Gynecomastia returns after 8 years on TRT

[testor0610]

Drs,
I have an unusual situation with gynecomastia that I've not seen addressed in other threads or on any other site for that matter.

As a 13 year old, during puberty, I experienced some of the traditional symptoms associated with gynecomastia. I noticed significant fatty tissue accumulation around my nipple areas but no presentation of hard lumps. This condition last about 3 years before it redressed at age 17.

Fast-forward 3 years and at the age of 20, I used an injectable form of testosterone that was prescribed to me by a physician (this was 1989 and AAS were not III scheduled at the time) for physique enhancement. I did this for 10 weeks at a time 2 times that year and in that time, again, developed an accumulation of fatty tissue around my nipples. This time the fatty tissue was accompanied by hard tender lumps.

After another year without any use of testosterone (age 22), I underwent a surgery performed by a very reputable cosmetic surgeon. The surgery went well and the gynecomastia was remove to my total satisfaction - no scaring, no problems with appearance, no lumps or fatty tissue remained.

Fast-forward again 17 years, at age 39 I began TRT with the use of 150 mg testosterone weekly and 1/2 mg Arimidex twice weekly. My blood work is done every 4 months (3 times a year) and my CBC, Liver, and Hormone panels have always been very good. My total test level ranges between 800-1200 ng/dl and my estradiol number is never above 20.
However, about 18 months ago, I notice some accumulation of fatty tissue around my left nipple. I was concerned and immediately scheduled blood work. Again my total test level was 1056 ng/dl and my Estradiol was 18. Because my estrogen was so low, my physician said that it is not estrogen related gynecomastia and not to worry about it. In about 4 weeks, the condition went away completely. I didn't give it a second through until two weeks ago when my nipples (both) presented sore lumps and the accumulation of fatty tissue.

Again, my TRT protocol has not changed at all in 8 year - 150 mg weekly and 1/2 mg of Arimidex twice a week. As I stated above, my estrogen levels are in the low range.

I've done some research in the medical literature and it seems that the estrogen receptor can actually be stimulated by other hormones including androgens. While the receptors have a much lower binding affinity for non-estrogen based substrates, apparently over time and in sufficient quantity, the tissue can be stimulated by other hormones and grow.

I would like to know if any of the Drs on this site have personal or anecdotal experience with anything like my case. Particularly, could you comment on the likelihood that this current condition will also regress.

Thanks for your time and any insights you might be willing to share.

[testor0610]

Bumping for physician input.
Any thoughts on the OP are appreciated.

[testor0610]

Bumping one final time with the hope that one of the physicians on site will have some input.

***Any*** physician input welcome.
Thanks!

[Litlriki]

I have never seen a situation exactly like yours, but I have seen patients who develop gynecomastia with no clear explanation but in the face of prior performance enhancement and other manipulations of the sex-hormone axis, and this development is in the face of prior experience with gynecomastia (either transient that resolved or a condition that was corrected surgically).  It's not always possible to figure out exactly what is going on in some patients, and the only thing I try to be sure of is that they have normal levels going in to the surgery. The main problem is that there are so many points at which something can go awry and lead to stimulation of breast tissue growth. Nolvadex can, for example, do the opposite of what is anticipated by "activating" rather than "blocking" the estrogen activity it is intended to block.  I suppose this may occur with other medications or hormones, but I don't know that off hand.  Arimidex, for example, is more specific in it's action than Nolvadex, so it doesn't cause the same problem. The one comment I would add--and again, this is anecdotal--I have seen more long-term hormonal issues with individuals who used performance enhancing agents as teens, most likely due to more significant compromise to the development during the late teen years. 
I'm afraid that you've gotten such a poor response to your question here, because it's really more of an issue of endocrinology, and we are all surgeons with a more modest understanding of the endocrine relationships involved. Your question is a bit more "in the weeds," so to speak.

[testor0610]

Thank you for the time and feedback. I appreciate the insights. As I've researched this for quite some time now, I too, have come to appreciate the very nuanced aspects of the HPTA.
The term I continue to gravitate toward is ***GASP*** "idiopathic."