Arrogant hey? I counted no less than 15 gross assumptions you have made about me. Thing is, I don't tend to plaster my whole life onto the net to convice people of who I am or what I know.
So maybe I copied a thing or two from the net for my posts. Maybe I didn't. Maybe I should give up my day job cuz selling in hormones in gynaecology and andrology to GPs and consultants on a daily basis according to you it just ain't my thing. Once my sales for Nebido and Testogel slump and my bonuses stop rolling in I'll know I am not good at what I do, I'll quit. Until then I will tolerate your attitude problem.
To assume is to make an ASS of U and ME.
The problem is that you do copy some things from the net and you get it wrong sometimes.
That is the point!
I made no assumptions about you whatsoever.
In fact given some of the things you have been saying I made it my business to find out about you. Interestingly there is as much about your life history in the 140+ posts that you have made than there is in all of mine. Not that there is anything wrong with that.
I found out that you have said things that imply that you something you are not;
Thanks for that Hypo-is-here
As it happens, I do understand. I work in andrology and more specifically male HRT.
.
I looked into your background and found this;
Hello ChristianTroy
I had surgery nine days ago.
1) I went back to work four days after surgery ( I am a sales rep, so lots of driving and I was ok).
Now there is a big difference from being involved in Andrology and understanding hormones and selling some products.
The fact is I knew exactly what you were before making my comments so I wasn't assuming anything.
You are a sales rep.
Does this mean that a realtor/estate agent is an expert in the design and building of houses?
NO
I am sorry if you find this offensive but I am just speaking my mind.
The fact is you are not a doctor; you are not involved in Andrology apart from as a sales rep.
A) You should admit you do not speak with the eminent experts in this field about the in depth details of testosterone deficiency and its diagnosis- I DO!
B) You do not speak with the actual numbers of patients that I do. This means you do not have an in-depth understanding of the realities of the diagnostic procedures and symptoms etc that such men go through- I DO!
C) You have no first hand knowledge of the symptoms or diagnosis of hypogonadism- I DO!
D) Your knowledge of Andrology is crude and this is because you have never studied Andrology and in fact have no medical qualifications in Andrology and neither are you a patient who sees it matters from the other side of the fence- I have studied the condition and understand it as patient and someone who speaks daily to fellow patients and endocrinologists!
E) You have very little if any interaction with actual endocrinologists when it comes to discussing the actual details of these conditions- I DO!
So in short you are not a doctor of any type having no qualification in Andrology and you are not a patient who meets with the above all the time and studies the condition from the patients position.
But lets do something radical and dispense with the “you and me” of the argument (you can respond of course to what I have said above but once you have lets concentrate on the facts below).
I didn’t want to argue with you in the first place I only wanted to ensure that people were not be misled by some of the things you have got wrong. My reason for this is that I have been putting in hundreds and hundreds of hours on this site and hypogonadism support groups for years to ensure that people get the correct information.
I do this so that people do not go undiagnosed for years as I did and many of my fellow sufferers.
If your information means that one man is mistaken about his situation then that is one man that could end up in 13 years time with osteoporosis as happened to me.
One man is one man too many for me, which is why I am here.
Let’s see what are we actually disagreeing about here and resolve the issues sensibly and then move one.
I said that a comment of yours was totally wrong.
It was this one;
But that only applies to men defined as having low testosterone (below 12nmol/L but this figure varies from country to country)
.
I am stating this is factually wrong.
It is explained at great length that this is utterly wrong and outdated thinking by Dr Eugene Shippen in his book The Testosterone Syndrome. It is also explained by Dr Malcolm Carruthers in his books The Testosterone Revolution and Androgen Deficiency in the Adult Male. I can tell you this having read all of them and having spoken at length with these eminent professionals.
Without copying their comments verbatim I will give you the idea of what he has said (of course you are welcome to go and buy the books and put in hour after hour getting to try and understand a little more).
Symptoms are more important that blood tests alone. Testosterone deficiency should be diagnosed on the basis of symptoms in conjunction with blood tests or additional testing of the HPTA, genetics and scans etc. Blood tests should only be used as a guide, not a rule when considering testosterone deficiency.
The reasons that bloods alone are flawed and in themselves cannot offer conclusive answers are many but I will detail the main issues;
1
The testosterone reference range for adults does not take age into account; this means that a 90 years old man and a 18 years old man will be deemed to both be normal if they are right at the bottom of the testosterone reference range. This is a flaw inherent in the reference ranges.
2
Gps tend to only test testosterone and have a very limited knowledge of hormones. When testosterone is tested what does it show us?
It shows us whether we are within the range or not.
However the fact is it doesn’t tell us whether or not we are at the point in the range that our bodies require.
Obviously if you test X number of healthy men you will find a range of testosterone values, some men will naturally be fairly healthy with quite low serum/total testosterone levels and other men quite healthy with more middling levels whilst others quite healthy with fairly high levels (for a very good reason).
It is not a coincidence that there are men with high and middling levels of testosterone, the body has not got it wrong. If these men with high or middling testosterone see a substantial drop in their testosterone level whatever the cause then they can still be within the so called normal range. In fact their testosterone level can be much less than their body requires and they can have all the symptoms of testosterone deficiency. This fact is detailed at length by Dr Eugene Shippen. So all the normal range means is that 95 percent of people will fall with these parameters as seen in gaussian graphs. It does not mean that any individual in the range is necessarily at the point in the range that is correct for them.
3
It is a long known fact that serum/total testosterone offers very limited diagnostic value.
If SHBG is high then a man can be testosterone deficient, irrespective of what level of total testosterone they have. This is because SHBG is the transporter protein that binds to testosterone. 98% of serum/total testosterone in the body is typically bound to SHBG making it unusable by the body. SHBG binds to androgens and estrogens, but it binds to androgens with greater affinity. This means that even subtle increases in SHBG can lower free testosterone levels and relatively lead to an increase in free estradiol.
The result of all this is that a man with high SHBG can have a normal or even high testosterone level and still be testosterone deficient.
Which is why a serum testostrerone value of 12nmol/l does not prove what you were saying and why I have told you it was wrong (I wasn’t just being awkward).
4
Elevations in Prolactin and Estradiol have the same effect in lowering free testosterone as the above.
For these reasons a single serum/total testopsterone assay is NOT diagnostically usefull in proving that an individual has or in fact doe not have testosterone deficiency- one way or the other.
5
The single point measurement also misses out the need to test Luteinising Hormone. LH is a messenger hormone that can often reveal that the body is crying out for more testosterone despite a seemingly normal testosterone level.
This again is not taken into account by the single point testosterone assay. Also this is something rarely tested at gp level.
6
There are many men with abnormalities that relate to the androgen receptor. Everything from CAG repeat defects, PAIS (Partial Androgen Insensitivity syndrome) to Klinefelter Syndrome.
I can go and get evidence right now that shows men with Klinefelter Syndrome who have testosterone levels above 12nmol/l.
7
Having detailed all the above I will detail the fact that you yourself have even disagreed with your own comments on the matter (you are inconsistent because this is not an area where you are sufficiently knowledgeable).
In you do a search and the search engine works you and other people will see that you sated that the bloods had their limitations and that they were not the be all and end all in one of your posts.
Number 138- your 138th post on this site to be precise.
Now how can you blame me for stating the truth and disagreeing with you when you can’t even manage to agree with yourself?
What else do you disagree with in terms of what I had to say?
I stated that I known men to try to commit suicide because they were testosterone deficient and that I have known many men that were on anti depressants for years- both never knew they were testosterone deficient. Many of them had very limited symptoms with depression being one of them.
This is a FACT!!
Are you disagreeing with me?
Because if you are I will show you their testimonies!
In fact here is one- I can present hundreds of them.
http://www.androids.org.uk/stories.htmlP.S
If I have told you that you were wrong at any point and disagreed with you it is because you have been wrong. If I have worded things in a way you find disconcerting or that have been unfair in any way then I apologise.
You have contributed some very good posts on the site like I have said and I know you are trying to help- and I am not saying that to patronize you and in fact if I have at any point again I apologise.
I would be quite willing to give my phone number privately so that we could talk about this subject. You are clearly an intelligent articulate guy and someone I would have thought could help me in trying to put a message across about the need for pathology testing for men that have gynecomastia.
I would like to show and detail for you many things which I am sure would change your outlook.
Again I am being brutally honest not patronizing.
I hope you do not feel upset about what has gone on and you can see why I have said the things I have.
I would hope to not argue in future, particulary as you have been doing a good job of helping people out in so many other posts.
And now... to an actual question.
My Endocronologist got approval for me to receive Testoterone gel. Which I daresay is much easier than the injections I used to have to shot into my thighs.
I have stayed off it since surgery for fear that it might bring back the onset of Gyno all over again. I am being paranoid? Do I have cause to be concerned? Should I go back to my gel?
Any and ALL feedback is appreciated.
Fajha.
Most endocrinologist and surgeons like to consider gynecomastia surgeries when the gynecomastia is in a stable/settled state.
For this reason quite often endocrinologists will tell men on testosterone replacement therapy to not have a surgical procedure for 6 months to a year on treatment, so your concern is legitimate.
Certainly being on the treatment and waiting for surgery whilst letting your hormones settle is the preferable way to go about things.
The form of treatment is for you and your endocrinologist to decide.
The fact is there is no one perfect treatment and it is very much a cases of horses for courses with what works for some men not working for others.
With regard to gynecomastia, some treatments elevate estradiol much more than others.
For this reason many men that suffer with gynecomastia and low testosterone tend to take TRT that has a low conversion to estradiol.
Testosterone ethanate or proprionate injections
The best treatment for low conversion of testosterone to estradiol (it differs between patients) but
tends to be Testosterone ethanate or proprionate injections using the new weekly protocol.
Testim, Androgel or Tetsogel as it is called in the UK (Many men do quite well on these products)
Increases estradiol via its delivery mechanism of going through the skin and the effects of aromatase. But it tends to be far better than;
Old traditional testosterone ethanate injections
250mgs given once every two to three weeks. Many men do poorly on this TRT.
Nebido
Is a relatively new long acting testosterone ester/product that uses testosterone undecanoate.
Although testosterone undecanoate has a low conversion rate to estradiol. So far many men have been quite poor on it. This is because although testosterone undecanoate converts less testosterone to estradiol per mg it is injected in large quantities.
It is usually given as a 1000mg injection. Many gps and endocrinologists like it because with one injection a patient can go away and there is little maintenance. But ALL the patients I have spoken to so far are unhappy woth it and their estradiol levels have increased quite high as a result of the quantities injected.
Testosterone patches scrotal and non scrotal
The patches converted very little testosterone to estradiol but Both are rarely used today due to their inconvenience.
Testosterone implants
These can be expensive and are difficult to dose correctly. If dosed correctly they are very effective and many men who try them never change to another form of therapy. If dosed correctly estradiol levels do not typically increase to the levels seen in gels, however many endocrinologists have failed to dose correctly over the years and large dosing can and often does lead to serious elevations in estradiol.
Testosterone undecanoate tablets or Testocaps
From my personal experience and from the experience of many other men these are only helpful for elderly men with mild deficiency and are just not an effective form of TRT.
As I said it is for you and your doctor to decide what is best for you. I have only detailed the issues with estradiol. There are many otyher factors in choosing an appropriate testosterone replacement therapy regime.
Many men try the gels first as these are easy to dose and go from there. You might be someone who would do well on the gels.
You can only tell by trying them and subjectively seeing how you are and having a close eye kept on your pathology results.
If your estradiol level does become a problem you have the option of switching treatment or having some form of anti estrogen or aromatase inhibitor prescribed (at least you do if your endocrinologist is forward thinking).
Quickly jumping to the main point of your question.
Will going on the gel increase your gynecomastia.
The answer is it might.
With a lot of men it doesn’t- but with a significant minority it does
It did with me.
It all depends on your body chemistry, why you are deficient in the first place, the dosage of gel etc.
I would say that if you are deficient in testosterone you should be on treatment as it is unhealthy not to be and this should come before your issues with gynecomastia.
You would be better placed having the testosterone deficiency treated while your doctors adopt a watch and wait approach regarding the gynecomastia.
Some men see gynecomastia increase and then settle, some see no change, a few men see an improvement and some like me see it get worse.
But what you can do is get on the correct form of treatment that works for you, get your hormones balanced and then go for the operation knowing that it has less chance of returing in the long term.
You can get the opinion sof many other patients regarding what i have said at the support groups below.
http://health.groups.yahoo.com/group/hypogonadism2/A US group for which you need to register.
And a UK group for which again you would need to register.
http://www.andropause.org.uk/newforum/forum_frameset.htmAdditional helpful information can be found here
http://www.androids.org.uk/In total you will be able to ask your question of the very people who have experienced the effects of al the said medication. People are there to help you- a culmination of hundreds of years of experience when you add up all the people and experiences.
Some of the guys have been dealing with hypogonadism and said medications for over 25years.
I hope that helps.
Hypo, I know you do indeed know a lot about testosterone deficiency and that at the end of the day an informed paitient is better than an uninformed one, but are you suggesting that I don't take my GP's advice on serious problems like testosterone deficiency?
The fact is testosterone deficiency can be caused by many serious problems (some life threatening) and if a GP mistakenly diagnosed someone as having a chemical imbalance of the brain instead of this he/she would be in serious trouble. If a GP feels there is cause for concern he/she will refer you to an endo. I would put faith in my GP rather than an anonymous source on the internet or Dr eugene Shippen or whatever his name is.
If phantoms has quoted correctly what a Gp follows when looking at this issue than that is fine by me. They have medical degrees and many years of experience. I really don't think they would like the fact that you are suggesting that their guidence is wrong.....
I am telling you that your gp is NOT an expert when it comes to hormones and testing for them.
I am telling you that the only person that should be consulted is someone who is an expert and that is an encocrinologist who has an interest in reproductive endocrinology.
I understand this is hard to accept but it is the truth.
OInce again I will quote The AACE verbatim (American Association of Clinical Endocrinologists) in their conclusion to their national guidelines on hypogonadism.
The recognition, evaluation and treatment of hypogonadism in the male patient are often dismissed by the patient and overlooked by the physician.
Unquote
The top authority in the USA is basically bemoaning the inability of gps when it comes to this subject matter.
Also Dr Eugene Shippen is one of the worlds foremost authorities on testosterone deficiency (although I can understand why you would not trust in something you are told on the internet and a doctor who you do not know, even if he is one of the best in the world).
Hopefully you believe what I am saying regarding the AACE.
If not I guess I will have to go and get the guidelines so you can read them for yourself.
Topic: Can Depression due to gynecomstia lead to suicide? (Read 22822 times)
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