Is hormonal screening always necessary?

[Seattle000]

I talked with three plastic surgeons and after I described my case they all discussed surgery, but neither of them asked me to get any labs done. My case is pretty standard: I developed breasts when I was little and they never went away (I am 26 now). I’m a pretty lean and a healthy guy. My gynecomastia was on the mild side with both fat and glandular tissue. I had surgery (lipo + excision) done around 1.5 weeks ago and the results are awesome. However, is it ok that my surgery was done without the labs, or should I go to an endocrinologist? (is there anything that doctors look for when they refer people to get labs done, and they simply didn’t find it in my case?)

[hypo]

It is pathetic of a plastic sugeon to not perform blood pathology to ascertain the cause of the gynecomastia or at least rule causes out.

Another reason that highlights the fact that plastic surgeons are experts at gynecomastia removal but not experts when it comes to gynecomastia overall.

The only people who are experts when it comes to gynecomastia are endocrinologists.

You should go and see one just as a precaution to make sure that you are not in the significant minority of people who have an underlying factor that can cause gynecomastia to re-develop.

[ModFive]

Seattle000 - First off, where did you go for the surgery? I am in seattle as well, scouting doctors, and I would *love* to know how that experience was for you?  Who did you consult, Who did you like? Did you pay out of pocket?

Also, I agree with the general consensus on this board which is: go see an endocrinologist and discuss the situation with him/her before surgery.  There are rare cases of re-growth and underlying problems which could be found during these consultations.

Let me know, man! You will probably be just fine, but it also wouldnt hurt to go see an endo now either!

[hypo]

Most people are fine- but re-growth rare?

No it it is not rare!!!!

25% of all people who have gynecomastia have an underlying condition that causes its development.

I would hardly call 25% of all gynecomastia sufferers  who are open to the re-development of their original problem rare would you?

Your correct in stating the need to see an endo though.

Diagnosis first- treatment second, any other way of looking at it is putting the cart before the horse.

Seattle000- you are probably A-OK, but you need to get yourself an appointment with an Endocrinologist who specialises in reproductive issues and get him to do blood pathology to ensure this is the case.

[doddy]

.. Really starting to worry that my surgery at the start of next month is going to be for nothing now. Blood tests etc will be done beforehand on the day though apparently.

[hypo]

doddy- pathology is about precaution and ensuring you are ok- it is nothing to worry about.

Seattle,

You should give one of these people a call.  All of them are in Seattle, are recommended by the American Association of Clinical Endocrinologists (AACE) and list reproductive endocrinology as an area of interest.


Elaine D Henley, MD, FACE
Univ Washington-Endo & Metab
Box 356426
Seattle, WA 98195-6426
Directions to Office
Phone: (206) 543-3470
Interest Areas:
   Diabetes Mellitus
   General Endocrinology and Metabolism
   Pituitary Disorders
   Reproductive Endocrinology
   Thyroid Dysfunction

Michael Scott Irwig, MD
Univ. of Washington Medical Center
Box 356426
Seattle, WA 98195
Directions to Office
Phone: (206) 543-3470
Interest Areas:
   Reproductive Endocrinology

Mikhail Koren, MD
Harborview Medical Center
325 Ninth Ave
Seattle, WA 98104
Directions to Office
Phone: (206) 744-9126
Interest Areas:
   Diabetes Mellitus
   Reproductive Endocrinology
   General Endocrinology and Metabolism

Savitha Subramanian, MD
Box 356426
1959 NE Pacific Street
Seattle, WA 98195
Directions to Office
Phone: 206-543-3470
Interest Areas:
   General Endocrinology and Metabolism
   Diabetes Mellitus
   Other
   Thyroid Dysfunction
   Osteoporosis
   Lipid Disorders
   Parathyroid Disorders
   Obesity
   Adrenal Disorders
   Pituitary Disorders
   Reproductive Endocrinology
   Geriatrics

Jenny Tong, MD
Mail Stop S152 1660 South Columbian Way
Seattle, WA 98108-1597
Directions to Office
Phone: (206) 277-1723
Interest Areas:
   Pediatric Endocrinology
   Other
   Obesity
   Osteoporosis
   Reproductive Endocrinology

Gunjan Tykodi, MD
125 16th Ave E, CSB-2
Group Health Permanente, Dept. Of Endo.
Seattle, WA 98112-5211
Directions to Office
Phone: (206) 326-3033
Interest Areas:
   General Endocrinology and Metabolism
   Pituitary Disorders
   Reproductive Endocrinology
   Thyroid Dysfunction

[doddy]

hypo, can you tell me other symptoms of hormonal problems relating to gyne? I mean I should be fine.. but still..

[hypo]

There are various problems that can cause gynecomastia.

10% of all gynecomastia sufferers- 1 in 10 have hypogonadism.  

If you want to know more about that

http://www.gynecomastia.org/cgi-bin/gyne_yabb/YaBB.cgi?board=1;action=display;num=1085955938  

8% of gynecomastia sufferers have liver problems, but these are usually, but not always older sufferers.

3% of gynecomastia sufferers have testicular tumours

2% of sufferers have hyperthyroidism

1% of sufferers have renal problems

And there are a number of other conditions that make up a very small number.

The Grand total being 25% of suffers having one causative/underlying condition or other.

But the majority of people are A-OK.

Pathology is about ensuring that is the case or sorting out health problems as well as getting the gynecomastia sorted.

[doddy]

OK - I'm feeling a lot better about it now. Cheers.

[Seattle000]

Hypo: none of the doctors that you listed work with my insurance. Is it ok to see somebody who doesn't specialize in reproductive endocrinology or is it a waste of time?

[hypo]

Not, it wouldn't be a waste but it is of course better to see someone who fits that bill.

I would phone one of them back up and say, 'can you find me an AACE colleague with an interest in this area or at least a good endo that I can see via my insurance’.

Give it a shot.  

P.S

I say this from the UK so I do not understand your insurance situation- just an idea.

Good luck