Gynecomastia: Clinical evaluation and management

[Nelson Vergel]

Click here for more information:
Gynecomastia: How to Diagnose and Treat it | Discounted Labs


As it is explained on the attached clinical nomograph, the diagnosis of the cause of a certain cases of gynecomastia (breast tissue growth in men) is complex and not necessarily explained by high estradiol blood levels.

Cakir B, Evranos B, Cuhaci N, Ersoy R, Polat S. Gynecomastia: Clinical evaluation and management.


Gynecomastia is the benign enlargement of male breast glandular tissue and is the most common breast condition in males. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important and patients usually seek medical attention.


Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both.


Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery.


The main aim of any intervention is to relieve the symptoms and exclude other etiological factors.
Combined surgical and medical treatment in an adolescent with severe gynecomastia

 

[Dr. John Crisler]

Very nice article.

 

[Ty Nordic]

Dr. Crisler,
I had a phone appointment with you 4 months ago. Your help in getting me set up was great! My Doc here doesn't know much, and pretty much does whatever i ask, which is great... in some ways.
My question is: Why are my nipples growing so much? They have quardrupled in size! Luckily, they were tiny to start, but they are getting really big. They are sore all the time.
I am on 80 IU of test cyp once a week, and 250 mg of HCG every other day. Blood levels of estradial, and estrogen are in normal ranges. Can this be corrected? Will they go back to normal?

 

[Ty Nordic]

My Doc here doesn't know much, and pretty much does whatever i ask, which is great... in some ways.
My question is: Why are my nipples growing so much? They have quardrupled in size! Luckily, they were tiny to start, but they are getting really big. They are sore all the time.
I am on 80 IU of test cyp once a week, and 250 mg of HCG every other day. Blood levels of estradial, and estrogen are in normal ranges. Can this be corrected? Will they go back to normal?

 

[Dr. John Crisler]

Dr. Crisler,
I had a phone appointment with you 4 months ago. Your help in getting me set up was great! My Doc here doesn't know much, and pretty much does whatever i ask, which is great... in some ways.
My question is: Why are my nipples growing so much? They have quardrupled in size! Luckily, they were tiny to start, but they are getting really big. They are sore all the time.
I am on 80 IU of test cyp once a week, and 250 mg of HCG every other day. Blood levels of estradial, and estrogen are in normal ranges. Can this be corrected? Will they go back to normal?

Without further evaluation--including labs--it's not possible to say. But nipples which are increasing in size is indeed a sign of gynocomastia.

Since we talked about it, I hope the estrogen test is appropriate for an adult male; that is to say an enhanced laboratory methodology.

IF the situation can be gotten under control right away, there is a chance it can be reversed.

Finally, "normal range" doesn't mean much around here.

 

[Gene Devine]

^^^^Exactly what the good Doctor stated.

You are presenting with symptoms and that would require labs for diagnosis.

While 80 mg a week is not large dose per se, for some men, with the addition of HCG increasing endogenous Testosterone, you could very well be in the early stages of gynocomastia via elevated E2 serum levels.

You need labs drawn very soon and make sure to ask for the "Sensitive" Estrogen lab...this is very important.

 

[Ty Nordic]

I just received my bloodwork that I had done in February, and my estrogen was 120 PG/ML, and my estradial was 49. SBG is 610 NG/ML.
As I looked at my numbers they are in the "normal ranges" for a healthy female... That can't be good...
What should I do?

 

[Gene Devine]

I just received my bloodwork that I had done in February, and my estrogen was 120 PG/ML, and my estradial was 49. SBG is 610 NG/ML.
As I looked at my numbers they are in the "normal ranges" for a healthy female... That can't be good...
What should I do?

120 pg/ml is extremely elevated and why you are in the early stages of gyno.

You need to be put on an aromatase inhibitor to get your estrogen levels down to the 20's as soon as possible.

As Dr. Crisler pointed out, "normal range" doesn't mean much around here as "normal" reference ranges are extreme in some cases such as E2.

 

[Nelson Vergel]

Ty

What we monitor in men is estradiol, not total estrogens (estrone + estradiol). Do you know if estradiol was measured using the ultrasensitive test?

One more thing: nipples can grow (protrude) on testosterone replacement. They can also become more sensitive. I am specifically saying nipples and not nipple area (which also includes the areola and ducts). Gynecomastia is the expansion of the area under the nipple.


Please read this: Gynecomastia: Types, Causes, and Treatments



Degrees of gynecomastia:


Bodybuilder - Before and after gynecomastia removal surgery

 

[Nelson Vergel]

Here is another great graphic description of the diagnosis of gynecomastia and the hormone cascade that can affect it.

Excellent guide for the diagnosis of causes of gynecomastia

 

[Ty Nordic]

I did NOT ask for the ultra-sensitive test this last time. So far, ONLY the nipples have grown, and they are always a little sensitive. Not painful. I had tiny nipples to start, and they are probably 4 times larger right now. So, really, only sightly larger than "normal".
Will they decrease again once I start the anastrozol? It shipped today...

 

[Nelson Vergel]

I doubt that nipple size is affected by anastrozole. But, honestly, no one has reported on this issue.

 

[jalago29]

May I please ask you how I can get rid of it without surgery??? Thanks

 

[Nelson Vergel]

In a study, 65 percent of boys with gynecomastia were able to reverse it with anastrozole treatment. However, advanced gynecomastia is hard to reverse and needs to be removed by surgery.

 

[Nelson Vergel]

Gynecomastia Associated with a Combination of High IGF-1 and Estradiol In Adolescents

 

[Bevaro]

I know nolvadex didn't help mine.

 

[Nelson Vergel]

DHT Gel Effectively Treats Gynecomastia in HIV + Men

 

[Dr. John Crisler]

DHT Gel Effectively Treats Gynecomastia in HIV + Men

I wish I could use it; but it's not approved here in the States.

 

[Jay555]

^^^^Exactly what the good Doctor stated.

You are presenting with symptoms and that would require labs for diagnosis.

While 80 mg a week is not large dose per se, for some men, with the addition of HCG increasing endogenous Testosterone, you could very well be in the early stages of gynocomastia via elevated E2 serum levels.

You need labs drawn very soon and make sure to ask for the "Sensitive" Estrogen lab...this is very important.

If the labs shows normal can a person get gynocomastia ? like I’m at 31.3 estradiol sensitive just wondering my nipple are hard but no pain

 

[MarkM]

It isn't likely that anyone would be getting gyno with an Estradiol Sensitive reading of 31.3. It is possible to have nipple sensitivity when initially starting TRT. Do you feel any type of lump or unusual hardness under the nipple.