Endocrinology visit

[normexcept]

Well, I finally had my endocrinology appointment last Friday.  I had been excited about going so that I could find out something, anything about what might be causing the gyno.  I guess I didn't know what to expect and found myself at the end of the appointment a little disappointed that I couldn't find out something right now. 
The Doctor asked me a lot of questions and wrote a lot of things on his note pad.  He examined my breasts and confirmed hard  breast tissue in both.  He examined my testicles and said they were in the normal range (size? feel? I don't know) but he did confirm that there was no testicular cancer risk present (not that I was even worried about that).  He gave me the impression that he thought my gyno was no big deal when he said that current statistics say that 50% of men have gynecomastia.  Nevertheless, he ordered another blood sample which I gave on site.  Now I have to play the waiting game again.  He verbally toyed with the idea of having me get an MRI to see if there might be a prolactinoma growth on my pituitary but in the end decided not to until he reads the results of the blood test.  So now, two weeks before I'm supposed to hear anything...........

[Jamie30]

What were you tested for?  I was tested at the weekend for the following:

- Estradiol
- Testosterone
- FSH (Folicle(?) Stimulating Hormone)
- LH (Lutenizing Hormone)
- Prolactin
- SHBG (Sex Hormone Binding Globulin)
- TSH (Thyroid Stimulating Hormone)

Free Testosterone will be estimated through calculation based on other factors.  The endocrinologist said this was more accurate than measuring.

It was my idea to test SHBG because I saw other people on here having it tested.  The doc was happy to add it to the list.

The results were ready yesterday, but I won't get to see them until I see the endocrinologist on Saturday.  Hopefully they are conclusive one way or the other...  it's getting a tad expensive.

Some other items will also be tested to check general health / organ function etc.  I can't remember what these are, but I'll post them when I get the results next weekend.

[normexcept]

What were you tested for?  I was tested at the weekend for the following:

- Estradiol
- Testosterone
- FSH (Folicle(?) Stimulating Hormone)
- LH (Lutenizing Hormone)
- Prolactin
- SHBG (Sex Hormone Binding Globulin)
- TSH (Thyroid Stimulating Hormone)

I guess I didn't go in as prepared as you did.  I don't remember all the things he tested for but some of the items in your list look familiar.  I had elevated prolactin levels prior to going in there and also lowest end of normal range on testosterone from earlier tests with my Primary Physician.  Because of these, he wanted to test other builders or blockers.

[Jamie30]

I'd be interested to see your results.  I'll post mine here at the weekend.

I'm also going to ask how these things vary over time and how they're affected by other factors.  I.e. can they be high one week and low the next?  Are they affected by lack of sleep the night before?  Recent sexual activity?  Diet, etc etc.  I just wonder if it's better to get an average reading from several tests.  I'll see what he says, but will leave to his expertise.

[Jamie30]

This are my results:

Endocrinology results are as follows:

FHS 5.67
LH 2.48
Prolactin 110 (0-500)
Oestradiol 92 (50-220)
Testosterone 19.4 (12.0-31.9)
SHBG 29 (12-57)
Free Testrosterone 428 (260-740)

Thryoid Virtual:
Free T4 11.4 (9-19)
Free T3 4.5 (2.6-6.0)
TSH 0.45 (0.3-5.0)

A whole suite of standard tests were run to check things like liver function and general health and so on; they were all fine.

Jamie

[normexcept]

I appreciate you including the normal scales next to your results.  How long did it take for you to get your results?  I still haven't heard anything and it was two weeks ago this past Friday that I had the blood drawn for testing.

[Jamie30]

I had the test done on a Saturday.  The results were back with the Endocrinologist on Wednesday, but I didn't get them until I saw him again the following Saturday  - one week after the test.  This is in Australia, so maybe things vary where you are.

[normexcept]

This are my results:

Endocrinology results are as follows:

FHS 5.67
LH 2.48
Prolactin 110 (0-500)
Oestradiol 92 (50-220)
Testosterone 19.4 (12.0-31.9)
SHBG 29 (12-57)
Free Testrosterone 428 (260-740)

Thryoid Virtual:
Free T4 11.4 (9-19)
Free T3 4.5 (2.6-6.0)
TSH 0.45 (0.3-5.0)

A whole suite of standard tests were run to check things like liver function and general health and so on; they were all fine.

Jamie

I finally got the results back today.  The Endocrinologist wants to work on the T4 and T3 thyroid hormones before working withthe prolactin levels.  Anyway, here are the results with the Dr.'s comments.  Since the numbers don't seem to compare with Jamie's I'm assuming there is a difference based on units of measure U.S. vs Australia.

Free T4                  0.89              low normal
Free T3                  1.7                low
?Hole punched?        2.56              normal
Prolactin                 67.5              High normally <17
Testosterone total    221               low (ref 250-1000)
Testosterone free     46.4              normal (ref 35-155)
estradiol                  19                normal

[Jamie30]

Since the numbers don't seem to compare with Jamie's I'm assuming there is a difference based on units of measure U.S. vs Australia.

I suspect standards also vary as to what might be considered high / low / normal.

Based on my results, the endocrinologist can't see any reason to proceed with any further investigations.  His recommendation is for me to continue losing weight and if when I'm down to a lower body fat % I still don't like the appearance of my chest, then get surgery, which he indicated is no big deal these days.

[normexcept]

My endocrinologist put me on Levoxyl for 6 weeks to see if the Thyroid would return to normal and to see if turning to normal would lower the prolactin level.
6 weeks later I had my blood checked again and they found the Thyroid levels normal. Yay!
Prolactin levels are still way high.  In fact not seeming to have been affected by the Thyroid levels.
Next step, the endocrinologist wants to have me in for an MRI to see if he can see a pituitary tumor.
That's happening this Friday.  I want answers!
The thing is, there is more going on that just extra breast tissue.  Something has caused low libido, E.D. problems, and depression as well.  The Endocrinologist thinks this could all be interrelated.  At least I feel more energetic since getting the Thyroid levels back into the normal range.  That's a positive to hold onto.

On another note, I had an appointment with a plastic surgeon who used the prolactin information as well as the physical exam information to put together an argumement for the insurance company to see if they would pay a percentage of the gynecomastia surgery.  Well, they won't pay for anything that is not reconstructive and they see this a cosmetic only.  So now, I will be persuing financing options or I will be trying to save up the cash $4,600.00 U.S. approximately.

[normexcept]

I had an MRI scheduled by my endo.  results came back - nothing abnormal.  Endo put me on Androgel to get the Testosterone levels up.  Been on that for 4 weeks now.  Lots of improvement in many ways to my engergy level and mental state but no affect on moobs yet.  Endo wants me to be on it for a while and then get the blood checked again.
I have to say I was actually disappointed when the MRI came back normal because I really wanted to find a REASON for having high prolactin levels.
Maybe time will tell and an answer will be found.  I hope so.
I just want this gyno gone and I want a normal life without thinking about having moobs!
Okay enough of the pity party.  On with the show.......LIFE!

[skyhawk]

Hey normexcept,

Glad to see the thyroid meds are giving you more energy. I could see the hypothyroidism in those numbers you posted. Fortunately for you, you had a doc that ran the free thyroid numbers or it would have never been caught.

your testosterone numbers you posted are exactly where mine are. Word of caution on the androgel, testosterone gels are notorious for converting into estradiol which induces gynecomastia. Keep a close eye on both testosterone and estradiol levels as you treat with androgel. If the Estadiol starts to climb too much, it can be controlled.  you don't want gyno to get worse. It was in fact androgel that gave me gyne in the first place.

looking at your numbers you posted, testosterone 221 and estradiol 19, you had a testosterone to Estradiol ratio of around 12/1.  although the estradiol at 19 was a healthy place to be , the testosterone was too low, causing a  a low T/E2 ratio. this may be why you got gyne in the first place. Some guys report feeling best with a ratio of 25/1 to 30/1. And I have heard of regression of gyne with those ratios.

Still, surgery is the most likely outcome to correct the gyno. Keep us all posted.

[latediagnosis]

yeah i have seen two endocrinologists and i must admit i was disappointed too. the first one was a youngish lady about 28 and she made me feel like a tool and said 'there is no reason to get surgery' in almost a rude manner saying there was almost nothing there although she did admit there was something..

the second one was a bit better, he was a 50 yr old man he understood that it was there but he told me to wait a few years (im 19 and i've had it since i was 14-15). i replied with saying 'its already ruined 5 years of my life, i need to get this taken care of', also to my understanding once you've had it longer than 3 years it doesn't really go away unless you get surgery.

he basically finished with saying 'if i could have your body i would and if i saw you walking down the street with no top on i wouldnt think a thing of it, this is coming from a person who deals with this kind of thing  for a living' then gave me a big speech on we are our own worst judge. they also knew that i had seen a cosmetic surgeon and they were basically criticising her for her willingness to do surgery on me, with comments like 'i believe you've seen a plastic surgeon and shes made up your mind'..

i just don't get how people can be so rude and not understand you when its basically what they're paid to do. bottom line was, all my hormone levels were fine and they said only way to remove it was surgery, but id be stupid to risk surgery.

[mouse88]

yeah i have seen two endocrinologists and i must admit i was disappointed too. the first one was a youngish lady about 28 and she made me feel like a tool and said 'there is no reason to get surgery' in almost a rude manner saying there was almost nothing there although she did admit there was something..

the second one was a bit better, he was a 50 yr old man he understood that it was there but he told me to wait a few years (im 19 and i've had it since i was 14-15). i replied with saying 'its already ruined 5 years of my life, i need to get this taken care of', also to my understanding once you've had it longer than 3 years it doesn't really go away unless you get surgery.

he basically finished with saying 'if i could have your body i would and if i saw you walking down the street with no top on i wouldnt think a thing of it, this is coming from a person who deals with this kind of thing  for a living' then gave me a big speech on we are our own worst judge. they also knew that i had seen a cosmetic surgeon and they were basically criticising her for her willingness to do surgery on me, with comments like 'i believe you've seen a plastic surgeon and shes made up your mind'..

i just don't get how people can be so rude and not understand you when its basically what they're paid to do. bottom line was, all my hormone levels were fine and they said only way to remove it was surgery, but id be stupid to risk surgery.

Realize that perhaps your best interests ARE what they are looking out for. Its very difficult for people to understand the psychological hell that gynecomastia can be, especially for relatively 'moderate' cases. The doctors probably think you are silly for worrying about it, and they are giving you their opinion (what they are paid to do). Surgery carries risks, not the least of which being permanent scarring. Personally, I have been told that my case is on the 'minor side,' and some people tell me I'm crazy for letting it bother me. On the other hand, people have also cracked jokes about it (I die a little every time) which convinces me that I should consider surgery very seriously.

[AnonNZ]

Yea, it takes me months to build up my confidence re and one nasty comment to crush it all.