28 y/o - gynecomastia - tamoxifen - possible low T

[anon111]

i was referred to this forum from a trusted source at gynecomastia.org. he says that this community has a wealth of info about addressing low testosterone and dealing with endocrinologists.

six months ago i noticed a small mass in my chest, near the nipple. it didn't go away after a couple months, and i noticed a dull ache/minor discomfort in my left testicle. after seeing several doctors, i was eventually diagnosed with gynecomastia. the urologist ruled out testicular cancer -- his physical exam and sonogram showed that the boys were working properly, and i haven't noticed any pain there since.

i've seen two endocrinologists to try to uncover the cause of my gynecomastia.

• 28 years old
• 5'11", 175 lbs, 10-12% body fat
• healthy blood pressure and cholesterol levels; resting heartbeat 50-60/min
• previously very active, exercising vigorously 4 times a week. i gained 10 lbs last year through consistent strength training
• no history of serious illness. don't smoke, drink, use steroids, etc. the only prescription i take is an antihistamine for allergies

if you'd asked me six months ago, i would've said that i was in the best shape of my life.

here are the basics of my lab results:

in the first test, the blood was drawn around 5pm:

• estradiol: 35.5 pg/mL (no range provided)
• total T: 288 ng/dL (262-1593)
• free T: 83 pg/mL (50-350)
• all other measures, including prolactin (for pituitary), were normal

in the second test, the blood was drawn at 11am:

• estradiol: 20.3 (7.6-42.6)
• total T: 342 (348-1197)
• free T: 9.9 (9.3-26.5)
• again, all other measures appear normal

both endocrinologists said that i might have "an increased sensitivity to estrogen." they both prescribed tamoxifen, which i haven't started taking yet. the second one told me to run the blood tests again in three months, first thing in the morning while fasting.

i've been under quite a bit of stress and anxiety. bouncing around the medical system and not getting answers hasn't helped.

i'll consider surgery to address the gynecomastia, but i first want to be sure i've addressed the underlying cause.

• is it possible that chronic stress can suppress testosterone production, enough to cause an imbalance and trigger the onset of gynecomastia?
• if so, is it possible for the natural production to rebound as i reduce stress and recover?
• what would you do in my situation?

[HRTstudent]

stress can absolutely lower testosterone. if you remove the stress and learn to handle it better then you could probably get back to where you were.

the underlying cause of your gyno, however, is really a mystery. I don't think anyone can tell you 100% for certain why you got the gyno. Some men just develop gyno as they age but I believe this is usually due to shrinking testosterone levels, increasing bodyfat, and a host of other things essentially related to aging and living in the modern world. but it doesn't seem like you fit that typical mold...

it could also very well be a nutritional change or issue.

it's also important to know that we don't know medically what is the exact cause of gyno. the entire issue is really complex and it's probably a few ways it can come about.

if I were you... I would take the tamoxifen because it is very good for resolving "new" gyno. (did they tell you how to use it?) and then I would look at improving my natural tesosterone via nutrition and lifestyle. read some of the vitamin D threads here as well. very convincing stuff for T levels. also, practice stress reduction. personally, I would also start supplementing with natural aromatase inhibitors and see if you get your estradiol lower by checking bloodwork. consider grapeseed extract and chrysin with piperine. you very well might be able to get away with something mild like that because your levels are clearly not going crazy high and they should be safe to take and really we can't expect any harm. as long as you don't buy the most expensive product, it should be very affordable as well. a natural aromatase inhibitor MAY POSSIBLY give you a very small boost in testosterone as well.

what supplements do you take?

it may suprise you to find that many "natural" supplements have plenty of hormonal stuff in them that can give people gyno. supplements can be very tricky in that regard...

[Babyslim]

Im sure some vets will check in and steer you in the right direction, some exceptional people here.

What other blood work was run? A great start would be at least the following;
Total Testosterone
Bioavailable/Free T
SHBG
DHT
LH/FSH
DHEA-S
Estradiol
E2 ultra sensitive (check the stickies on the top of the forum, this needs to be the proper test)
Prolactin
Cortisol
Thyroid Panel (TSH, FT4, FT3)
Comp Metabolic Panel
CBC
Lipid Panel
PSA
Progesterone

Your Total and free T are both on the low side but not in the tank. Your estrogen isn't very high, but i'm not sure if you have the proper lab ordered.

[bass]

your e2 is very low right now, i don't think you should mess with it. definitely stress will suppress your test to a certain extend like HRT wisely noted, but also allergy meds can do some damage on your test production as well, and any kind of oral meds unfortunately! you need to post your entire blood work if you have and like BaySlim posted you need to do a complete blood work to determine whats wrong. need to know if your thyroid is functioning normally, and your FSH/LH as listed above are very important.

[kelkel]

Good advice above. Agree with HRT on his Nolva recommendation for new gyno. Your second E test appears to be a sensitive assay and your 20 level is within the range the Life Extension Foundation claims we should aim for (20 - 30,) but that depends on how you feel. Your E appears to have gone down between tests and your T came up some, as expected. Some people are more estrogen sensitive/nip sensitive even with low E levels btw. I'm that way.

Your endocrinologists said your prolactin was normal so I assume they were considering a prolactinoma. Did they speak to you about an MRI to rule out any other pituitary issues? Not all are prolactinomas.

I would be specifically curious about your shbg, albumin, LH/FSH, Vit D for many reasons and TSH as hypothyroid can bring about the same symptoms as low T. Take a look at the links provided below. One is from this site and is huge. The others are more medical related.

http://forums.steroid.com/showthread...now-about-GYNO.

http://www.ncbi.nlm.nih.gov/pubmed/11034434

http://www.ncbi.nlm.nih.gov/pubmed/20050857

[anon111]

thanks for your responses so far. i've been reading up on vitamin D (i don't drink milk, maybe that's contributing to low vit D and therefore low T??) and will check out the other links you've posted.

for the sake of completeness, i'll post all the blood work i have on hand.

first test:

- estradiol: 35.5
- FSH: 2.6
- LH: 1.9
- SHBG: 17 (13.00-71.00)
- free T: 83 (50-350)
- total T: 288 (262-1593)
- TSH: 0.79 (0.55-4.78)
- prolactin: 2.9
- thyroxine (t4 free): 1.0 (0.7-1.7)
- hcg serum, qualitative: negative
- a/g ratio: 1.5 (1.1-2.2)
- albumin: 4.2 (3.5-5.0)
- alkaline phosphatase: 56 (38-126)
- ALT: 26 (13-69)
- anion gap: 11 (7-16)
- AST: 24 (15-46)
- bilirubin: 0.5 (0.2-1.3)
- BUN/creatinine ratio: 19
- calcium: 8.9 (8.4-10.3)
- chloride: 105 (98-107)
- co2: 26 (22-30)
- creatinine: 0.9 (0.66-1.25)
- glucose: 76 (74-106)
- potassium: 4.1 (3.5-5.1)
- protein: 7.0 (6.3-8.2)
- sodium: 142 (137-145)
- urea nitrogen: 17.0 (9.0-20.0)

second test:

- TSH: 1.19 (0.45-4.5)
- T4, free: 1.26 (0.82-1.77)
- glucose: 79 (65-99)
- BUN: 20 (6-20)
- creatinine: 0.97 (0.76-1.27)
- eGFR (non african am): 106 (>59)
- BUN/Creatinine ratio: 21 (8-19)
- sodium: 143 (134-144)
- potassium: 3.8 (3.5-5.2)
- chloride: 104 (97-108)
- carbon dioxide: 21 (20-32)
- calcium: (8.7-10.2)
- protein: 7 (6.0-8.5)
- albumin: 4.6 (3.5-5.5)
- globulin: 2.4 (1.5-4.5)
- a/g ratio: 1.9 (1.1-2.5)
- ast: 18 (0-40)
- alt: 17 (0-55)
- LH: 5.9 (1.7-8.6)
- FSH: 2.7 (1.5-12.4)
- total T: 342 (348-1197)
- free T: 9.9 (9.3-26.5)
- cortisol 15.3 (2.3-19.4) NOTE: i took saliva sample at midnight and the results also offer reference range "cortisol AM" as 6.2-19.4 and "cortisol PM" as 2.3-11.9
- hcg, beta subunit, qnt: <1 (0-3)
- prolactin: 5.7 (4.0-15.2)
- insulin-like growth factor: 283 (117-329)
- prostate specific ag: 0.6 (0.0-4.0)
- estradiol: 20.3 (7.6-42.6)
- SHBG: 19.5 (16.5-55.9)
- estrone: 55 (12-72)
- salivary cortisol: 0.012 (<0.010-0.090)

that's everything i have, so nothing to share on vit D or some of the other measures babyslim mentioned.

i've had puffy nipples for most of my adult life and have just been oblivious (ignorance is bliss, eh?), so i might very well might be nip sensitive, as you say kelkel.

i've been extremely fatigued lately and believe that i have a mild case of adrenal fatigue. i've started to think that chronic stress suppressed my T levels and with the possibility that i'm already estrogen sensitive, it was enough to trigger gynecomastia growth. who knows.

i've not been recommended for an MRI, most assuredly because my prolactin hasn't raised any concerns.

i'll continue to read through what you all have posted. please let me know if you have any additional thoughts or recommendations on how to proceed. i started on tamoxifen this morning.

[anon111]

HRTstudent...

i don't take any currently. i recently added a daily multivitamin.

i do often drink veggie smoothies in the morning. i've looked at the ingredients for anything like soy that has estrogen but didn't see anything alarming. also, my estrogen doesn't appear to be the problem. if there's something in particular i should be looking for, let me know.

since i seem to be suffering from adrenal exhaustion (which i think is independent of the gyno -- my body finally shut down after so much stress), i'm thinking about the recommendation to support recovery, which is basically vitamin C and other natural herbs.

[HRTstudent]

you'll be suprised when you finally figure out that really the only cure-all that seems to help with just about anything is high quality nutrition and lifestyle.... it's just that, well, most people simply cannot make that shift. it's hard to do in a world that basically works against you in this regard.

regarding the milk and vitamin d, it probably won't impact it that much. vitamin D3 is dirt cheap and the amount you need is far more than you can get from food. The walmart brand stuff is about 10 dollars for 250 caps of 5k IU. Take one of those a day with food/fat to get that D bumped up.

Also, it seems like stress really might be your biggest issue. Learning stress reduction could probably be the best thing for you. Stress has a profound effect on everything physiologically.

As for the nips like you were thinking you were nip sensitive. well, like others have said some people are just like that. I get no bloating from estradiol but my nipples grow like a pubescent girl. My recommendation for a natural herbal supplement for estradiol was moreso just to prevent your estradiol from getting too high again. right now, you are right in that it seems okay and you don't have the gyno symptoms. as far as I know, the risk of decimating your estradiol on herbs is not like it is with potent drugs like anastrozole or letrozole.

[anon111]

so i guess this is the direction i'm headed:

- i started on tamoxifen this week to address the immediate gyno growth
- i'm going to pick up the vit D3
- i'm going to explore the possibility of a medical leave or vacation to see if that can alleviate stress in the short-term
- if my blood work looks much better (T levels up) in a couple months, then i'll know i'm on the right track
- if not, i'll see about getting on HCG to jumpstart my natural testosterone production

does this sound right?

[bass]

yes, good start! don't forget about good diet and exercise.

[HRTstudent]

so i guess this is the direction i'm headed:

- i started on tamoxifen this week to address the immediate gyno growth
- i'm going to pick up the vit D3
- i'm going to explore the possibility of a medical leave or vacation to see if that can alleviate stress in the short-term
- if my blood work looks much better (T levels up) in a couple months, then i'll know i'm on the right track
- if not, i'll see about getting on HCG to jumpstart my natural testosterone production

does this sound right?

For you, I honestly think the first thing you should do is practice stress reduction. Namely things where you clear your mind like meditation, yoga, just being in nature and away from work and ALONE (stress free).

The stress in your life is probably not a short term thing, so why would we want to limit ourselves a short term strategy?

As far restarts go... that's tricky. I definitely wouldn't be doing that without a real expert in male HRT on my side. Keep in mind, HCG will suppress your endogenous production to some degree. Not only that, but restarts are not always "successful" in the long term. I'm not trying to deter you from doing it, but I don't want you to put all your eggs into a basket that I know may or may not help.

For the tamoxifen, Dr Crisler recommends 40mg until symptoms subside then taper off. You don't really want to be on tamoxifen long term. It's also worth noting that tamoxifen is a drug used in restarts. That means, you should certainly expect a boost in Testosterone. Honestly, my personal opinion is that I would rather be on tamoxifen or clomid if I was going to try to boost/kickstart my T instead of HCG monotherapy. It's a very personal decision though to make with your doctor. There is no one best method (and that goes for just about all aspects in HRT).