Gynecomastia + prohormones

[OK123]

Trying to get some opinions on gynecomastia after pro hormone use.
A friend took methyl-1-D which is a testosterone booster, less than a few months later he developed bilateral breast tissue enlargement. He has presented to a couple surgeons (one plastics & one cosmetic surgeon) for consultations. He is a very healthy 28 yr old on no medications. The plastic surgeon was willing to set up surgery & did not mention any further testing. He was informed of the pro hormone usage(which lists gynecomastia as an adverse effect). The cosmetic surgeon has recommended an endocrinology consult to rule out pituitary adenoma. I am a physician assistant & believe that this would be looking for a "zebra." what do you think & do you routinely recommend endo consultations? Also there are no other symptoms (headaches, blurred vision, etc). Thank you for your time.

[Dr. Elliot Jacobs]

Common sense would seem to indicate a causal relationship between the pro-hormones and the onset of gyne.  I have seen many patients with a similar scenario.  On the other hand, the other doc is simply being extremely thorough -- but if he were to suspect a pituitary adenoma, he should also work up the patient for multiple other potential causes for gyne.  He is just "covering his a$$."

In general, I do not feel the extra expense is necessary if there seems to be such a blatent cause and effect story.

Dr Jacobs

[OK123]

That was my thought. He doesn't have health insurance & it would be a costly workup. Any further symptoms & I will personally take him to
Thank you for the input!

[Litlriki]

I agree with Dr. Jacobs.  Because of my involvement with bodybuilding, I see many patients with gynecomastia related to anabolic steroids and pro-hormones, and the pro-hormones have really been causing much more gynecomastia than some of the previous formulations in the past.  Gaspari Nutrition products, I've found, seem to be the most common culprits in the past couple of years.  This is just an observation, but I've definitely seen an upswing in that group. 

Generally, I recommend that the patient be off of everything for six months to see if the condition will resolve on its own.  If it hasn't by six months, it typically won't go away without surgery.

Good luck,

Rick Silverman

[OK123]

Thank you Dr. Silverman and Dr. Jacobs. I have looked at both of your websites...and WOW I was blown away with your credentials!

To Dr. Silverman:
I have reviewed your FAQs on your site. He has been off of the prohormones since 2008 with no regression of tissue. I do know at one point maybe in the 2006 time period that he did try some type of anabolic steroid (I don't know names bc I know nothing about them!). But the gynecomastia occured soon after the Methyl-1-D usage. He is currently scheduled for excision/liposuction of the tissue. In your experience, with this history, is there a decent chance for recurrence of the tissue if he stays away from any prohormones or anabolic steroids? Over the past 3 years, he has only intermittently used Jack3D, super pump, creatine, and protein shakes.

[Litlriki]

He should definitely avoid any supplement that has any hormonal activity, including "boosters" and "blockers."  These supplements ARE NOT DRUGS, and they are not regulated.  As a result, you don't always know what you're getting.  To avoid problems in the future, it's best to avoid the potential stimulating factors.  I tell you this as someone who uses supplements--I am not anti-supplement.  But it seems foolish to go through surgery and then tempt fate with a supplement that may or may not have any real benefit.  In my estimation, 98% of results in bodybuilding are related to genetics, training and nutrition.  There may be a small contribution--I'm giving it 2%--from supplements.  I am not referring to anabolic steroids--the real ones.  That changes the numbers, but it moves you into the over 100% range, if you know what I mean.

RS