puffy nipples with recent growth in one side

[anon111]

i'm 28 years old., 5'11" and 175 lbs. i'm quite lean and have 10-12% body fat. i work out regularly, have never used steroids or drugs of any kind, including marijuana, and to my knowledge don't eat copious amounts of soy, etc.

six months ago i noticed some soreness and growth near my right nipple. after seeing several doctors, i was diagnosed with gynecomastia. i think that i've had puffy nipples for a long time, at least since my early 20's, but the new growth is alarming. i've been more concerned that it's a symptom of a bigger problem and went to see an endocrinologist.

in a nutshell, here's what i learned:

- total T = 288
- free T = 83
- estradiol = 35
- prolactin, thyroid, FSH, HCG, etc all tested normal
- a urologist ruled out testicular cancer

my first endo said that everything tested normal and that perhaps i have a "increased sensitivity to estrogen," and prescribed tamoxifen. i was alarmed by my T results, which he described as the "low end of normal" and decided to rerun the tests and get a second opinion. i'm awaiting my results.

note that i've been under chronic stress and anxiety and the addition of gynecomastia only added to it. i think that my worry led to a mild case of adrenal fatigue, from which i'm recovering. the second endocrinologist is also checking my cortisol levels.

a few questions for those in the community who might know:

- could chronic stress interfere with my testosterone production enough to trigger gynecomastia?
- what are the side effects of tamoxifen? if my T levels turn out to be normal, would tamoxifen curtail the growth? could it decrease the the gyne? would i need to stay on it permanently to remain free of gyne?
- if my T levels turn out to be low, what are the side effects of testosterone replacement, such as androgen? could increasing T be enough to eliminate the presence of gyne, or would i need to pursue surgery in addition?
- is there the risk of gynecomastia returning after surgery? how can i be sure that it's no longer growing before surgery?

any advice or commentary is appreciated.

[xelnaga13]

What time was your blood work completed?

Please list the ranges along with the level of hormones. Otherwise the numbers dont help me.

Chronic stress can and will lower your testosterone. Its a proven fact that high stress jobs, specially those with long hours, lead to low levels of testosterone. Cops are a great example of this, many find themselves needed trt faster than men with other professions.

Tamox has low side effects. It's possible that it will decrease the size of your growth, but the chances of this get lower the longer the gyne has been established. Tamox will raise your natural testosterone levels by tricking your body into thinking they are low ( due to your body sensing less circulating estrogen).

It's possible that your gyne is caused by an unfavorable test/estrogen ratio. In this case testosterone replacement may be of help. Personally, I will never tolerate my test level dropping below high normal. We get one shot at this life, and I will not accept age as an excuse to feel less than perfect.

Gyne can return after surgery. I had my FIRST surgery at 14. A year later it grew back to it's original size. I was lucky enough to have the surgery again at 26. I not get blood work and keep medication on hand in case I feel it's returning. ( Tamax, femara) I dont recommend this for a novice. I have studied the endocrine system for years and know exactly what changes every mg of substance produces in my system.

My advice to you is to make your health and well being a top priority. At 28 your test levels should be normal to high normal.

[anon111]

my first blood work was done late in the day, around 5pm. for that reason i wanted to redo the tests earlier in the day. i'm still waiting for the results, but the blood was taken at 11am.

here are the first results (5pm), this time with ranges (when available):

- total T = 288 (262-1593)
- free T = 83 (50-350)
- estradiol = 35.5
- TSH = 0.79 (0.55-4.78)
- FSH = 2.6
- prolactin = 2.9

unless i learn something entirely new from my second blood work, i'm thinking i'll take the doctor up on the tamoxifen for a month and monitor my progress. i'd like to raise my T through that, reduction of stress, and other natural ways if at all possible. if i've made progress after several months, i'll look into the surgery for a more permanent solution to the appearance. if i haven't made progress and T is the culprit, then i'll consider TRT.

sound right? curious to hear your thoughts.

[xelnaga13]

Im not shocked that your blood work was done late in the day. A proper testosterone reading needs to be completed at 8am in the morning. Testosterone fluctuates throughout the day/night, reaching a high point in the early AM and then dropping of significantly the rest of the day.


As far as your tamox plan, it appears to be sound. Hormone replacement is a last resort. However, considering your age,  if your second set of tests reveals similar data you're on the fast track for testosterone replacement therapy.

If you do find yourself diagnosed with low testosterone, or even lower end levels, you will need to do a great deal of personal research. TRT is relatively new and misinformed doctors are the rule rather than the exception. People are just starting to understand the psychological and physical consequences of low T. It can lead to everything from not having any confidence in yourself at work to causing diabetes.

[anon111]

thanks for your input.

[xelnaga13]

I would like to add that testosterone replacement therapy is hardly the end of the world. I have known many guys that claim it changed their life. Many low-low end T guys get used to a laundry list of negative symptoms not realizing its directly attributed to low T.

About 10 years ago my father began show symptoms of profound depression. He was irritable and unhappy. His doctor put him on xanax and anti depressants such as prozac. He had never been an unhappy man, and in 26 years I have never seen him let anything in life get to him. After reading about TRT I called him doctor and suggested that they look into this possibility for my dad. The resulting blood work showed he was not producing even the slightest amount of testosterone.

After this discovery he was put on androgel with much success. His mental health improved 100%. He also stopped getting skin psoriasis, his diabetes improved, and a strange swelling in his foot stopped.

It scary to think how many men over the years have just accepted low T as a part of getting older.

[anon111]

i spoke with my endocrinologist yesterday about my most recent test results:

- total T: 342 (348-1197)
- free T: 9.9 (9.3-26.5)
- all other measures 'normal'

in this case, the total T is technically below normal whereas last time it was slightly above, even though the blood was drawn six hours earlier.

she basically concurred with the first doctor, saying that i might have an increased sensitivity to estrogen. she feels that this doesn't warrant testosterone replacement therapy.

she prescribed tamoxifen and said that in three months i need to rerun the tests first thing in the morning (8am) while fasting.

she says that the tamoxifen could reduce/eliminate the growth and if it does, i can stop taking it. if it doesn't work, she says the only option is surgery, and she claims that gyne doesn't grow back after surgery.

is this all true?

i'm concerned that i go through this process without addressing an underlying problem, such as low T, only to have it return.

in the spirit of what you say about your father and the effects of low-normal T on men, have you heard of Dr. Henry Lindner? he advocates for something he calls "restorative endocrinology." his website is www dot hormonerestoration dot com.

[xelnaga13]

Your second test. confirms that you are suffering from low T. Are you having any symptoms other than the gyno? Also are you boozing, eating terribly, not sleeping, taking drugs, or chronically ill? ( dont answer if too personal for web)

Tamox may be able to shrink the size of your gyno by blocking the estrogen the growth needs to grow or remain. It also has the effect of tricking your body into producing more T because it senses no estrogen ( part of the feedback loop). However, at your levels I dont think the improvement will be significant. Furthermore, any improvement in either condition will be reversed once tamox is stopped and your body returns to it's current state. Tamox has many side effect including cancer- so it cannot be used to treat low T long term.

Gyno can return even after surgery. Specially when the underlying endo issues have not been addressed. Almost every surgeon will leave a small amount of breast tissue in order to prevent a crater.

If I were in your shoes I would do the following:

Run tamox for 3 months
Find an endo that takes your low T seriously
Run a testosterone replacement protocol ( there are gels- but injections are more potent and cheaper)
once you get your system stable , if your gyno is still there consider surgery ( you dont want to have surgery prior to getting your trt in balance)

Gyno should be a secondary concern for you. Your main concern should be how low your T levels are for your age.

[HellandBack]

How long does it usually take for everything to stabilize so that you know gyno won't grow back?

[xelnaga13]

How long does it usually take for everything to stabilize so that you know gyno won't grow back?

If you're referring to testosterone replacement therapy typically you get blood work done every 3 months after starting. I would suggest a full year if you really wanted to be safe.