my non surgical treatment....attempt

[Hypo-is-here]

Yes I know, but still. There is not all that much known about Gyne, and extensive ttests on every scenerio have not been performed. Because of this, I don't think anyone should speak definitively about it.

There is quite a lot known about the aetiology of gynecomastia.

But this is not a difficult/grey area we are talking about here.  We factually know that there are many causes of gynecomastia and you are taking a shot in the dark and without any evidence treating one potential cause.

The cart should not be in front of the horse.  At the moment that is where you have it.






 

[plato]

The principle metabolites of testosterone are DHT and estradiol, anything that boosts testosterone has the potential to increase estradiol via aromatase.  Depending on what you took they can cause or add to the problem.  


SERM (selective estrogen receptor modulators) block the actions of estradiol at the estrogen receptors (ERs) by placing a weak estrogen in their place.  This means that the serum/blood level of estrogen remain/are no longer a relievable measurement of the biological/free level of estradiol or total estrogens within the body..  Because of the mechanism of action blood tests are rendered useless.  Added to that having already  started on this medication we have no idea what the blood levels of estradiol were prior to messing with the HPTA (hypothalamic pituitary testicular axis).  

In terms of your specific response, there is no way of knowing yourself and there is no way any endocrinologist could tell you your specific response (they would be measuring lipids, CBC, biochemistry, liver and kidney function etc if they were prescribing and they would only have prescribed having seen evidenced justification for its use).

Plato;

At present you are in the process of blocking the effects of estradiol if self medicating Tamoxifen, Nolvadex is the brand name for Tamoxifen. Irrespective of the form it is still a SERM medication which has the same problems/drawbacks when self medicating without having had prior pathology.

The problems generally and specifically are numerous;

How do you know that the cause of your gynecomastia was high estradiol and even if it was, how do you know if it is still high?

How do you know that is the problem given that gynecomastia can be caused by a whole host of differing factors?

How do you know that it is not caused by any of the following;

high prolactin?
Low testosterone?
Low dihydrotestosterone?
thyroid disorder?
liver disorder?
Kidney disease?
Temporary hormonal imbalance

Or any one of a number of rarer conditions?

All in all though 25% of all gynecomastia sufferers have underlying causative conditions.  Having not had any investigations/hormone pathology how do you know what boat you are in?

One thing for sure if high estradiol is not the cause of your gynecomastia then significant doses of SERMs or aromatase inhibitors are very likely to cause you problems, whether it be fatigue, lowered libido, erection problems, hot flushes etc.

Another thing that SERMs can do is cause problems with liver function, so let's hope you're not in the 8% of gynecomastia sufferers who has underlying liver disease as that would be very unfortunate.  

Unless you have hit the nail on the head what else will these meds do?

Well they can delay a proper endocrine investigation or worse still they can skew the results of one and allow the real cause of the gynecomastia to be missed.  

Bottom line here;

You don't know what you are doing.  You have no idea as to what has caused your gynecomastia (unless you explain otherwise).  You have no idea if there is an underlying cause or not.  Supposing for one second that there is an underlying condition, how do you know whether or not you are medicating the correct hormone.  If you do have an underlying cause what will happen if you stop self medicating?  

Even if you were medicating the right hormone, you have no idea as to dosage/cause and effect.

What about the potential for rebound effects?

You have no idea whether any real cause/culprit is being left alone to continue to cause the problem whilst you hammer the wrong hormone.
 
Can you see where I am coming from and the potential pitfalls?

All valid points. However, I would be very surprided if estraidol was not the cause of most pubescent gynecomastia. Do you agreee/disagree?

If true, why would hormonal treatment not be at least partially effective if the subject is still is not done with puberty?

[jk_2k8]

I think Gilbert said it best that surgery is the only surefire way to go. You could probably save the money you spend on some of these drugs and just get surgery. Then you would be all set and wouldn't have Hypo on your butt! lol.  

[Puff_daddy]

hypo,

what if the test booster is also a anti aromatase? that would not cause more production of estradiol right. just in case of a rebound affect i have alot more tamoxifen laying around.

when i got my blood work done my test levels were ''normal" but my doctor said the ammount of active binding test was ok but i did not have high numbers or free test. i am 20 years old and my test should be at its peak. im getting my blood work done again soon and demanding to get the numbers becuase the results were read over the phone.

would it be safe for me to use a non tribulus testosterone booster?? if so im going to taper off the tamoxifen and use the gaspari novedex xt

[kennyb]

If I'm not mistaken, most people have no specific reason for gyno.  They just got it during adolescense and it didn't go away.  

Most endo tests won't tell you anything.  Many will have 'low normal' test.  OK, what do you do with that?  Most healthy people with gyno are non-idiopathic or something.  Not sick in any way, just have it.

I'm not sure about dosages for anti-aromatase.  Estrogen is needed for alot of things so messing with it might not be the best idea.  

But if it works for you, i'll probably try it.  Give it a whirl.

[Hypo-is-here]

All valid points. However, I would be very surprided if estraidol was not the cause of most pubescent gynecomastia. Do you agreee/disagree?

A)
That is over simplifying matters and not necessarily true, certainly there are many, many people for whom this is unequivocally not so, around 50% of gynecomastia cases are caused by either underlying conditions or medications.. at least according Glen D Braunstein and his 19193 white paper entitled Gynecomastia and according to Ismail and Barth and their 2002 white paper entitiled Endocrinology of Gynecomastia.

B)
You are not most people, you are an individual and you need to know why your gynecomastia developed, or at least have endocrine investigations to try and ascertain the cause.  Such investigations and a consultation with a competent endocrinologist can help rule out potential underlying causative conditions and give a view of what is happening hormonally in your body.  

C)
Even if you hit the nail on the head in your case and your gynecomastia was caused by a temporary pubertal increase in estradiol, how do you know it is still high now?  If it isn’t then you will lower it dramatically with SERMs or aromatase inhibitors and cause yourself problems.

D)
Because you are not having pathology whilst on treatment, CBC, lipids, biochemistry, liver and kidney tests etc, something you would be having if prescribed a given treatment, how do you know if there are real problems in the background when taking the drug (not common but certainly possible).

If true, why would hormonal treatment not be at least partially effective if the subject is still is not done with puberty?

If gynecomastia has developed and hormonal pathology shows that estradiol is elevated/high and a SERM or aromatase inhibitor is prescribed at a sensible dose and you were had follow-up tests whilst on treatment….then there is nothing wrong with the use of these meds and they can be very effective.

But you’re shooting in the dark and have little to no idea about anything that is going on in your endocrine system.

hypo,

what if the test booster is also a anti aromatase?  that would not cause more production of estradiol right. just in case of a rebound affect i have alot more tamoxifen laying around.

A)    
Very few people are aware of the power of too high a dose of aromatase inhibitors.  At too high a dose they actually supress the HPTA and testosterone production, almost the complete reverse of what they do in lower doses.  Now I bet that has surprised you hasn’t it!

I have seen the above first hand.


B)
Lets say you suppress your HPTA with too high a dose of an aromatase inhibitor.  You would lower your testosterone level and probably feel pretty awful.  But how would you know that you had done this without pathology investigations?

C)      
I guess you could then throw Tamoxifen at the problem. On top of the aromatse inhibitor that could result in very low testosterone and estradiol.  You would then be in a whole world of back pain, fatigue, poor thyroid function, lowered libido, erectile dysfunction and hot flushes and you wouldn’t even be able to see an endocrinologist who could help you out as any blood test would be invalidated by the use of Tamoxifen.

D)      
Let’s say that you don’t have these problems and just use tamoxifen, can you tell me how you are going to know if it is causing any problems regarding liver or kidney function?

E)      
What if high estardiol is not the cause and you simply lower the effects of estradiol too much?  Again the side effects of such will be waiting.

F)      
What if you take either an aromatase inhibitor or tamoxifen and suffer no ill effects at all, great, but what if the cause of the gynecomastia is low testosterone.  10% of all gynecomastia sufferers have hypogonadism.  I have spoken and helped many men here with low testosterone and without proper endocrine investigations you would be brushing over a serious underlying condition.  What if the cause of your gynecomastia is high prolactin.  I have helped quite a few people on this very site with high prolactin.  Some of these people had prolactinomas that caused their gynecomastia, what if you were in that boat and ignored proper endocrine investigations for self medication?  

Recently I have been helping out a really nice guy who has a problem of elevated SHBG (sex hormone binding globulin).  This protein binds testosterone in the blood and amplifies the effects of estrogens over androgens.  What if your problem is also caused by elevated/high SHBG? You would then just be throwing medications at estradiol and the underlying cause would be untreated.

I could almost raise an infinite number of reasons as to why what you are doing is flawed and worst case scenario dangerous.  I think I have detailed enough in terms of peotential problems.

I do not deny that you could be lucky, that is also a possibility, you could hit the nail on the head and it could work. I would not really like to be playing Russian roulette with my health but it is your prerogative in terms of what you do.

hypo,
when i got my blood work done my test levels were ''normal" but my doctor said the ammount of active binding test was ok but i did not have high numbers or free test. i am 20 years old and my test should be at its peak. im getting my blood work done again soon and demanding to get the numbers becuase the results were read over the phone.

If you were taking anything that altered your endocrine system and the hypothalamic pituitary negative feedback system either at the time of your pathology or even a couple of months before (depending on the substance) then your blood tests could be completely invalidated/skewed.  E.g A low amount of an aromatse inhibitor could increase an LH level and boost testosterone, this could boost a hypogonadal testosterone level that needed diagnosis and long term TRT into the normal range and ensure that an incorrect diagnosis of eugonadal status was found.

In terms of future endocrine tests/pathology they will be invalidated by your use of tamoxifen, in particular your estradiol level will be completely redundant.

You are quite correct to wish to get your actual test results including reference ranges for your test.  However your tests need to be conducted off of all endocrine affecting drugs/meds for a few months so that the results are valid.  It would be good to test the following in your situation;

LH
FSH
Free testosterone or testosterone and SHBG
Estradiol
Prolactin
Dihydrotestosterone
TSH
Liver function
Kidney function
CBC
Lipids/biochemistry

[Ffurg]

Does anyone here actually bother reading hypo's posts?

Personally I think his copy n paste job from obscure online medical journals are not only boring, but seriously if you really want to read that crap just type "estradiol" into google, that's basically all he does...

maybe im just pissed with him because any decent point anyone makes he totally takes out of context and tries to make out there an idiot.

I'm all for helpfull advice, but all i see is condecending bullsh!t.

The guy just types and pastes away forever until he bores everyone into submission, then all the fools who don't have the first idea behind science or hormones think 'wow' he's a genius.

Oh whatever, go kiss his arse.

[Worrier]

No Hypo is a good guy. He comes here to help people and I know for a fact he helps some.

If you don't like what he writes don't read it.

I'm surprised how nice hypo is with some of the idiotic suggestions made on this site. He can't help it if some of the stuff he has to correct is idiotic.

I actually quite enjoy his debates with Graham.Both intelligent people with different viewpoints.

[Hypo-is-here]

Does anyone here actually bother reading hypo's posts?

Personally I think his copy n paste job from obscure online medical journals are not only boring, but seriously if you really want to read that crap just type "estradiol" into google, that's basically all he does...

I rarely copy and paste anything and almost never from medical journals, but I am sure you will think that irrespective of what I say so

maybe im just pissed with him because any decent point anyone makes he totally takes out of context and tries to make out there an idiot.

I'm all for helpfull advice, but all i see is condecending bullsh!t.
.

I could say your entitled to that view, but you might see that as condescending so again

I think my posts in this thread are very much to the point, maybe you could explain how that is not so instead of simply insulting me?

Also maybe you could point to anywhere on the internet that deatils the rebound effect of aromatase inhibitors.  I copied that from no one, it is what I have seen evidenced in my own pathology and that of others (prescribed aromatse inhibitor for hypogonadism).

The guy just types and pastes away forever until he bores everyone into submission, then all the fools who don't have the first idea behind science or hormones think 'wow' he's a genius.

Oh whatever, go kiss his arse.

I don't think anyone has kissed my arse and I never said I know everything, I just know an awful lot about very specific areas of medicine due to my own concerns.  When I am trying to help people I tend to let them know that my input will be that of a lay person, although I have written letters for board members to endocrinologists before and have helped them obtain various referals.

Ok you think all I do is copy and paste.  Well I tell you what you name a time on this website and ask me questions and I will reply to each one in turn within a matter of minutes.  You can choose the relevant questions on gynecomastia or hormone related issues in such a way that I cannot go off and research answers.

And we shall see whether or not I am doing what you are saying Ok?

I suffer from hypogonadism.  As a result I am medicated with testosterone and have all the regular/required health checks including regular pathologies.    

I have read all the works of the top hormone specialists (Malcolm Carruthers Androgen Deficiency In The Adult Male, Testosterone Revolution, Eugene Shippens Testosterone Syndrome etc and have read a great many of the relevant articles published internationally on the subject, from as far back as the 1930s.    

I have met, been treated by and written to some of the top endocrinologists in the world including both previously mentioned authored specialists; I have viewed hundreds of pathology reports of fellow hypogonadal men and gynecomastia sufferers and am conversant in their interpretation, also knowing how to re-calculate differing levels into different molecular reference ranges.

I have been a member of the Andropause society and at the forefront of hypogonadal support groups for a number of years.   I am fully aware of the aetiology of both hypogonadism in its many differing forms and of gynecomastia and am also aware of the guidelines for the treatment of hormone disorders in the US, the UK and Australia, also being aware of the positions taken by other key organizations such as the hormone society and the pituitary.org.

I have been prescribed many differing forms of testosterone replacement, DHT, HCG and SERM and aromatase inhibitors and know first hand the effects of such both on pathology and upon symptoms in myself and that of other men.

When I am writing something I do so from the knowledge base I have gained first hand and very rarely need to cut and paste anything, if I do it is from the best endocrine sources. I do not get any of my information from bodybuilding boards but legitimate and trustworthy endocrine sources, sometimes directly from a world leading hormonal expert.

So that is me,. I suppose I have just gone on and bored you now haven’t I/catch 22 maybe?

Frankly I would rather not know anything about hormones and related matters.  However I had to become very well educated on these matters due to health grounds and the management of my own condition.

In doing so I found that such information could be valuable in helping other people with potential hormonal problems and gynecomastia and that I could also use it to dissuade people from self medicating steroids and other related meds to their detriment.

Again sorry to bore and sorry if my tone is condceending (difficult to put across tone on a flat message board), if you want to do that Q&A session to see if I know my onions name a few times and we can do it.

P.S

If my tone or intentions have come across wrong at any point I apologise to all concerned.  I admit that I don't always put things across as well as I would like.