How does one differentiate between gynecomastia and non-gyno nipple growth/sensitivity on TRT?

Thread starter #1
I'm a 36 year old male and I've been on TRT for a little over 3 months. After approximately 3 weeks on TRT at 100mg Testosterone Cypionate every 7 days I started noticing changes in my nipples. They'd get pointy and erect much more easily when cold, or even at room temperature with my shirt off. They'd stick out farther and be more "cone shaped" with a wider base than before. They were sensitive and sore when erect.

When pushing on my nipples I don't feel any lumps directly behind the nipple or areola, but I do feel a lump approximately on the bottom edge of my areola. I'm not sure whether this is muscle or glandular mass.

I've heard that some of the nipple growth and sensitivity can be normal while on TRT and not related to gynecomastastia or elevated E2 levels.

My question is: How can I tell whether I'm experiencing the beginning stages of gyno, or whether my nipple sensitivity is just normal? Is the "lump" I'm feeling near the bottom edge of each areola a gland, or a muscle, and how can I tell?
 

Gene Devine

Super Moderator
#3
You need blood work and have estrogen tested using the "Sensitive Assay".

Gyno is rare and takes time to develop but you need BW to confirm E2 levels.
 
Thread starter #4
You need blood work and have estrogen tested using the "Sensitive Assay".

Gyno is rare and takes time to develop but you need BW to confirm E2 levels.
I'm in a bit of a strange position because I've been with a doctor who seems to be less than knowledgeable. I suspect that my E2 was high for a month or two before they would test it or consider an AI. They finally did test it (using the standard, not sensitive E2 test, which I understand is pretty much worthless) and then prescribed me 1mg of arimidex per day. That took care of my sensitive, large nipples pretty quickly but after 3 weeks or so my E2 levels crashed hard. I felt like crap. I did my own labs through privatemdlabs (sensitive E2) and the result came back as < 3. I've tapered off the arimidex on my own and am now starting to get a bit of nipple sensitivity again. I plan to get another sensitive e2 test on my own in another couple of weeks to see where I am. I'm also in the process of trying to find another doctor.

I guess the bottom line is that I may have been at untreated high E2 levels for up to two months, and my nipples seem larger. I understand that prompt treatment is necissary in the case that this IS gyno, so I don't want to delay much longer. What exactly should I be feeling for to to confirm gyno vs normally pointier TRT nipples with underlying fat and muscle tissue?
 

Gene Devine

Super Moderator
#5
Ok, first and foremost; as you stated, your Physician is not trained in TRT for men.

Not testing or monitoring for E2, 1 mg of an AI daily...WTF!

You can't do this on your own and need proper care.

Call Jasen at Defy and see how they can help you.

You didn't state what your E2 levels were with the standard default E2 lab but I am guessing they were very elevated. If so, you could have been in the early stages of gyno.

Taking the AI would have prevented this if you were being monitored correctly...which you weren't.

What you're probably feeling now is estrogen rebound and your nipples are responding which is not uncommon and doesn't mean that your gyno is coming back.

You need to get blood work done as soon as you can and have a trained TRT Physician review it and consult with you...no more of this malpractice.

If you can post your last blood work complete with ranges and your weekly TRT protocol that would be great.

And do yourself a fav and call Defy and see how they can help you...the call costs nothing!
 
Thread starter #6
Thanks. My initial protocol was 100mg Test Cypionate IM every 7 days. No AI, No HCG. When doc tested E2 before prescribing an AI the result was 42 (range <=63). Not sure what lab they used.

Doc then changed my protocol to 60mg Test Cypionate IM ever 3 days, 1mg arimidex every day, no HCG. After 3 weeks or so on this I felt like crap, went and got my own LabCorp labs through privatemdlabs. The results were:
TT:1077 (peak, taken 24 hours after injection), 784 (trough, taken just before next injection) range: 348-1197.
E2, sensitive: < 3 (peak), < 3 (trough) range: 3-70

I decided on my own to taper of the arimidex and took .25mg every 3 days for a couple of weeks, then discontinued it alltogether a few days ago. Now I'm just taking 60mg test IM every 3 days, no AI, no HCG. My nipples now feel pointy and sensitive again.

Still looking for a new doc, and will look into Defy. I'd appreciate any advice I can get in the meantime.
 

Gene Devine

Super Moderator
#7
Thanks. My initial protocol was 100mg Test Cypionate IM every 7 days. No AI, No HCG. When doc tested E2 before prescribing an AI the result was 42 (range <=63). Not sure what lab they used.

Doc then changed my protocol to 60mg Test Cypionate IM ever 3 days, 1mg arimidex every day, no HCG. After 3 weeks or so on this I felt like crap, went and got my own LabCorp labs through privatemdlabs. The results were:
TT:1077 (peak, taken 24 hours after injection), 784 (trough, taken just before next injection) range: 348-1197.
E2, sensitive: < 3 (peak), < 3 (trough) range: 3-70

I decided on my own to taper of the arimidex and took .25mg every 3 days for a couple of weeks, then discontinued it alltogether a few days ago. Now I'm just taking 60mg test IM every 3 days, no AI, no HCG. My nipples now feel pointy and sensitive again.

Still looking for a new doc, and will look into Defy. I'd appreciate any advice I can get in the meantime.

If it were me I'd get blood work done ASAP. E2 takes time to rebound...it doesn't happen in a few days or even weeks.

You know what to do...
 
#8
Mine are doing the same thing. It reminds me of how they felt when I went through puberty many, many years ago. I don't feel any mass under them, so I'm hopeful its just part of the process. Lab work came back today and my estrogen sensitive is only 12. I commented to share my experience and see the responses to this thread. I'm on week 12 of TRT.
 

Gene Devine

Super Moderator
#9
Mine are doing the same thing. It reminds me of how they felt when I went through puberty many, many years ago. I don't feel any mass under them, so I'm hopeful its just part of the process. Lab work came back today and my estrogen sensitive is only 12. I commented to share my experience and see the responses to this thread. I'm on week 12 of TRT.
It is "part of the same process" when you went through puberty; the nipples are just sensitive to the reactivation.

Your labs still have E2 at a low level and goes to show that E2 doesn't rebound so quickly.

Thank you for sharing your experience here with us man, and keep THIS thread updated on your TRT experience.
 
Thread starter #10
Thanks for the info. I didn't realize that they could get sensitive again as E2 builds back up, even when E2 is at or below normal levels. That's probably what's happening with me and makes me feel better. Thinking back, this is probably what happened when I first started TRT. When I started both my T and my E2 were low (as expected). As I started TRT my E2 went up and caused my nips to get sensitive. Maybe it never actually was outside of the normal range before I started arimidex. Maybe it was just my body getting used to having slightly higher (but still normal) e2 levels. I'll never know for sure because the doc used the non-sensitive e2 test.

Here's a stupid question about feeling for gyno lumps: Can someone please explain to me about feeling for lumps "under" the nipple? Does "under" the nipple actually mean "behind" the nipple, i.e., between the nipple and the rib bones, or does "under" the nipple mean "lower than" as in, slightly away from the nipple towards the toes?

Should I be looking for lumps directly "behind" the nipple only, anywhere "behind" the areola, or even slightly outside the circle of the areola? Or are all 3 locations possible?
 
#11
someguy - Your last line is correct, behind all three. Under just refers to basically looking at it from the Doctor's POV as you are laying down being examined and not south of the nipple.
 

Nelson Vergel

Founder, ExcelMale.com
#14
Gynecomastia is the growth of mammary gland tissue under the nipple. It feels like a small cherry. Gyno is more common in men with low T than in those on optimized TRT. A study showed that a high estradiol to testosterone ratio may increase risk of gyno. Interestingly, giving men with gyno testosterone may improve this problem since the ratio is decreased.

TRT can increase nipple size and sensitivity. Some men love this and some hate it. This has nothing to do with gyno.

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Gynecomastia: Clinical evaluation and management
 
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