My story of Gynecomastia

[texastoast88]

I just wanted to start a thread so I can chronicle the the path leading up to the day I cross over, both for myself to look back on, as well as for others.

Basically, I've had Gynecomastia since the onset of puberty (7th or 8th grade). I can't quite recall exactley when, but I sure remember all those times that it got in the way that I know many of you can relate to. The locker room changing, Shirts v Skins, summertime, clothes chose specifically to cover up..all that jazz. Anywho, I'd done a fair amount of research on getting rid of them by working out/proper nutrition. I got on the straight and narrow while attending Texas State University, eating right, working out, cut alcohol intake almost completely and completely stopped smoking weed which sucked worse than anything . For a solid year I did this and got in great shape but looked even more awkward with protruding puffy nipples on my chest. With the additional muscle though, I had some newfound confidence so I would wear T-shirts (except plain white) and I'd occasionally go swimming but I never was all that comfortable with a shirt off and I got those stares from people looking at my chest which basically crushed the confidence back down to 0. Did some research and found this website and saw that my only out would be surgery. I've since graduated and am unfortunately still looking for that "right" job. Recently, because of boredom, I've started smoking weed again (the last few months) but I have been clean for 2 weeks, heh. I only mention this because my puffy nipples have remained stable for the past 7 or 8 years I'd say which is before I ever touched the wacky tabacky. Anyway, I have come into some money and my Dad has agreed to help me out so I'm going through with this.

It started a week ago with a physical. I mentioned the gyne and how long I had had it so my doctor (who is an awesome guy by the way) ran some additional tests to check some levels of hormones. By the way, if you have a physical just mention the gyne. I JUST had my follow-up appointment maybe 30 minutes ago to go over the results and he said had I not said something, he would have missed it completely. My liver, kidney functions looked great. Good cholesterol - off the mufuggin hook. Everything was good except for my prolactin levels which he said registered as 15.4 where a guy my age should have it around 5. On a side note, prolactin is the hormone that helps with breast development/breat feeding. it's more prominent in women, but men have it too. A possible cause of this could be a tumor on or around the putaitary(sp? not a Dr.) gland which is completely non-life threatening, but could cause my gyne to come back if it isn't treated. SOO, I've set up an appointment to have an MRI done next week to check my brain for that tumor's size (if it exists) as well as a meeting with an endocrinologist to help treat my high prolactin levels. If I respond to treatment and levels drop, I can go ahead with surgery. Although I really want these douche bag man boobs off my chest, the last thing I want is for them to come back - esp. after dropping all the money for surgery. In the meantime, I'll focus on cutting as much fat as possible and work on getting my hormones in balance. Then, I will get the surgery. As my Dad has said my entire life: "Patience is a virtue."

So that's where it's at right now. I'll keep this thread updated as I learn more. Hopefully it will help someone out too because Lord knows there are a ton of you who have helped me out tremendously.

PS, I'll put up some pictures later on. Until then, take care!

[Dr. Elliot Jacobs]

Congratulations on beginning the road to the other side.

Elevated prolactin levels (frequently from a benign tumor of the pituitary gland) are often treated with medication (Dostinex).  Once the prolactin levels are brought to normal levels, and assuming your gyne is stable, then you would be a candidate to consider gyne surgery.

BTW, if indeed the above scenario plays out, then more than likely you would have to remain on the medication indefinitely.  That is, unless or until a better treatment becomes available.

Good luck!

Dr Jacobs

[DrBermant]

I just wanted to start a thread so I can chronicle the the path leading up to the day I cross over, both for myself to look back on, as well as for others.

Basically, I've had Gynecomastia since the onset of puberty (7th or 8th grade). I can't quite recall exactley when, but I sure remember all those times that it got in the way that I know many of you can relate to. The locker room changing, Shirts v Skins, summertime, clothes chose specifically to cover up..all that jazz. Anywho, I'd done a fair amount of research on getting rid of them by working out/proper nutrition. I got on the straight and narrow while attending Texas State University, eating right, working out, cut alcohol intake almost completely and completely stopped smoking weed which sucked worse than anything . For a solid year I did this and got in great shape but looked even more awkward with protruding puffy nipples on my chest. With the additional muscle though, I had some newfound confidence so I would wear T-shirts (except plain white) and I'd occasionally go swimming but I never was all that comfortable with a shirt off and I got those stares from people looking at my chest which basically crushed the confidence back down to 0. Did some research and found this website and saw that my only out would be surgery. I've since graduated and am unfortunately still looking for that "right" job. Recently, because of boredom, I've started smoking weed again (the last few months) but I have been clean for 2 weeks, heh. I only mention this because my puffy nipples have remained stable for the past 7 or 8 years I'd say which is before I ever touched the wacky tabacky. Anyway, I have come into some money and my Dad has agreed to help me out so I'm going through with this.

It started a week ago with a physical. I mentioned the gyne and how long I had had it so my doctor (who is an awesome guy by the way) ran some additional tests to check some levels of hormones. By the way, if you have a physical just mention the gyne. I JUST had my follow-up appointment maybe 30 minutes ago to go over the results and he said had I not said something, he would have missed it completely. My liver, kidney functions looked great. Good cholesterol - off the mufuggin hook. Everything was good except for my prolactin levels which he said registered as 15.4 where a guy my age should have it around 5. On a side note, prolactin is the hormone that helps with breast development/breat feeding. it's more prominent in women, but men have it too. A possible cause of this could be a tumor on or around the putaitary(sp? not a Dr.) gland which is completely non-life threatening, but could cause my gyne to come back if it isn't treated. SOO, I've set up an appointment to have an MRI done next week to check my brain for that tumor's size (if it exists) as well as a meeting with an endocrinologist to help treat my high prolactin levels. If I respond to treatment and levels drop, I can go ahead with surgery. Although I really want these douche bag man boobs off my chest, the last thing I want is for them to come back - esp. after dropping all the money for surgery. In the meantime, I'll focus on cutting as much fat as possible and work on getting my hormones in balance. Then, I will get the surgery. As my Dad has said my entire life: "Patience is a virtue."

So that's where it's at right now. I'll keep this thread updated as I learn more. Hopefully it will help someone out too because Lord knows there are a ton of you who have helped me out tremendously.

PS, I'll put up some pictures later on. Until then, take care!

Please note the date of this prior post and my answer here in this forum:

• I was just wondering how mNy of the Physicians on here come across patients with increased Prolactin levels as a reason for their Gynecomastia.
  

  
  I have seen quite a few patients with increased Prolactin as the cause of their gynecomastia.  Some come already with the diagnosis already stabilized. Others had no idea why their breasts were growing.  They were Reg Flagged by my evaluation, had an endocrinology evaluation, then were stabilized. Most were from prolactinomas (tumors of the pituitary gland). A Prolactinoma tumor makes too much Prolactin a hormone that causes breast growth to make milk for pregnancy.  Prolactinoma in men can be large enough to press on the optic nerves restricting vision.  It is one cause of gynecomastia. Dostinex (Cabergoline) is a medication that can be used to treat prolactinomas.  When effective, glandular growth is sometimes stabilized, and sometimes regresses. 
  
  Others had prolactin elevated as a component of other endocrine issues.
  
  Gynecomastia surgery is better deferred until such problems are stabilized.
  
  My patients awaiting stabilization for such issues as an endocrinology problem as a prolactinoma have expressed how helpful No Surgery Body Shaping Garments have been to temporize a natural chest contour.
  
  Hope this helps,
  
  Michael Bermant, MD
  

Here is the link to the original question and my answer:

https://www.gynecomastia.org/smf/index.php?topic=21744.0

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737[/list]

[texastoast88]

Alright, just wanted to update the thread and to thank you doctors for the solid information.

Just got off the phone with my doctor and I have an 11mm protrusion on my pituitary gland. My Dr. is basically 100% sure that is the cause of my boosted prolactin levels which in turn gave me the gynecomastia.I meet with the endocrinologist on Thursday and am not really sure what to expect. I'll let you guys know what the endo's recommendations are on Thursday. As much as it sucks knowing I have this growth and the possibility of having to take medicine indefinitely to remedy it, I sure am glad I now know what the cause is and it isn't a mystery anymore. The gland's days are numbered..

[Dr. Elliot Jacobs]

Glad that you are taking these steps and that you are receiving appropriate care.

Let's hope that your condition is amenable to medication and that it stabilizes on the medication.

Best of luck!

Dr Jacobs

[Raider Fan]

I'd be interested in knowing why your prolactin level was considered high.  According to my lab, normal prolactin levels are between 2.1 and 17.7, so your level should have only been at the upper end of the normal range.  So the question is, why would someone in the "normal" range have a tumor?  

[texastoast88]

Really not too sure on that Raider, maybe it's a proportional thing. I'm 23 years old, 6 foot one and weigh 190 at the moment. My Dr. did mention that the cut off for what is considered normal would be 15.2, so I was just outside that range. My honest guess would be that "normal" prolactin levels have something to do with age and maybe size. When I see the endo tomorrow, I'll make a point to ask her and get back to you ;p

[DrBermant]

Alright, just wanted to update the thread and to thank you doctors for the solid information.

Just got off the phone with my doctor and I have an 11mm protrusion on my pituitary gland. My Dr. is basically 100% sure that is the cause of my boosted prolactin levels which in turn gave me the gynecomastia.I meet with the endocrinologist on Thursday and am not really sure what to expect. I'll let you guys know what the endo's recommendations are on Thursday. As much as it sucks knowing I have this growth and the possibility of having to take medicine indefinitely to remedy it, I sure am glad I now know what the cause is and it isn't a mystery anymore. The gland's days are numbered..

Lab values vary around the country. Many Endocrinologists ask specifically where the testing was done as some labs have less reliable results. That is why I prefer to let the Endocrinologist order and evaluate the lab work.

Breast gland is swollen from stimulation by hormones. As I discussed in my prior posts, Prolactinoma tumors are one such cause. Sometimes there are multiple causes. Once the hormonal effects have been lifted, the stimulation stopped, gland swelling can go away. Unfortunately, there is often residual deforming gland. How much is really unknown. However, being patient and waiting for the endocrine issues to stabilize is the first step. I have seen in my practice many such patients and helping them with the waiting period was an important factor in my developing resources demonstrating the power of Body Compression Garments as a temporizing emotional bandaide. I took the time to take pictures of various types of gynecomastia and to what degree the garments helped hide the deformity. Check out this post:

https://www.gynecomastia.org/smf/index.php?topic=18919.msg131399;topicseen#msg131399

Be patient, it can take time for the swelling component to resolve. Congratulations on the problem now being defined.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[texastoast88]

Well, I went to the Endo the other day and left very confused as to what the future may hold. So I walked in, waited awhile and was finally called back. The nurse asked me if I was there for Diabetes or Thyroid and I said neither. She took my blood pressure and bounced, so I  waited for Dr. Sumana Ganji to come take a look at me. When she came in, she introduced herself and glanced at my chart. She said that she was wondering why I was coming in with my prolactin levels only being 15.4 (apparently 20 or above is high to her). I told her about my Gynecomastia and that my regular doctor was convinced the tumor on my pituitary gland was to blame for the high prolactin levels and in turn, the gynecomastia. She asked me if she could see my chest so I took off my shirt for her to check out my puffy nipples. She said she'd seen puffy nipples like mine but would expect them to disappear by the age of 20 or so. She was beginning to make me mad when she felt around my breast area and said she didn't feel tissue. When I do, I can feel small round bumps underneath and a circle of what I would describe as firm tissue encircling my areola. Even when I said I told her how I had them and that they were stable for 8+ years, she insisted that they would burn off with exercise..I then responded how I had been very dedicated to working out/eating right and had seen fat loss all over my body, my chest muscles were rock hard but my nipples never shrunk, always super puffy and noticeable. She prescribed me Bromocriptine and told me to hold off on surgery for a year to year and a half and to "try and burn some of that fat off my chest". The nurse came back in, drew my blood for tests and I then dropped $220 for the visit, walked out pretty pissed that she didn't listen to a word I said.

I KNOW I have Gynecomastia - I know. I know it won't burn off with diet and exercise. I don't know what to do next. Just keep my mouth shut and eat the pills for a year or more? Or do I go to another Endo for a second opinion? Pretty weak..

[Raider Fan]

Hmm....well I can definitely understand your frustration if she didn't even seem to know about your pituitary tumor and didn't seem to know anything about gyne.  It's unbelievable that a specialist in glandular problems wouldn't be an expert on the subject.  Surely she's seen gynecomastia many, many times and can tell the likelihood of it going away (or not).  Everyday people on this site have a better understanding than that.  

The med she gave is for high levels of prolactin, but for prolactinoma tumors, I thought Dostinex was the drug of choice.  Wonder why she didn't prescribe that?  Was a prolactinoma definitely diagnosed or did your doctor just say that's what he "thought" it was?  I mean....you DO know for sure that it IS a prolactinoma?  Correct?

How long will you take the med she gave you?  Forever?  Is she going to keep a watch on the tumor to make sure it isn't growing?  Seems like she would have mentioned these things to you. I mean....it IS rather noteworthy if you have a tumor.  I have a friend that has a prolactinoma and his doctor likes to do an MRI on him every once in a while just to make sure the tumor's not growing.  You sure don't want any optic nerve problems.  He said his tumor was discovered when the hair on his body started turning soft (instead of being coarse).

I think I'd definitely get a second opinion and ask the doctor these questions.  Also, I'd still like to know why you have a tumor if your prolactin level is only in the upper limits of the normal range. The doctor you saw also didn't seem concerned about your 15.4 prolactin level.  So why do you have a pituitary tumor?  It just seems if you have a prolactinoma, your prolactin level would be WAY higher than the normal range.  I'm certainly not a doctor, but I don't know why a "normal" level of anything would produce a tumor.  

[texastoast88]

Well, I had the MRI and my family doctor said there was an 11mm protrusion on my pituitary, but he never used the world "Prolactinoma". I know the MRI results were faxed to her office but I don't recall her ever mentioning the results, I'm the one who did. I am scheduled to come back to her office in a little over a month, I assume to check my prolactin levels. My general doctor told me that I would need to have another MRI several months down the road to ensure the treatment the endo prescribes is doing its job but she made no mention of that. I appreciate the advice Raider, I am definietly seeking a second opinion, I really don't think she did her job as an endo. I'll let you know what happens.

[Dr. Elliot Jacobs]

An 11mm bulge on the pituitary is not normal.  I am sure your endo knows that.  Perhaps another endo opinion is indicated.

However, she did put you on Dostinex (Cabergoline)-- so there is no harm in taking it and observing what happens to your prolactin levels.  As for her cursory exam of your chest -- forget it.  Even experienced hands at times have difficulty telling breast tissue from fat.  And her comments on gyne disappearing by age 20 should just be forgotten.

One important fact:  while your situation is still in flux, surgery is out of the question.  Just concentrate on losing weight and working out -- and be patient.  Your endo will follow things with periodic  MRI's and prolactin levels.  If the prolactin levels decrease while on the medication, then you have your diagnosis.

Dr Jacobs

[texastoast88]

Thanks for the reassuring words Dr. Jacobs, definitely makes me feel a lot better. I agree, I am gonna keep taking the Bromocriptine and hope my Prolactin levels fall and continue to workout and get into shape. Realistically, could I consider surgery within this year? Reason I ask is because we have met our insurance deductible and if they will cover this surgery, even out-of-network, I'll save a bundle. At any rate, thanks again for replying to my thread and keeping me reassured that the end is in sight, even if it's farther than I'd like. Hopefully I'll meet you in person one day Dr. Jacobs so you can eliminate my Gynecomastia

[Dr. Elliot Jacobs]

Insurance very rarely covers gyne surgery.  Better to wait for surgery until your endo condition has stabilized -- more important than possibly saving on your deductible (on a condition for which insurance reimbursement is at best problematic).

Dr Jacobs

[texastoast88]

Just an update:

Continuing to take the Bromocriptine. I received a call from the endo and she said all my levels looked good and that I was to remain on the prescribed medication at the same dose. I was talking to my dad about how I have to wait to get surgery and he offered to basically float me the cash to get the surgery when I get back from Washington. I'm doing an internship in DC for a couple months where I plan to continue working out and taking my medication. If it's been stable and I'm treating my prolactin levels (which by the way, the endo still said were in the normal range), could roughly 3 months of Bromocriptine be enough to where I could proceed with surgery and continue treatment? I'm just getting really ready for these ole boobs to come off. Like very desperate.