Hi drush,
So you've been diagnosed as having secondary or hypogonadotropic hypogonadism as it is medically termed.
Your pituitary (hormone control panel) is faulty and provides an insufficient hourly pulsation of the messenger hormones LH (Luteinising Hormone) and FSH (Follicle Stimulating Hormone) to your testosterone and sperm production factories- the testicles. Your testicles stopped producing sufficient testosterone via the leydig cells and less sperm via sertoli cells, because your pituitary "lost the plot".
Unfortunately some people who go on TRT (testosterone replacement therapy) convert (aromatase) to much of that TRT into estradiol and this leads to gynecomatia. In other people the cause can be high SHBG and in others a more complex issue that is hard to decipher, that I shall leave to your endocrinologist (although one cause can be metabolic hypogonadism as explained by Eugene Shippen in his book Testosterone Syndrome). Given that the most common cause of gynecomatia in this context is due to estradiol, it is that I shall speak about.
How much the gynecomastia will grow if you are left on your current treatment is difficult if not impossible to say, although it will if left probably settle down quite soon. This is a vague statement, but as firm an answer as can be given, it is not satisfactory so I shall try and provide more info to help you.
As it stands, even if the gynecomastia does settle down soon, you will still have an underlying hormone imbalance that can negatively affect your health.
Problems caused by high estradiol in the male endocrine system;
A) According to the latest research thought to be a prime culprit in the statistical increase in prostate cancer.
B) Can make it difficult to reach orgasm, reduce your libido and cause erection difficulties in some men if high.
C) Blocks testosterone receptor sites meaning reduced effectiveness of TRT. So some of your testosterone is being converted to estradiol, something that would not have happened when you first took TRT (until recognized by the pituitary and affected by the negative feedback mechanism) and some of your testosterone is being blocked at the receptor sites.
A double whammy.
If this is the cause of your gynecomastia I'd wager that you felt great early on with TRT (between 1 day and 3 weeks) but some of those feelings of well-being died off within a short space of time.
Did this happen?
I think you and your endocrinologist need to look at your treatment options to halt the gynecomastia and maybe reduce/resolve it. To correct this hormone imbalance and hopefully allow you to feel even better on your medication.
So what meds? What changes? What to do?
Well of course the first thing you need to do is have your endocrinologist perform pathology investigations to see how high your testosterone, estradiol and SHBG are.
If SHBG (not mentioned so far) is high this can be lowered by medication which will increase your fraction of free testosterone. This would alter your androgen to estrogen balance in favor of androgens and help to halt and maybe reduce the gynecomastia.
If SHBG is not an issue, then the question is how high is your estradiol?
Lest assume that your estradiol is high.
The decision on all this can only be made by you, it is your prerogative to make the decisions that you see as right for your health in conjunction with your doctor. But I shall outline some of the available options.
Most men who have high estrogen try to lower that first and look at the Testosterone medication later. Certainly it can make more sense to deal with one thing at a time so that it is possible to understand why changes are positive or negative.
One medication to lower estradiol is Arimidex.
Arimidex is a very powerful aromatase inhibitor; it helps prevents/lower the conversion of testosterone to estradiol. Some men find this effective in small doses and your doctor may trial you on this medication.
Another option would be to go a natural route to reducing the estrogen. Zinc is a natural aromatase inhibitor when taken at RDA levels and combined with the use of DIM with indolplex can help some men lower their estrogen levels.
Another option is reducing your testosterone dose as this can lower the conversion of testosterone to estrogen. I am not a fan of this unless you are overdosed.
You could try another form of testosterone therapy to see if you fair better. You said you are on gel so I am presuming Androgel or Testim. If your on one you could try the other, alternatively some people fair better on implants
You could try Andractim another form of androgen replacement instead of testosterone. Your estradiol level would come down and it would minimize the effects of estradiol and reduce your gynecomastia. This is because Andractim cannot be converted to estradiol as it is the powerful non aromatizing androgen dihydrotestosterone. Some people will fair well on this therapy others will not. Some people feel too tired on this therapy (double the dose of that used to simply to treat gynecomastia is often required) as testosterone is required for stamina and energy and it doesn’t help that.
Another option in your case would be to look at testosterone in a different way. Sometimes doctors look at testosterone as the only medication for hypogonadism. But given the fact that your testicles work another option would be to treat your pituitary insufficiency. To tell your pituitary to produce the messenger hormones so your tetsicles produce their own testosterone.
I think this is a superior and more natural treatment for those who have hypogonadotropic hypogonadism like yourself.
HCG (Human Chorionic Gonadotropin) and even possibly tribulus are treatments that may work better for you. Certainly they are treatment options that your doctor should have explained and laid before you at the time of offering you treatment (I hope they did that?). The advantage of these treatments are a) your body would be producing its own testosterone, B) your testicles would remain fully functional and would not shrink (if they have already they would return to full size) and C) they ensure continued fertility something that testosterone destroys over time.
This is a website/support group for hypogonadism.
http://health.groups.yahoo.com/group/hypogonadism2/You will find support and a great deal of help here.
Books that I would recommend are Testosterone Revolution by Malcolm Carruthers endocrinologist M.D and Testosterone Syndrome by Eugene Shippen endocrinologist M.D
I apologize for not answering/replying to your post sooner. I hope this helps.
Topic: Important information for gynecomastia (Read 47147 times)
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