TRT - A couple questions about Gynecomastia

[hatemymoobs]

Hello again doctors...
I know the endocrine system isn't your area of specialty- but I'm hoping to squeeze some wisdom out of you if possible.

First off, I already have gynecomastia. After seeing an endo it was discovered my T levels were below optimal.
I was just put on Testim gel starting yesterday. I've read Testim and Androgel can cause breast pain or enlargement.

1. What about a TRT would potentially cause gynecomastia?
2. The 2 days I've been on Testim- my "breasts" feel slightly sore every once and a while. Not painful, but slightly sore. This could be my paranoia playing tricks on me, or perhaps it's real. How can I tell for sure if this medicine is causing growth, other than waiting it out to see if they get larger? Would there be pain? Or just very mild soreness.
3. If you know much about TRT- is there one treatment option that is better for people with gynecomastia than others? (do injections vs gel cause less or more conversion to E2 or is one more effective than the other)

I do realize most of the time TRT won't reduce gynecomastia, that's not the answers I'm looking for- I just mean better for not creating a bigger problem than I have already I guess. Thanks!

[Litlriki]

Gynecomastia results from an imbalance in the relationship of estrogen and testosterone with a higher ration of estrogen than is "normal."  If you have low testosterone, estrogen levels are likely high relative to the testosterone levels, thus leading to gynecomastia development.  If you add testosterone to bring you to normal levels, it should serve to correct the ratio to a normal level, thereby diminishing stimulation of breast tissue.  As a result, one would anticipate less of a "florid" character to the gynecomastia, and it is typically "florid" gynecomastia, which is accompanied by swelling and discomfort.  That's the rationale of testosterone replacement therapy, so what you're feeling may be a hold-over from where you were, or it might be related to your constant attention to the nipple area (in other words, if you're testing to see if it's bigger every hour on the hour, you may cause some discomfort by squeezing repeatedly). 

The approach to replacement should be guided by the desire to have stable levels, rather than fluctuations up and down, which can lead to fluctuations in the ratio with resultant stimulation intermittently.  With injections, this can be a problem if injections are less frequent with higher dosage, since this can result in more highs and lows.  Gel should be fairly constant, providing that absorption is good, and if injections are used, lower dosages administered weekly will result in less fluctuation than higher doses less frequently. 

Your endocrinologist is probably the best person to help you determine the best approach to replacement therapy. 

Rick Silverman