Gyne, surgery and low T

[claude1980]

Hello! Having finally decided to have surgery in the Autumn to fix my chest issues, I wanted to ask a Dr. about some surrounding factors involving testosterone.

I have somewhat low testosterone (13 nmol/l with a ref range of 11-32), but am not wanting to undergo t replacement therapy at this point, although I might in the future (no real symptoms now, other than difficulty losing stubborn fat, but I am more interested in tackling that problem in the gym and the kitchen instead of with a lifelong therapy of injections or gels). How will this potentially impact my surgery? If I have excision and lipo (what I imagine will be called for), and do decide to begin TRT down the road, will it impact the chances of glandular tissue returning? I assume it increases the risk of reappearance (more T=more estradiol=more glandular tissue?), but might be totally wrong, or it might be as simple as ensuring that TRT includes close monitoring of all other hormones also.

For reference, I am 34 years old, 6'.5", and around 190 lbs, in decent shape and working out to lose another 8kg or so and add some muscle. I've had stubborn gyne since 13-14, and I think it is likely glandular/fat mix, and it has not changed in about 20 years despite periods of weight loss/gain.

What say the doctors? Also, just a tip of the hat for providing your professional insights on this forum; it's rare to see something like this, with such skilled doctors willing to help talk people through their problems and questions. Kudos!

[Dr. Elliot Jacobs]

If you are otherwise healthy and have a decent libido, the there is no need, IMHO, to complicate matters by adding T supplementation.

Having a borderline low T will not have any implications as regards possible gynecomastia surgery.  And for the vast, vast majority of patients, the gyne doesn't return after surgery (unless there are unanticipated factors, such as taking anabolic steroids, side effects of some medications, hormonal imbalances that may develop on their own, etc).

Should you decide to have T supplementation after gyne surgery, then both your T and E should be carefully monitored by an endocrinologist and any elevation of E should be treated with an appropriate E blocker.

Dr Jacobs

[DrPensler]

I think your plan is reasonable and acceptable. Testosterone supplementation under medical direction for aging males is a very new phenomena ,which is totally different from unsupervised anabolic supplementation for the acquisition of muscle mass ( body builders ). I have not seen a case of new gynecomastia with supervised testosterone treatment ,however I have seen an exacerbation of a preexisting significant but untreated case with supervised treatment.

[Dr. Schuster]

Supplemental testosterone should be much of a factor after surgery as long as the surgery completely removes all of the breast tissue (with the exception of a very thin layer directly beneath the nipple).