My Hormone test Results (please read)

[Hypo-is-here]

Hi Hypo,
what do i do now

I honestly don’t know, I feel bad for you because I don’t think you have received a proper and thorough endocrine evaluation.  I don’t know but maybe where you are in the world in terms of endocrine practice is hindering you.

1) this doc didnt talk anything abt Higher Prolactin levels

Which is absolutely stupid because you were tested for prolactin and it was higher than normal, but nothing is being done which is wrong.  You should have an MRI or CT scan to rule out a pituitary issue and you should also probably have it medicated lower..

2) he asks me to go for semen count- which i clearly dont need- does he mean that i cud be impotent...

Semem analysis is to see if you are able to have children and relates to fertility.

I'm contemplating going for a CT scan and MRI. But i dont have the exact tests that i shud go for.
Hypo-is-here  : can u let me know exact names of the tests.
Also do u suggest i go for 4rth opinion from an endo or a Andrologist?

Like I said I feel for you given he situation because this is very difficult for you and you don’t seem to be able to get anywhere with these endocrinologists.  The only way of obtaining an MRI or CT scan of the pituitary is via an endocrine referral.  Likewise the only way you could have the prolactin and estradiol levels medicated properly is via endocrinologists prescription.

I don’t want to tell you to keep seeing endocrinologists, on the other hand I don’t want to say every thing will be fine if you just go for surgery, because there is a chance with that pathology of it coming back.  I think you are the only one who can decide what is the best thing to do.

The tests you would need  as I see it if you are to go to yet another endocrinologists would be;

A) An MRI or CT scan of the pituitary

B) An LH test (gives an indication of what is happening at the pituitary level and should always be included in endocrine assessments).

C) An SHBG test (which give an indication of free testosterone levels, without it total testosterone means little- should always be included in endocrine assessments).

D) a second confirmatory testosterone test, estradiol and prolactin tests

E)  I never mentioned this but if your tests are not conducted between 9 and 11am in the morning or close to that time that are total invalid.  Particularly testosterone tests MUST be taken in the morning in line with the bodies circadian hormonal rhythm for which the tests and the normal range have been calibrated.

Also i wud like to tell u that i have a problem in urinating, Tht is when im alone i do it peacefully, with out much delay, but when the urinal is crowded then i find it difficult to urinate. Is it because of any psychologial problem? I forgot to ask doctor yesterday.....

If you can urinate perfectly well when you are on your own but not as you have described then the problem is psychological.  In fact this is a something that I have heard about before and I think in fact this is classed as a type of phobia.  It does not relate to anything that we have been talking about and is something you would nee to see a psychologist about if it is something that hinders you.

I have found this link http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/prolactin.html

at the bottom it says:

Common manifestations of hyperprolactinemia in women include amenorrhea (lack of menstrural cycles) and galactorrhea (excessive or spontaneous secretion of milk). Men with hyperprolactinemia typically show hypogonadism, with decreased sex drive, decreased sperm production and impotence. Such men also often show breast enlargement (gynecomastia), but very rarely produce milk.


so i think Dr Vasan was targetting the Sperm Count test because of the above reason.
what do u say Hypo?

I have no idea as to his though process, I have difficulty with what he thinks to start with without trying to second guess him.

What I can say is that Semen analysis is not something used to evaluate the pituitary.  To evaluate the pituitary in this context you conduct a prolactin test and you also look at LH because they can indicate pituitary problems.  You also look at testosterone and binding globulins (SHBG) because this can also indicate problems at a pituitary level.  If anything in the above tests is suspicious you conduct an MRI or CT scan of the pituitary.

A high prolactin level is suspicious and require further evaluation.  In my opinion it also requires medicating if high even if the pituitary scan is normal, particularly if the individual is going to have surgery for gynecomastia.


What you have to understand is high prolactina and high estradiol are two things that can cause gynecomastia and that is before you even bother to look at testosterone.  Because of this you obviously would prefer to have low normal levels of both hormones before surgery if possible.


Despite everything I have said it is possible that surgery alone could be all that is required- it isn't back and white.

Sometimes when people have surgery the vascular changes that occur mean that the glandular tissue that is left behind no longer has what is required in order to act upon the hormones as they would have done before.  Maybe surgery alone will work for you.  I think you get to a point where you have to say is it worth seeing yet another endocrinologist and is it worth taking a chance?

I do not know what you should do, I have just tried to put what I feel is relevant in front of you so that you can decide what is best.

[hungry.tides]

hi Hypo,

Thanx alot of the helpu have given, I'm thinking of taking Dr Vasan's prescribed tests, Thenif every thing is ok with Semencount and every thing then probably i will go for MRI CT Scan. By the end of all this i think picture will be clear, Isnt it?

Also MRI is for finding out if ur pitutary gland has a tumor or not, right?? Then i have already under gone ultrasound for testis and abdomen, both were fine,no issues... then i guess that rulesout any pitutary gland tumor !!!!

whats ur take Hypo...
Also can u tell me some links or people who themselves had a harmonal issue like mine.... so that i can have an educated opinion about my own results.

Gosh!!! I'm learning alot with this Gyne..   

ciao

[Hypo-is-here]

If you register at this site

http://health.groups.yahoo.com/group/hypogonadism2/

You can post your pathology and get other views on it- see if they concur with my own.

Regarding a MRI scan- yes if that is clear it pretty much rules out a pituitary tumor for the cause of the elevated prolactin.  If it was a pituitary tumor it would have to be small given the elevations, but it is worth checking out and should have been forwarded by one of your endocrinologists.

[Hypo-is-here]

Views?

[hungry.tides]

Views?

hey sorry Hypo was late in responding, was kinda disappointed with the situation i m finding myself in, Abt tht yahoo grp u mentioned i have got loads of mails, daily abt 20 !!!
for my mail i got responses asking me to get free testosterone test: also one respondent said a pill of Femara ( ehh !!!) to supress the aromatisation.

im pasting the mail responses, pls guide me

1) Well, seeing as how your estrogen is at the very highest end of
the range, clearly you would want to look into reducing that,
ask doc about 1/2 a Femara pill every seven days. And, once
you got gyne, you can work out until the cows come home, but
that will not get rid of it. So, yes spend a couple thousand
and have that fat sucked out, and then knock off for life all
refined sugar, soft drinks, fatty foods, deserts, etc. Eat
lots of protein and whole fruits and vegetables.
Worked for me
Norton

2) Most likely cause for high prolactin is a prolactinoma a usually small
tumor in the prolactin portion of the pituitary. (Don't panic at the
word tumor. The vast majority of these are benign and most respond to
medication.) An MRI is essential for confirmation/diagnosis. usually
these respond well to medication.

3) you need to be prescribed anti- estrogen pills.

4) HI

Looking at your prolactin levels this is causing your gyno.

You have to get an MRI done on your pituitary to rule out an
emerging tumor growth or other pit disease that could be causing it.

In my case my prolactin levels were always in the upper 3rd of the
range at times and then slightly elevated like yours.

My doctor ordered an MRI and we found that the anterior part of my
pituitary gland was smaller than the posterior side and spinal fluid
is getting in the empty space around the gland and compressiing the
pituitary stalk preventing adequate supply of dopamine into the
blood stream from the hypothalamus.

Dopamine helps keep your prolactin levels down and your E2 is a
cause for concern because high prolactin actually shuts down
the GNRH from your hypothalamus that in turn shuts down LH and FSH
which causes secondary hypogonadism leading to low levels of
Testosterone and a T to E2 ratio that will mess with your mind.

What most people don't know is that Prolactin at these levels also
shuts down the TSH and this can cause wide swings in thyroid
hormones in the body as well. I was getting irregular heart beats
from 50 to 108 while sitting and taking my pulse over the course of
a day .

Another side effect of Prolactin is it can give you acromegaly like
symptoms that resemble the same as HIGH IGF 1 levels in the blood
(Growth hormone) as it is produced in the same area of the pit gland
off the acidophillic cells of the anterior pit.

Prolactin is very potent and it doesn't take much believe me I have
gone undiagnosed for a long time and I have acromegaly in my hands.

Wishing you the best
ASK for AN MRI as soon as possible

Manraj

5) A couple questions. First what was your actual prolactin level? If your doc thought you
had elevated prolactin, why didn't he or she order the MRI of your pituitary gland?

Second, it is important to know if you have true gynecomastia instead of the psuedo
gynecomastia. True gynecomastia means that you have actual breast tissue that is
developed or as some call it glandular development. Psuedogynecomastia or lipomastia is
really just fat deposits in the area of the breast. Men with low T and high E will have fat
deposits in areas that females typically have. However, you can also have a combination of
gynecomastia and lipomastia as well.

I agree with the other posts, your E2 levels are high and are at the very least a partial
cause of your gynecomastia. If you truly have high prolactin, prolactin can induce a form
of secondary hypogonadism.

Here is a list of drugs known to cause gynecomastia

Drugs that can cause gynecomastia

DRUG MECHANISM

Amiodarone Unknown

Calcium channel blockers Unknown (diltiazem,verapamil,nifedipine)

Central nervous system agents Unknown (amphetamines,diazepam,methyldopa,
phenytoin,reserpine,tricyclic antidepressants)

Cimetidine Androgen receptor antagonism

Cytotoxic agents Primary hypogonadism due to Leydig cell damage (alkylating
agents,vincristine, nitrosoureas,methotrexate)

Flutamide Androgen receptor antagonism Hormones

Androgens Aromatization to estrogens;other mechanisms?

Estrogens Direct stimulation of the breast

Human chorionic gonadotropin Stimulation of testicular Leydig cell estrogen secretion

Isoniazid Possibly refeeding Ketoconazole,metronidazole Inhibition of testosterone
synthesis

Marijuana Androgen receptor antagonism

D-penicillamine Unknown Phenothiazines Elevated serum prolactin
Spironolactone Androgen receptor antagonism;at high doses, interference with
testosterone biosynthesis

Theophylline Unknown

6) A good article regarding this subject..

http://www.nature.com/ijir/journal/v16/n1/full/3901154a.html

7) You are correct that going to a cosmetic surgeon and having
the gyne fat sucked out of your chest area is NOT going to do
anything to reduce estrogen levels, it will obviously go a long
way to making you feel, and look, better about yourself, and
should give the added incentive of knocking off all sugars and
fats for life, to keep it from coming back. And, it does NOT have to
come back, you just gotta get educated about diet, and just as
importantly, if you are on supplemental testosterone, then you
HAVE to do something about keeping your estrogen level in the middle
of the range. By far the best way is to get a prescription of either
Arimidex or Femara, both very powerful estrogen blockers. I am
on 100% testosterone, pellets, and I take 1/2 of a little Femara
pill every seven days, this is much much cheaper than arimidex, and
just as effective. My blood work shows me right in the middle of the
estrogen range, where you want to be. On a side note, I have been
on T for 35 years now, and I loving pellets, been on them for over
two months now, feel great, it is wonderful not to have to think about
self injections, and these pellets should last at least four months.
If you can afford pellets, I think they are the best way to go.
Norton

Personally, I stay away from Hospitals if possible, their full of unhealthy
people and therefore potentially dangerous to ones' health. In addition, if one
looks at the sites of doctors who want to remove your breasts, you'll see that
often the results are disappointing with it still clear that you have larger
mounds than usual. Soon enough if not already, you'll be balding and sagging,
etc., which makes the typical man breasts less important. We rarely become more
than an A which is easily covered with no effort. They're only noticeable when
swimming etc. I have had Gyno for some years and have never been in any way
commented on or stared at, etc., for my 36-a/b's.
If anyone ever did, I'd inform them that Gyno affects a high portion of older
men etc. Take a look at older guys in T shirts when the weather permits and
you'll see lots of it.
While fundamentalists or other ridged persons might frown on your breasts,
the rest of the population seems not to notice or care.
I DO find that my breasts are erogenous zones -- which are nice to have more
of and that many women like them.
Give me back my hair and leave my breasts alone~~
cheers

9) Gynecomastia is not caused by fat in most cases, rather it is caused
by glandular breast tissue as a result of a poor androgen to estrogen
ratio/balance or overtly high estrogens. This is a result of a
temporary hormonal imbalance such as ouberty or a more permant one
such as hypognadism.

Most gynecomastia surgeries involve cutting out the breast tissue, a
process called glandular excision. Lipo suction is sometimes used as
well but lipo suction only works in the removal of fat otherwise
referred to as pseudogynecomastia in this setting.

Sugars has nothing to do with the aetiology of glandular
gynecomastia, only excess weight gain which can result in
pseudogynecomastia.

Arimidex in the context of TRT is helpful at preventing gynecomastia,
it is however faily poor at reducing or resolving it. The best
option is surgery. The best drug therapies for gynecomastia are the
SERMs Tamoxifen and Clomiphene Citrate. Another semi successful
treatment is dihydrotestosterone gel.

[hungry.tides]

Any comments !!!!!!

[Hypo-is-here]

As far as I can see people said;

A) your estradiol was too high, B) it should be medicated, C) your prolactin was too high and D) you should have an MRI of the pituitary, E) medication of the prolactin level was also mentioned.

That just so hapens to be exactly what I have said to you....

[hungry.tides]

yeah Hypo
U were right
I need to get medication, but u think i shud go for those femera things they mentioned?
Also is it required to get the free testosterone test done?
ciao

[Hypo-is-here]

My thoughts are exactly what I laid out in my prior mails.

You either have to just go ahead with surgery and take your chances or somehow find an endocrinologist/specialist who is forward thinking and willing to help (you certainly can't do anything to medicate this by yourself).

The problem has been you haven't been able to see anyone who has been willing to help or at least haven't seen someone who correctly understands enough about these issues to be able to help, something that may relate to where you live.

If you can get an MRI, additional testing and relevant medications via a specialist that is preferable.

I wish I could help you further, unfortunately your location has meant that I have been able to do so.

Unless you get lucky in terms of finding an endocrinologist/specialist you may have to accept your chances with surgery.



 

[hungry.tides]

hi Hypo,
I spoke to my Endo (whom i consulted first and who said go 4 surgery) I asked
1) why she didnt recommend MRI scan- She said she doesnt think there is any problem with the prolactin level
2) When i said my prolactin was 16.5 which is out of range (4.04 - 15.2) - she said it is still not too hight, different people have different profiles, so its perfectly normal
3) why is my estradiol 42.57 very close to the extreme range ( 7.63 - 42.6)  - she said it is normal, as it is under the range.

finally she said i can get another round of blood tests done, but if the results are same, surgery is the way ahead

Pls post comments, I have figured out that i will first go ahead with the tests again. Do i take any additional tests ? like free testosterone.

Gynecomastia has effected me my family and my career. i dont want to be a slave of gynecomastia.

Ciao

[Hypo-is-here]

The doctor you are dealing with simply doesn't understand what she is dealing with, I am sorry but it is as plain as that.

On the one hand she is saying that a level above a normal range is normal and on the other hand is saying that another level is normal because it is under the range.

You cannot have these things both ways.

You either have this idiotic and simplistic way of looking at the numbers and saying everything under range is normal and everything over range is not or you have a more progressive way of looking at the pathology as a guide in relation to syptoms and conditions.  If she is playing the numbers game (which is too completely ignore the limitations of these types of tests) she can tell you your estradiol is normal (even though it is not) but she cannot tell you your prolactin level is normal as it is outside the normal reference range.  If she is playing the numbers game she should forward you for an MRI and look towards medicating your prolactin level.

The fact of the matter is there is ZERO differentiation in the reference ranges between young and old men.  This means that the upper and lower levels of the various reference ranges are skewed by the extreme ends of the spectrum.

This means that whilst it maybe normal for the bottom of the testosterone range to be 300ng/dl, it does not mean that 300ng/dl is normal for a young man as this would be lower than the 5 percentile.

The above does not rleate to your situation but the next example does.

It maybe normal for the top of the male estradiol range to be of 42.6 and it maybe normal for to have this level of estradiol if you are 90 years old.  But it is not remotely normal or healthy to have an estradiol level in the upper third of the reference range if you are a young man who doesn't want to have breasts!!!  Your level for your age will be outside of the 5th percentile and not normal for your age.

This level is not normal or healthy and neither is your prolactin level.

But like I said if she wants to play some retarded numbers game old school style of endocrinology irrespective of the facts she still cannot have it both ways.  If she lives and dies by the reference ranges then she can maintain that your high normal estradiol level is normal when it is not, but she cannot then try and say that a prolactin level above the normal reference range is normal.

If a hormone level within the reference range is deemed as normal by her then what does she define as a hormone level above the normal reference range?

If she is saying that this level is normal as well then why does it not fall within the normal refernce range?

Her logic is laughable and her endocrinology in this area poor.


Unless you have pathology with a gross abnormality she will just say normal- that much is clear, it is though all roads lead not to Rome but in fact to the word normal.

It is this pathology that has almost certainly led to the development of your gynecomastia in the first place- perhaps she regards this as normal too.


The only way I see you getting anywhere here is either going with surgery and hoping it doesn't come back or traveling to a competant endocrinologist/andrologist in Europe or preferable the US who deals with these matters on a regular basis.

You have seen countless people in your own country and you have not managed to see a single endocrinologist who understands this area of medicine.  I think constantly seeking new doctors where you are in order to try and find someone who understands this area of medicine would be like finding a needle in a haystack- it's just not likely to happen judging by your experience.

Don't just take my word on this- post it on the other site and see what other people have to say.










 

[hungry.tides]

Hypo, thank alot for your reply, Can you give me some link where i can post my blood test results and get informed comments. My search at yahoogroups site didnt prove fruitful.

Thanks

[problem man]

Hungry.tides, i found a good endocrinologist who has good knowledge about gynecomastia and Hormone imbalance. I have consulted him, he said that my estradiol level is higher and he also prescribes me some hormone tests TSH and HCG-beta. also Scrotal ultrasound and Breast ultrasound test. I will let u know what happens later. I suggest even u consult him, he is very good. Be sure to take all ur previous hormone test results with you.
Thanks for Tony_ss for suggesting me this Endocrinologist.

Dr.Vagesh Ayyar
St. johns hospital
Bangalore.
phone no: 08025530724

[lestat]

hungry.tides - did you get around to talking to Dr Ayyar ? I want to get my hormone tests done and looked over by a endo too. Do let us know your opinion of him

[problem man]

Dr Vagesh Ayyar prescribed me Tamoxifen 10mg, twice a day for 3 months bcoz my Estradiol levels were in the upper third of normal range. After taking of 1 day, i have developed a slight sore throat. I might visit him again next week if the sore throat does'nt go away.