Need help with Blood Work to see real reason for my Gyno

[Pain]

Moved to General Talk from Ask Doctor section since no responses from any of the supporting Doctors. I have added my own analysis now hope someone can help me in concuring my findings.

Hi Everyone,

I have been living with the Pain of Gynecomastia since my early teens. Possible reason is because I have been on the heavier side since my early childhood although I'm quite tall.

However I was able to loose massive weight with diet control when I went to college but my gyno still didn't go away... my parents & family doctors brushed this aside saying that this would go away on it's own naturally.

But this just socially impaired me in a number of ways & I was depressed & my confidence has suffered massively.

After joining work I gained most of my weight back over last 10 years but my weight keeps fluctuating like the stock markets but the gyno still refuses to go away.

I'm 31 rite now & I just need get this monkey of my chest... literally & I'm also working to loose my weight realistically so that I'm able to sustain my weight in the future. (Currently 214 pounds & in last 6 months have lost 33 pounds)

With regards to solution; as I understand after going through this forum - Surgery is the only option to get rid of Gyno.

Hence I needed someone to help me with my blood work (please see below) to see if all is in order or if any other underlying reason needs to be corrected before I visit a surgeon so that there is no relapse after the Op.

My Analysis - please if someone can concur my findings

From the below my liver tests SGOT ↑ & SGPT ↑ are way of the chart but the underlying reason for this is Fatty liver. In liver disease there is an increased production of Androstenedione by the adrenal glands, increased aromatisation of Androstenedione to Oestrogen ↑, loss of clearance of adrenal androgens by the liver and a rise in SHBG ↑, which results in Gynaecomastia.

Hence both my SHBG & E2 levels are High.

My DHEA levels are also less than minimum so this impacts Testosterone production as it is essential for it.

My Prolactin levels are also high; just few shy away from the maximum but elevated prolactin secretion can suppress the secretion of FSH and GnRH, leading to Hypogonadism.

Hence my FSH & Free Testosterone levels are pretty low.

While LH and Testosterone levels are both average.

However my Oestrogens levels are High (More than maximum range for a male.)

Hence Oestrogens & Obesity seems to the root cause for my Adolescent Gynecomastia. (Hope if someone can concur on this. Any advice from anyone would be very much appreciated.)

I'm already working on reducing by body fat percentage but do I also need to do something to avoid this synthesis of Testosterone to Estradiol?

Test Name	Value	Units	Reference Range
ANTI MICROSOMAL ANTIBODY (AMA)	8	IU/mL	<34
THYROID STIMULATING HORMONE (TSH)	1.7	μIU/ml	0.3-5.5
TOTAL TRIIODOTHYRONINE (T3)	91	ng/dl	60-200
FREE TRIIODOTHYRONINE (FT3)	2.9	pg/ml	1.7-4.2
TOTAL THYROXINE (T4)	7.1	μg/dl	4.5-12
FREE THYROXINE (FT4)	1.09	ng/dl	0.7-1.8
FOLLICLE STIMULATING HORMONE (FSH)	2.92	mIU/ml	1.4-18.1
LUTEINISING HORMONE (LH)	4.28	mIU/ml	1.5 - 9.3
PROLACTIN (PRL)	15.32	ng/ml	2.1 - 17.7
TESTOSTERONE	433.8	ng/dl	241 - 827
FREE TESTOSTERONE	8.56	pg/ml	4.25 - 30.37
ESTRADIOL/OESTROGEN (E2)	41.7	pg/ml	0 - 39.8
DHEA - SULPHATE (DHEAS)	96.3	μg/dl	106 – 464
BETA HCG	1.2	mIU/ml	< 10 mIU/ml
SEX HORMONE BINDING GLOBULIN (SHBG)	37.72	nmol/L	14.5 - 48.4
ASPARTATE AMINOTRANSFERASE (SGOT )	63.3	U/l	< 37
ALANINE TRANSAMINASE (SGPT)	45	U/l	13-40

[dr.moe]

I would suggest you see an endocrinologist to find out why your hormone levels are where they're at.  Even then, you may not find out the exact cause - in my case, I've been working with my doc for years to try to balance my hormones and rule out other underlying causes (to no avail).

Not being a medical professional, and not giving medical advice, I will note that your testosterone being in the normal range, but the high estrogen suggests that it is being aromatized.  I have the same issue.  There are aromatase inhibitors that can block this action; talk to a doctor to see if this might be a path to try.

The human endocrine system is an incredibly complex, inter-related system.  Small changes in one part of the system can cause significant effects elsewhere.  You really need to work with an endocrinologist, who's trained in understanding and treating that system.  But be aware that even as well-trained as they are, the endocrine system is still not perfectly understood, so  you may be in for some period of trial and error as your doc tries to adjust various hormone levels to balance out the entire system. 

As I noted, I've just accepted that my hormone levels are bent toward female levels. I'm 58 - gynecomastia is not a social issue for me anymore. Even with an aromatase inhibitor and TRT, my testosterone stays very low and my estradiol is very high.  I'm one of those cases that defy current endocrine system knowledge, evidently.

Good luck on finding the cause and getting your T and E back to normal levels.  Then, when that's balanced and there's no more breast growth, surgery may be what you opt for.  I wouldn't suggest surgery, though, if there's still any breast growth.

[Pain]

Thank you so much Dr. Joe for sharing your valuable insights & experience in responding to my queries. Your answers have sort of giving me a vision as to how I should approaching on this quest to getting my T&E sorted & ultimately my Gynecomastia .

I'm having an Endocrinologist appointment next week & the reason for my first post was to do some prognosis on my own so that I could ask the right questions, cut short the analyze phase & get jolted towards fixing my multiple problems. Based on your answer it looks most of the doctors here are more of surgeon types who would be fixated on the solution rather than the root-cause of the problem. But never the less it is good to connect with like minded people like you who have gone through the same & who could have far more better advice in dealing with it as Gynecomastia is more of psychological issue.

From my own case my breasts are large but due to my large frame (height & broad shoulders) it almost looks like a chiseled chest even while wearing a T-shirt. But my under-developed arms & bisceps sometimes just give it away. I have tried working with weights a lot but it has just not helped me in developing them.

So externally even though I can put a facade of sense of confidence but internally I do feel psychically & more so psychologically week. I'm just so afraid of removing my top body garments that I avoid all water places & getting wet in the rain & at 31 I still don't know swimming.

My relationships have never worked due to my fears of getting undressed & I have passed far too many opportunities of getting intimate with the opposite sex. Also due to adolescent gyno my testes & penis are quite small but even then I have an insatiable sex-drive which I cut-loose by jerking off. But now due to turning religious I have stopped doing that as well. No wonder I'm single still.

My natural voice is also very high pitched & often people mistake me for a lady when I talk on the phone. Hence consciously I have to make an effort to speak from the lungs to make my voice stronger to overcome this.

My facial hair is very less compared to the rest of all body. So people may say it is a boon as I don't have to shave often but then somehow I feel I'm missing something.... Maybe it's our social media which is to blame which has always associated beards & mustaches to manliness.

And last but not the least lately my breast have become highly sensitive & I sort of feel turned-on by any touch whether be through any fabric or physical touch on my nipples. This just makes me feel really weird & have sort of started even questioning my sexuality as I'm pretty straight guy.

So to sum these are all the physical & psychological ailments that I have & which I'm looking to correct. Not sure if these can be fixed now since as I have sort of missed the puberty bus on most of this. If any of you have been through this & have overcome this then any suggestions & feedback would be quite helpful.

Many thanks,
Brutus

[dr.moe]

If your voice pitch isn't as deep as you think, and your sexual development seems less than you think it should have, an endocrinologist may provide even more answers than just the gyno.  My second son had a higher-pitched voice and not a lot of body hair or other secondary-sex-characteristic development. We got him tested and on TRT, and his body is making up for lost time.  Additional testosterone for you might help.

Sending a PM with a few other "private" details which I hope will help you see a different perspective.

[Paa_Paw]

I was an Air Force Medic as a young man and I had access to Medical Libraries where I was stationed.  I researched my condition and never wound up with any concrete solutions.
I had a slight voice change in puberty, very slight.  I was still a counter Tenor capable, with practice,  Of singing soprano parts.  That lasted until the age of 35 when my voice changed again, but again only slightly.  At the age of 80 I still get yes Ma’am on the telephone.  Others call, not knowing me and ask to talk to my husband.  
At the age of 48, I had an accident.  the resulting injury to my wrist was described as an epiphyseal separation of the distal radius.  The problem with that diagnosis was that I was 48. After my wrist healed and before releasing me back to work, the orthopedic surgeon asked for a bone age study.  While the joints gave away my true age, the ends of my long bones looked like those of a 17 year old.  Pelvic and cranial results were similar. 
I am happily married, sexually active and the proud father of 8,  I never did find out what caused me to have such a high voice or what contributed to my Gynecomastia.  But now, at the age of 80, it really no longer matters. 
I recall visiting with my mother and having some of my children with me.  The phone would ring and my Mother would answer.  The person on the other end would say something like:  "Hello dear, is your mother at home?"  My Mom would hand the phone to my eldest daughter, who even as a child had an unusually deep voice.   We had fun with it. 
I wish you well, and think that the Endocrinologist is probably your best bet.  But keep in mind that not all questions can be answered.   

[Pain]

Thanks Dr. Moe & Grandpa Dan for your words of wisdom they have certainly changed my perspective on a number of things. I guess somethings can't be changed unless your Doctor can find figure out that magic stimuli but until then patience & self-acceptance are the only ways to keep yourself motivated on this journey.

From my personal background... I come from a conservative right wing Christian family so from an early childhood I was taught to despise modern health-care life sciences & to embrace my body just the way it is... the former was easy but the latter was just so hard to accept. Hence I never took care or bothered about my body & this ultimately affected my internal self image.

In my work environment I recently moved to a senior management role which involves a lot of public speaking & being in the limelight.... and hence a good deep voice has become an essence for me. I'm also planing to join singing classes on someone else suggestion although I'm not sure how much that could help.

This year I also got braces to fix my teeth & add to that my baby face & lack of facial hair makes me look much younger than my age & many people mistake me for an intern instead of a senior executive at my company. Sometimes it is flattering but many a times it is also a nuisance.

Anyways as you all suggested I'm hoping to get started on working with my endocrinologist by early next month. I was scheduled for this week but he had to go on a emergency holiday. Will keep you all posted on his prognosis of my situation & the treatment to follow.

Many thanks,
Brutus