Possible Gynecomastia Causes

[Graeme]

I've got a problem with gynecomastia, and I'm trying to figure out possible causes. I had a couple of blood tests just before Christmas, and the results are below, along with another draw from August last year.

I think that it's been around since adolescence, but seems to have worsened recently. I put on about a stone (6 to 8 kg) during November and December, though I'm not sure if that was down to coming off an SSRI.

I've got typical eunuchoid body proportions (long limbs, lower body segment longer than the upper, arm span greater than height, wide hips), which can be indicative of hypogonadism during adolescence. However my testosterone levels are in the low-normal to normal range, so I'm not sure that's the issue.

E2 is on the low side, and Prolactin seems normal, so that doesn't appear to be the cause either.

I had low Vitamin D in August, and started taking 5,000 iu per day, which appears to have cured that problem.

My details:

• Male, 43 years old
• 6'3" / 1.9 metres
• 220 lbs / 100 kg

19th August

Albumin: 47 g/L (36 - 47)
Vitamin D: 18 nmol/L LOW (50 - 250)

TSH: 1.26 mU/L (0.5 - 5.0)
FT4: 16.7 pmol/L (11.0 - 22.0)
FT3: 4.5 pmol/L (3.2 - 6.4)

T: 18.5 nmol/L (= 534 ng/dL) (9.7 - 27.8)
SHBG: 67 nmol/L HIGH (17 - 56)
Free T (calculated): 231 pmol/L (= 6.7 ng/dL) (170 - 670)

7th December

Albumin 42 g/L (36 - 47)
Vitamin D: 87 nmol/L (50 - 250)

TSH: 2.11 mU/L (0.5 - 5.0)

FSH: 6.6 IU/L (1.5 - 9.7)
LH: 5.9 IU/L (1.8 - 9.2)
Prolactin: 266 mIU/L (90 - 400)
E2: 46 pmol/L (= 12.5 pg/mL) (< 160)

T: 12.8 nmol/L (= 368 ng/dL) (9.9 - 27.8)
SHBG: 37 nmol/L (17 - 56)
Free T (calculated): 243 pmol/L (= 7.0 ng/dL) (170 - 670)

10th December

T: 16.1 nmol/L (= 464 ng/dL) (9.9 - 27.8)
SHBG: 35 nmol/L (17 - 56)
Free T (calculated): 339 pmol/L (= 9.8 ng/dL) (170 - 670)

 

[Graeme]

And lipids.

12th December

Cholesterol: 6.3 mmol/L HIGH (3.5 - 5.5)
Triglycerides: 1.6 mmol/L HIGH (< 1.5)
HDL Cholesterol: 1.31 mmol/L (> 1.0)
LDL Cholesterol: 4.3 mmol/L HIGH (< 3.5)

 

[Megatron28]

Have you used steroids or prohormones? If not, it sounds like it could be Pubertal Gynecomastia. Have had your gyno diagnosed by a doctor? If not, it could just be pseudo-gynecomastia.

Read the FAQs link in my signature. It has a section on Gyno.

 

[Graeme]

Thanks Megatron. I took a look through the gyno sticky before posting, and suspect it's pubertal.

I haven't used any AAS. I did try an over the counter prohormone, might have been Androstenedione, briefly in the late nineties, but I can't remember if I finished all the tablets. I don't drink or take any of the drugs that are listed as causes online.

My doctor's back from holiday in a week and a half, so we'll see if she's got any more ideas. Klinefelter's Syndrome is one possibility, but I think that my FSH and LH levels are a bit low for that.

 

[Megatron28]

Thanks Megatron. I took a look through the gyno sticky before posting, and suspect it's pubertal.

I haven't used any AAS. I did try an over the counter prohormone, might have been Androstenedione, briefly in the late nineties, but I can't remember if I finished all the tablets. I don't drink or take any of the drugs that are listed as causes online.

My doctor's back from holiday in a week and a half, so we'll see if she's got any more ideas. Klinefelter's Syndrome is one possibility, but I think that my FSH and LH levels are a bit low for that.

If it is really Pubertal Gyno there isn't a whole lot of options. You can try Raloxifene but it doesn't work well on really old entrenched Gyno. Surgery may be your best option.

 

[Graeme]

Thanks again.

The doctor thought that it was gyno when I saw her a couple of weeks ago. So it looks like surgery if I want it fixing, oh lucky me!

 

[Megatron28]

Thanks again.

The doctor thought that it was gyno when I saw her a couple of weeks ago. So it looks like surgery if I want it fixing, oh lucky me!

I would try meds before surgery. Afterall they might work. Raloxifene is expensive if you get it via prescription. RUI (banner ad at top of the screen) does sell it much cheaper if money is an issue for you .

 

[Graeme]

I'm in Australia, the country that busted Stallone for bringing in a suitcase full of HGH, so it's probably not a good idea to do a personal import of a prescription medicine.

 

[Megatron28]

I'm in Australia, the country that busted Stallone for bringing in a suitcase full of HGH, so it's probably not a good idea to do a personal import of a prescription medicine.

But you can probably get Ralox a lot cheaper than we pay in the US at the pharmacy! I would try it before surgery.

 

[Graeme]

Medicare limits the cost of any prescription here to $38 (about $30 US), so you're probably right about it being cheaper.

I'd prefer a drug to surgery too.

 

[Graeme]

The doctor ran a karyotype test for Klinefelter's Syndrome, and that came back negative. I think that if it had been an issue then my LH and FSH levels would have been elevated.

I think that the most likely causes are:

• It's a holdover from puberty.
• High SHBG levels pushed my FT / E2 ratio out of balance.

I've seen a few references to the latter, for example:

patient.info/doctor/gynaecomastia

I think that the gyno has been getting worse recently, however I've had a complete health and fitness disaster over the last few months and put on 8 to 10 kg (about 20 lbs) in that time. I'm not entirely sure how I managed that, but think it's depression related. So it could just be fat distribution.

I'm off to see the doctor on Tuesday. Last time I saw her I suggested seeing an endocrinologist, but she thought that would be a waste of time. Most likely it'll be straight to surgery.