Are My Hormones Still Out of Wack? Some Blood Test/Photos

[GynoHelpWanted]

Hi,

I took propecia a couple of years ago, and have had some slight growth in my chest area; with some of the tissue being mostly firm.  I can also feel some slight lumps when I lay down, and press my skin between my fingers.  These seem to come and go. 

The gyno does not center around my nipple, nor is there really anything around my nipple within maybe an inch or so.  It protrudes from my armpit, and extends outward to my nipple.  It is probably 3/4" or so around my armpit, and about 1/16" deep or so around my nipple area.

The gyno feels more or less tender at certain times, and there are definitely things that can make it feel worse with some slight discomfort (I would not call it pain at all)....such as: ejaculation, less than 9 hrs of sleep, alcohol, exercise, going too long without food, it being later at night, etc.  I touched on most of this in a longer post in my thread, which also included some photos.  Link to thread with photos: https://www.gynecomastia.org/smf/1/gyno-one-doctor-says-no-one-says-get-checked-out-immediately/

I can feel the gyno getting worse, and can feel many other symptoms that all come and go.  I have had this going on for a couple years now, and although some symptoms have disappeared, others have not.  The gyno has slowly worsened. 

Given the very noticeable changes throughout the course of the day, is it possible that my hormones are still out of wack?  If so, how can I possibly fight this?  It seems like exercise makes things worse, but it is hard to tell.

Here is some recent bloodwork.  I am a 30 year old male:

Testosterone, Total:       628 (241 to 827 ng/dl)
Testosterone, Free:        11.2 (8.7 to 25.1 pg/ml)
DHT:                         46 (16 to 79 ng/dl)
Estradiol:                 37.1 (<=39.8 pg/mL)
Cortisol, serum(9am):     23.24 ug/dl (4.3 to 22.4, AM range)
SHBG:                        53 (11 to 56nmol/L)

Do any of these results seem out of wack?  It seems as if Free T is a bit low, Estradiol a tad high, cortisol a tad high, and SHBG a tad high.  Given that the gyno is not terrible, but it is very troublesome, does this make sense?  These tests are in the morning, on a day when I was feeling slightly better.  I am always worse at night.

[GynoHelpWanted]

I should probably include...here is a pretty complete list of symptoms I am experiencing, or have experienced since I took propecia:

--much lowered sex drive
--morning erections are nonexistent, maybe 95% of the time
--much lower quality of erections, but not terrible I guess; maybe for my age?
--a slightly different feeling when ejaculating; tough to explain.  I am normally knocked out, and all symptoms are worse for a few days after.
--originally, semen quantity was lowered, now seems okay, unless I ejaculate a couple times in within 3-4 days
--premature ejaculation, this happens quicker when all other symptoms are worse; was not a problem before
--irritability, which often occurs with some slight stress
--gynecomastia, or at least breast tissue growth, and fat on my chest.  This feels tighter/more pressure in that area when other symptoms are worse.  Is this growth?
--wrists/ankles are smaller, slight indents under eyes, red veins in eyes; veins have stopped worsening, but have not improved...its been a year and a half
--wrists almost seem flatter than before
--exercise seems quite difficult, and I was extremely fit pre-propecia.  I would describe it as much, much harder, with a lack of energy, but still doable.  I used to run a lot, and I cannot run nearly as far, but can still run a couple miles (used to run marathons)
--occasionally, I can get pretty tired/worn out
--tougher to get up in the morning, but this has improved quite a bit
--very mild joint pain, this seems worse when other symptoms are bad
--I just noticed my shoulders are curving inward; not sure if related; but I feel a discomfort on my inner shoulder when other symptoms are worse
--some very slight stomach fat; may not be related, but diet is great
--severe headaches (this lasted 3 months; I no longer have this at all)
--severe brainfog (this also lasted 3 months; I no longer have this at all)

[Litlriki]

My expertise is only with gynecomastia and not with all of the other issues you've described. I would say, however, looking at the photos you posted previously, I am unimpressed that you have gynecomastia at all.  Your description of your sensations and symptoms is not typical of most gynecomastia symptoms, and the location is atypical. So, whatever is going on may or may not be related to Propecia use, but based on what you've presented so far, I don't think you have gynecomastia.

Rick Silverman

[GynoHelpWanted]

Thank you very much Dr. Silverman!

Have you ever seen any gyno that would have developed around the armpit area, and not around the nipple area?  I do feel some small lumps around my nipple, when laying down, and rubbing my skin between my fingers...but they are at least an inch away from the nipple itself, and I feel absolutely no tissue centered around the nipple.  The entire breast has what I would describe as an added layer of fat, though....but what I think feels like tissue has been centered from my armpits, extending outwards towards the breast (as shown in the photo).

I can grab quite a bit of fat/tissue that is around the armpit/upper breast area, and, if I grab it, and bunch it together near my upper chest, I feel like my chest looks/feels similar to how it used to (although still much fattier/softer).  Before propecia, I would have difficulty pinching anything on my chest for a fat caliper test; now I can grab many inches (and it was that way right after propecia...maybe 3 months, and is getting worse, slowly).

Since I have always been very fit, and extremely skinny (never more than about 14% body fat), this is very noticeable to me.

It seems like this is hormonal related, since I only feel discomfort in my chest at certain times now (used to fell almost 90% of the time two years ago...now maybe 30% of the day), which are all centered around things that I believe influence my hormones - like a lack of sleep, being later at night, ejaculation, exercise, stress, etc.  Over 2 years, I've become pretty good at identifying the things that affect me now that I can feel it in my chest, and have kept a detailed daily log.  I've definitely picked up extra fat/maybe tissue in my chest.  Is any fat/tissue growth on my chest, that is hormonal related, gynecomastia?

I'll be checking with a plastic surgeon to at least get an opinion.  Is it normal for gyno patients to feel discomfort around their chest only occasionally?  Mostly after the items I have mentioned?  If I am feeling that discomfort, it would seem like my hormones aren't back to normal yet, and that any gyno surgery would be a waste.  I would definitely love any advice you can offer.

[Litlriki]

As I said, my impression from the description of your symptoms, from your description of the distribution, and from the appearance of the photos is that you DON'T have gynecomastia. It is common for pain to wax and wane when gynecomastia is developing, and in long-standing gynecomastia, there is often no pain.  Also, patients who develop gynecomastia related to steroid use, as an example, typically have pain during the active or "florid" phase as the gynecomastia develops.  But sometimes they still have pain long after their hormonal levels are back to normal.  That's not an accurate predictor of you hormone levels.

Speak to your primary care doctor and a plastic surgeon.

RS