Yes the phrase
“normal” is a very vague word given the huge bandwidth that labs regard as the
“normal range”. The
"normal range" can cover men from the age of 16 to 90 and as you can imagine the testosterone (T) and oestradiol (E2) levels of men varies greatly with age. Also as Flex1appeal has mentioned it isn’t just the T and E2 results that matter, it is their balance.
You might have read this before so I’ll try to be brief:
The T
“normal range” for the lab I use is 14 - 40 NMOL/L (UK measures). You would expect a man in his 20s to be near the top of that range and a man in his 90s to be near the bottom. However if a 20 yr old man gets tested and his result comes back at 15 NMOL/L (therefore a low value), a GP or inexperienced doctor will often say that it is ok because it is within the
“normal range”.Likewise the E2
“normal range” for the lab I use is 55 - 184 PMOL/L (UK measures), so as long as your result falls within that range a GP or inexperienced doctor will say that it is ok because it is within the
“normal range”.The important thing to remember is that glandular gynecomastia is simply caused by an imbalance of androgens (T) and oestrogens (E2 is the most potent one). Finding what is causing that imbalance is often the challenge.
There are a number of reasons why a male can develop gynecomastia The following causes of gynecomastia and percentages are taken from a medical paper .. The Endocrinology of Gynaecomastia by AAA Ismail and JH Barth (Department of Clinical Biochemistry and Immunology, Leeds General Infirmary, England.)
Cause (%)
Idiopathic (unknown) 25
Puberty 25
Drugs 10-20
Cirrhosis or Malnutrition 8
Primary Hypogonadism 8
Testicular tumour 3
Secondary Hypogonadism 2
Hyperthyroidism 2
Renal Disease 1
Others 6
A male can have a low T
and low E2 level but because they are in balance he may
not develop gyne. Likewise a male may have high T
and high E2 levels and again because they are in balance he may
not develop gyne. The problem usually arises when either T is low and E2 is normal or high, or when E2 is high and T is normal or low. In these instances although the values for both hormones are still within the
“normal range”, the balance is lost and gyne is more likely to appear.
The point I am trying to make is to take the phrase
“within the normal range“ with a very large pinch of salt.
It is the balance that matters as well.Again as Flex1appeal says, if you aren’t already seeing a decent Endo then get your GP to refer you to one. Unfortunately a run of the mill Endo is sometimes in the dark regarding this subject; most of them specialise in the more common diabetes ailments and often don’t have the in depth knowledge or experience required to investigate causes of gynecomastia. I personally went through 2 Endos before I saw one who knew more than I did on the subject, and my knowledge is very limited. There are doctors called Andrologists who specialise in the male hormonal system. These are the real experts and if you can get to see one of these then you won’t go far wrong.
I think that the bottom line is you need your low T levels investigated and treated, and there are a number of options for that so that your quality of life can improve.
Sorry I said I would try to be brief and as usual I have rambled on
. All the best to you.