Establishing cause of gynecomsatia

[ethanhunt]

Dear Doctor,

I have been weightlifting for a almost 10 years now since I was 26.
I have never taken steroids or any serious supplements other than whey protein and until recently creatine.
However, although I only noticed my gynecomastia two years ago looking back I’m pretty sure it started when I was training as my chest started getting bigger and my shirts and t-shirts were tighter in that particular area ever since.
It was only after a friend pointed it out that it was definitely not muscle that I realised there was a serious problem.
However, after having 2 sets of blood tests done, 5 weeks apart, the endocrinologist last week after weeks of waiting on the NHS (UK) informed me that there was nothing abnormal about my blood sample tests.
He said that a 3rd set would be performed which so I gave another sample to carry out the same tests and also to carry out additional tests (although I’m not sure what these will be).
He examined my testicles for size and shape and concluded from my answers regarding hair growth that he could not understand the cause and the most likely scenario would be to establish the cause through excluding other conditions.
I am 5’11’’ and I weigh 75kg which I have managed to maintain and last year I lost 9kgs on a diet as I wanted to rule out pseudogynecomastia and that it was possibly fat.
After losing all this weight I noticed that my chest was exactly the same size as it was prior to starting the diet.
It stands out significantly as I have a very flat stomach for a 35 year old male through weightlifting, dieting and sit-ups.
Should my endocrinologist have ordered a CT scan?
As my GP suggested this would be one of the most likely scenarios once I was referred to the hospital.
I am willing to send you a copy of my blood sample results if that would help.
Although my prolactin levels were not outside the range they were high.
So if this had been the case for 10 years would it not account for my gynecomastia?
Surgery is a last resort but a definite possibility, however, unless the cause is resolved it would mean that after surgery my gynecomastia would still return surely, no?
If you have any suggestions please let me know what I should do.
Many thanks for dealing with my enquiry.
Kind regards.

Ethan Hunt

[Litlriki]

It is unusual to see delayed onset of gynecomastia, where none existed before, without some cause, such as an endocrine issue, a medication, or some other external factor.  A CT scan can be worth while if there's concern over a pituitary tumor, for example, but if this is causing your gynecomastia, one might expect to see an elevated prolactin level.  The laboratory testing tends to be reasonably sensitive, where a CT scan is fairly non-specific and in the absence of something suspicious, not all that sensitive either. 

Your comment about "serious supplements" raises my concern, primarily as I have seen a number of patients who have used sports supplements that should not have been suspect as causes of gynecomastia, but in the end were likely contributors.  Two of the patients brought the products in, which they most closely associated with the development of their condition, and at least one of those products contained ingredients labeled as "proprietary blend."  This was in an NO2 product.  The other was a protein powder, and there were ingredients other than protein on the label, but none that I could identify specifically as potentially causative.  Because of the variability of regulation in the supplement industry, there are instances of contamination of non-hormonal products with hormonally active substances, and similarly, products that are billed as one thing may have ingredients that do other things, including causing side effects.  Perhaps if you are able to look back at any supplementation you were doing when the condition started, you might identify a culprit that you didn't think was a problem.

In the absence of any of those issues, a thorough evaluation that is normal three times over an extended period of time would suggest that it's safe to go ahead with surgery, though, obviously, there is no guarantee that you wouldn't experience a recurrence. Similarly, there is no way to say that recurrence is a sure thing, even if the issue remains unresolved.  Caution is certainly appropriate, but there are reasons that "idiopathic" is a common diagnostic term in medicine.

Good luck,

Rick Silverman

[ethanhunt]

Dear Dr. Silverman,

Thank you very much for taking time to reply it is really appreciated.
Just to clarify that I started weightlifting just before the end of 1999 (aged 25) and I only started taking supplements the first of which was protein shakes since September 2008 (a good 9 years later).
I have never taken the protein powder or any other supplement prior to this.
Also since September 2008 I have occasionally taken creatine.
But I had already had my chest pointed out to me by my friend from it's shape and significant size for my slim physique.
Looking back it definitely started getting bigger and was first noticeable around 2002 (aged 28) although it may have started prior to this.
I can't say it didn't exist prior to weightlifting as I never paid attention to my chest.
So this data is 'missing'.
This is why I am baffled.
Also my Serum prolactin levels (mu/L) were 334.0 + (on 1/12/9) and 542.0 + (on 4/1/10).
I am more than happy to send my endocrinology, haematology and biochemistry results to your e-mail address below if you feel this may help.
If not then no worries and thanks for your help and advice during another difficult waiting period until my next results.

Kind regards

Ethan Hunt