Your surgeon is correct regarding your situation in that it is good that the gynecomastia occurred a long time ago and has been settled for a long time. This does not mean there cannot be a problem with hormones but it can mean it is less likely. The checks are precautionary and in that regard should be taken by everyone as a matter of course, particularly when surgery is being considered.
SHBG or Sex Hormone Binding Globulin to give it its full title is a carrier protein made in the liver.
SHBG binds to androgen and to estrogens though it binds to the latter with less affinity (less percentages). This means that the higher the SHBG level the more usual it is to see a low free testosterone level. Total testosterone is just that washing around the blood stream, the testosterone that your body is actuall able to use is called free testosterone and that is the bit that is usually not bound to SHBG (or blocked by estradiol at the receptor sites).
Overtly high or relatively high SHBG then and usually the more typical it is to see low free testosterone, it can also usually means a poor androgen to estrogen balance overall.
If someone just has a free testosterone test and free testosterone is low, then we would then want to know why it is low.
If total testosterone is low then the answer is probably that simply there is not enough of the raw ingredient.
However if total testosterone is adequate or low but not as low as the free testosterone, we will want to know why?
The usual reasons for this are high SHBG and/or high estradiol.
Also if total testosterone and free testosterone are low and the endocrinologists does not test for SHBG, then that endocrinologist might just prescribe testosterone replacement therapy (TRT).
But....
If the low levels occur in the presence of either high SHBG and or high estradiol then that will fail to help the individual concerned.
In the setting of high SHBG addional testosterone may just be bound in the blood by the SHBG and remain unusable by the body.
If high estradiol is the issue then the additional testosterone might be blocked at the androgen receptor sites and be unusable to the body and certainly increased total testosterone can lead to increased estradiol and make the lack of free testosterone even more significant (Testosterone is always to some degree converted into its metabolites dihydrotestosterone or estradiol).
Overtly high or relatively high SHBG can be treated by the endocrinologist with Danazol which can reduce the binding protein and free up- allow for a higher level of free testosterone. That medication can be prescribed on its own to free up an individuals own testosterone or be used in conjunction with TRT where appropriate.
When estradiol is overtly high or relatively high it can be lowered to an appropriate level with an aromatase inhibitor such as Arimidex. This again can free up testosterone and be used alone or in conjunction with TRT as in the above described situation.
It is vital that these measures are only considered in appropriate cases by qualified endocrinologists and andrologists in patients with these hormonal issues in light of relevant pathology and clinical presentation and symptoms.
If SHBG or estradiol are lowered too much they can created serious health issues as bad as that of hypogondism/low testosterone- again hence the reason for the prior statement above.
LH is the pituitary messenger hormone that requests that the body/testicles produce testosterone.
It is tested because in the event of hypogondism/low testosterone it can help offer a likely cause for the problem, be that the hypothalamic/pituitary or the testicles.
Prolactin is tested because it can explain low total and free testosterone via a low LH level if very high. When it is very high it can sometimes be due to a benign pituitary tumor such as a prolactinoma. Such tumors are not cancer, the pituitary is not the brain either. They can usually be medicated away these days, but sometimes they require surgery. When that does happen the surgery is usually minor and a day case and via the nose cavity. When surgery is required medication of hormones including testosterone is usually required post surgery.
An endocrinologists can sometimes spot via clinical presentation/examination in conjunction with pathology a potenial genetic issue where the blood test results alone are not always a very good indicator of hormonal health. Even when free testosterone appears ok, sometimes it is not if the body has a problem on a genetic level. In such a situation the endocrinologist concerned should/will perfom a chromosomal test or other relevant genetic testing.
TSH is the messanger hormone that tells the thyroid to produce thyroxin.
TSH is high or low and diagnostic for over 90% of thyroid conditions.
FreeT3 is the actual free thyroid hormone and in that respect the key factor in thyroid health, it is the equivalent to the thyroid that free testosterone is when looking at androgens.
Sometimes TSH is produced by the pituitary, but the thyroid does not end up with enough of the free hormone produced, this can occur because of a failure of the thyroid or because too much of the hormone is bound or not converted from T4.
The above is why TSH is NOT completely diagnostic for thyroid disease, the reason why free T3 must be considered.
in those have significant symptoms of thyroid problems and the condition seems obvious but the pathology unhelpful, then in such people thyroid antibodies and cortisol should also be tested for as well as T4 and reverse T3.
But they are less relevent in this setting- hence me not including it in the general pathology list.
Odds are in your case there is no hormonal issue at all, and this is just a sound precaustion that you as all pople should take.
Good luck with the surgery when you move forward with that and good luck in helping people in the future and giving something back.
Topic: Hormone test please help (Read 5049 times)
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