Testosterone and gynecomastia

[chestyoldman]

My urologist is testing my testosterone level and said we would talk about me going on testosterone therapy if it is too low. I should get the results back soon, but I suspect that it is low. If I start the testosterone therapy, what effect can I expect it to have on my breasts? I used Axiron for a while in the past, but my insurance company made me switch to a gel. I didn't care for either one and I didn't notice any changes, so this time if I need it I'm leaning toward the injections. I am insulin-dependent diabetic, so I'm used to giving myself shots (at least 5 per day) and my doctor says I should be able to give myself the injections at home. Do the different types of testosterone have different side effects that I need to be aware of?

[Dr. Elliot Jacobs]

There is a large range of what is considered "normal" for testosterone.  If you think it is too low based on blood tests, then would recommend you seek the advice of a hormone doctor (endocrinologist) who can carefully monitor your testosterone levels and also some of the other hormone levels (ie estrogen) which might also be affected.  

Dr Jacobs

[DrPensler]

Testosterone management by physicians is relatively new for individuals like yourself. Administration of testosterone is done in conjunction with monitoring blood levels. The side effects are serum dose related and there are differences in absorption depending on the route of administration. The most reliable absorption is with injection.A growing variety of physicians are administering testosterone today so you should be certain the physician has experience in the area.

[chestyoldman]

Since my initial question back in July I have now started testosterone injections and I had my first of 4 last Tuesday. After the 4th injection I will go back to my urologist to check my T level.
In doing my reading about the benefits and side effects I repeatedly saw that TRT can cause enlarged breasts. Since I already have "enlarged breasts" (AKA gynecomastia) does this mean I should expect them to get larger, or is this just a possibility? How common is it for men on TRT to report breast enlargement? Of course, like so many other things, I understand that "my mileage may vary" and it might not affect me at all. I would just like to start preparing myself and my wife for the possibility that my breasts will get larger and I may need to buy bigger bras.

[DrPensler]

Testosterone injections may certainly result in gynecomastia. For individuals with gynecomastia testosterone may increase the development of gynecomastia. Having said that the majority of testosterone injections in the past were performed for the anabolic effect of the drug ,ie build muscle. Testosterone injection under medical supervision in older males is relatively recent so there is not as much experience.Also of great importance , testosterone under medical supervision is done in conjunction with the measurement of blood levels which are not done for illicit use. I certainly  cannot say with any certainty that medically administered testosterone in conjunction with monitoring of blood levels of testosterone within normal range has a certainty of X% incidence of gynecomastia.

[chestyoldman]

Thank you, Dr. Pensler. I'm not really looking for a statement of a percentage probability of increased breast size, but rather to see if there is any evidence to suggest that starting testosterone injections with preexisting gynecomastia has a tendency to increase the size of the breasts. I'm just trying to find out as much as I can about what to expect. I believe I can already tell an improvement in how I feel after the first shot. I will take my 2nd shot on Tuesday 8/29. 

[DrPensler]

I totally get your question the quick  answer is that certainly testosterone can increase gynecomastia. It a bit like saying if I drink beer can I get drunk. The answer would be you drink enough you get drunk.In your case as you are under the supervision of a physician and the testosterone blood level will be monitored I am assuming , to me the question  to add onto the beer analogy is will I feel a buzz after 2 beers. Its a bit nuanced of a question in your case,will a slight elevation of testosterone that stays in the normal limits result in an increase in the size increase of your  abnormally enlarged breasts. Definitive information just does not exist.

[chestyoldman]

Thank you, Dr. Pensler. It's going to be interesting to see what happens. One thing is for sure, though, and that is I would rather have larger breasts than to not feel well or get erections. My doctor said he wanted to get my testosterone level up before we address the ED issue. I see nothing but win-win for me, including the possibility of larger breasts!

[DrPensler]

Good luck,I would do what you are doing for what it's worth if I were the patient.

[chestyoldman]

Dr. Pensler, that's worth a lot!  Thanks for the encouragement!