Gyno flare-up. Low E, "Normal" T. What next?

KarlHungus · Jul 11, 2017

Went to my GP for gynecomastia flare up (firm, tender sub-areolar lump, no fluid draining). I had dabbled with prohormones in the past (at least 10 years ago) with lousy PCT, hence the gyno. She ordered some preliminary labs (at my urging) and a mammogram (her idea) which I have had years ago. The previous mammo showed gyno. I am 55 years old, 5'10", 170#, exercise regularly and eat clean, not on any meds.

Here are my labs:

TT 390ng/dl (220-716)
Free T 6.29ng/dl (4.7-24.6)
SHBG 47.3nmol/L (11-78)
Estradiol <10 (11-44)

As you may have noticed, the estradiol was not the sensitive test. Also, I am having low-t symptoms: losing muscle mass, low libido, irritable (per my wife), lack of drive/focus, mental fog, sleep issues, etc.

Question: what is my next move? Do I focus on getting the gyno under control? Push for additional labs. Start looking at TRT options?

Vince · Jul 11, 2017

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CoastWatcher · Jul 11, 2017

KarlHungus said:
Went to my GP for gynecomastia flare up (firm, tender sub-areolar lump, no fluid draining). I had dabbled with prohormones in the past (at least 10 years ago) with lousy PCT, hence the gyno. She ordered some preliminary labs (at my urging) and a mammogram (her idea) which I have had years ago. The previous mammo showed gyno. I am 55 years old, 5'10", 170#, exercise regularly and eat clean, not on any meds.

Here are my labs:

TT 390ng/dl (220-716)
Free T 6.29ng/dl (4.7-24.6)
SHBG 47.3nmol/L (11-78)
Estradiol <10 (11-44)

As you may have noticed, the estradiol was not the sensitive test. Also, I am having low-t symptoms: losing muscle mass, low libido, irritable (per my wife), lack of drive/focus, mental fog, sleep issues, etc.

Question: what is my next move? Do I focus on getting the gyno under control? Push for additional labs. Start looking at TRT options?

If gyno is comfirmed, I would arrange a surgical consultation and discuss having the gland - the entire gland - excised. Then I would sort out my hormonal challenges. TRT, with the possibility of it recurring, is too much of a challenge (in my opinion).

KarlHungus · Jul 11, 2017

I'll check on that, but I believe my insurance considers it a "cosmetic surgery", ie. no coverage. I'll look into it though.

CoastWatcher · Jul 11, 2017

KarlHungus said:
I'll check on that, but I believe my insurance considers it a "cosmetic surgery", ie. no coverage. I'll look into it though.

The clear advantage is an end of the problem. If the gland is removed, all of it, gyno simply can't recur. Presenting as it seems to be doing now, it may well be a thorn in your side as you work to balance your hormones.

CoastWatcher · Jul 11, 2017

By the way, based on the reference range quoted, your doctor ran the incorrect estradiol test for men. You'll want the sensitive, LC, MS/MS, assay performed. It's the only one that men can rely on.

KarlHungus · Jul 11, 2017

CoastWatcher said:
By the way, based on the reference range quoted, your doctor ran the incorrect estradiol test for men. You'll want the sensitive, LC, MS/MS, assay performed. It's the only one that men can rely on.

Yeah, by the time I noticed she ordered the wrong one, it was too late. Am I correct that the main problem with the standard lab is that the results are falsely high? I'm also gonna ask the doc about tamoxifen since I've read a few research articles that report very high success rates against lump gyno.

Really was looking forward to hooking up with Defy, but I'll need to get this taken care of first. I did a successful self treatment of the other side a few years ago. Lump completely gone. Just can't figure out what triggered this. I expected my T/E ratio to be much lower. When it happened on the other side my test was in the low 300s and Estra was 20.

CoastWatcher · Jul 11, 2017

KarlHungus said:
Yeah, by the time I noticed she ordered the wrong one, it was too late. Am I correct that the main problem with the standard lab is that the results are falsely high? I'm also gonna ask the doc about tamoxifen since I've read a few research articles that report very high success rates against lump gyno.

Really was looking forward to hooking up with Defy, but I'll need to get this taken care of first. I did a successful self treatment of the other side a few years ago. Lump completely gone. Just can't figure out what triggered this. I expected my T/E ratio to be much lower. When it happened on the other side my test was in the low 300s and Estra was 20.

Tamoxifen can turn things around if introduced early. Defy certainly could help with this if you choose to treat it medically, there's little they've not seen. The issue is the time it may take to see one of the medical staff once you're in the system. It would be worth calling them, explaining your situation and seeing what they suggest. At the very least, it would line you up for full-on treatment.

As as far as the e2 test, you may well be at a different level than that test reports. Typically it is higher, unless it's not. Not trying to be snide, just pointing out that it's unreliable for men.