

You are looking out for your own health in a responsible way as advocated by endocrinologists.

Ask them to test for total testosterone, FSH, LH, shbg estrogen and Prolactin.

Furthermore given that you are not seeking an endocrinologist do not accept statements like your results are "normal" or within the "normal range".

Gain a copy of the actual levels in each instance and post them here and I'll let you know if they are considered normal by the worlds leading endocrinologist.

Once this has been done you can move forward with your surgery in complete confidence:)

Knowledge is power!

[skelekey]

Hey board, first time visiting and posting.  Here's my story:

I've been overweight for about 10 years, but not completely obese. Unfortunately during that time I've had larger breast mass.  In the past couple years I've lost a good amount of the weight (maybe 40) and now stable around 240lb.  Very recently my fiancee seemed concerned about my chest seeming larger although I'm continuing to lose weight.  She suggested seeing my doctor and checking hormone levels.

I did visit my doctor, female, and told her my concern and she made an order for blood work, though she said it may just be folding tissue from losing weight.  I had the blood taken and just yesterday I got a paper saying results were normal.

Where can I go from here?  As listed above, the symptoms and how they relate to me:
YES: low stamina eaily fatigued (similar to chronic fatige syndrome)
YES: Poor concentration
NO, opposite: Sparse body hair particularly underarms
NO/YES: erection problems/low libido
NOT QUITE YES/YES (LITTLE excess on arms and legs)Difficulty losing weight/excess weight on the stomach and chest but no excess weight on arms or legs.

The only other cause of Gynecomastia I can relate myself to is I was on the antidepressant Wellbutrin for about 3-4 months, and that MAY have been the period of time my chest got slightly bigger, but nonetheless it was larger than normal before that.

If anyone can give me some advice on where I can go from here, that would be great.  

Josh, 22

[hypo]

Hi skelekey,

I'll check out the anti depressant for you and fin out if that could be a cuase for the gynecomastia and get back to you in the next couple of days.

What blood work did you have done?

If you have a testosterone test what was the actual result?

[skelekey]

Hi,
  I actually don't know the specifics of the blood work I got done.  On my response paper saying everything was normal, there was no listed tests.  I did ask my doctor to check my hormone levles, so I assume testosterone was checked.  I'm actuallyu kinda unhappy with my doctor system right now as well.  They're not concerned about this problem, but I am.

Thanks
Josh