Author Topic: 2 surgeries/androgel....now what?  (Read 4680 times)

Offline knightboat

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ok i was dumbass and did some steriods (7 yrs ago, 28 yr old now) and obviously i did too much....well anyways after the gynecomastia was very visible i went with a general surgeon since insurance was going to cover it(shoulda gone with plastic surgeon) and I didn't have any money.  He did an ok job but then it came back....a little bit after that i went to an endocronolgist and got my testosterone checked where it was around 150, i was put on androgel and was back in the normal range....since the gynecomastia was still there and growing i went to a plastic surgeon in the area this past feb(voted best in the area by a couple magazines) to get rid of it once and for all...at first he it looked like he did a good job but it  started coming back just a few months afterwards and now is the biggest its ever been.....Is there any advice on what i should, I thought surgery would remove gynecomastia permanetly(right now my test level is 450 and taking 2 packets of androgel a day)?  

Linkback: https://www.gynecomastia.org/forum/index.php?topic=7353.0

Offline 808gyno

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It might be that the Androgel is causing an increase in the aromatase enzyme which converts excess testosterone to estrogen.  Some men are more prone to aromatisation than others.  Not saying this applies to your case, just throwing a possibility out there.

Offline Paa_Paw

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There are many possibilities, none of which are really good news.

The fact that you must continue the Androgel to maintain your testosterone level suggests that your prior use of Steroids caused a permanent reduction of your natural Testosterone. (I'm sure you already knew that)

You don't hint at what your DHT level is nor do you mention what your Estrogen levels are or have been. These would be important things to know. The exact numbers are less important than than how they relate to each other.

Your best bet would be to stick with the Endocrinologist. If this Doctor does not have a specific interest in reproductive matters, you might consider changing Drs.

Hopefully  our friend Hypo will weigh in on this; His knowlege in this area is Encyclopedic.

Grandpa Dan

Offline knightboat

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cool thanks for the replies...paa_paw i was thinking about getting a test for my estrogen levels to see if they out of the normal range soon, but why DHT?.....if its the androgel thats causing, would that mean any type of HRT will cause it?

Offline Hypo-is-here

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Hi knightboat.

The most important thing to do is ensure that you are investing your time, patience, health (money too if insurance related) in an endocrinologist or andrologist that treats many men with hypogonadism and associated conditions, keeps up-to-date with current thinking and has real experience in this arena.

There are FAR too many general endocrinologists, or endocrinologists that specialize in diabetes or a whole number of conditions that think they can just come along and dabble in this area of medicine- very often they are incompetent and unable to deal with many of the issues that raise themselves.

Nothing I say will be better advice than that above.

You need to invest in your own health and the outcome of appropriate treatment.  Self education is a must if you have hypogonadism and you certainly have that with a pre treatment level of 150 ng/dl.  A great endocrinologist makes this less of an issue obviously, but you can certain help yourself and may need to do so in order to get where you want to be.

On that note register with the forum below- you can then post any questions you may have on the condition and get help from people who also live with it;

http://health.groups.yahoo.com/group/hypogonadism2/

This site below offers some helpful information as well;

http://www.androids.org.uk/


I can tell you some basic facts about your situation with the limited information you have given me.

1
Irrespective of the exact reference range those numbers indicate the ng/dl reference range- often used in the US (some other places too).

2
450 is going to be towards the bottom of the reference range may well not be adequate testosterone replacement therapy despite the fact that you are on the maximum Androgel dosage, something that might necessitate a change in the form of treatment or the addition of complimentary treatment(s).

3
Certainly an increasing development of gynecomastia suggests a poor endocrine balance/a hormonal imbalance.  If this times-in with you commencing and continuing with treatment it suggests a poorer endocrine balance than prior to testosterone replacement- something that can easily happen.

4
A poorer balance can occur because one number that has increased namely serum testosterone does not mean that your androgen to estrogen ratio is superior than pre treatment as many factors are crucial.


5
The crucial level of free/bioavailable testosterone may actually be lower than prior to treatment.  Free testosterone should be measured in the US- it is more important than serum/total testosterone that you have had measured.  

6
If you cannot have free testosterone measured or free testosterone is too low then SHBG should be measured- increases in SHBG can have a major impact on free/bioavailable testosterone.

7
The most potent estrogen a byword for estrogen in the male- estradiol should also be measured.  Like SHBG it is crucial in affecting free testosterone.  It is also important in its own right as elevated estradiol can easily cause gynecomastia as it can cause a relative imbalance of androgens to estrogens.

8
Estrogen/estradiol often increases with testosterone replacement.  Quite a few men find that a maximum dose of Androgel causes substantial levels of estradiol.   I have seen the detailed information on Androgel that shows that it does indeed often cause substantial increases in estradiol at higher doses- over and above that of some other forms of therapy.

9
Many men find that if a form of treatment doesn't work, either an increased dosage is required; a change of therapy required or ancillary medication is required- to lower estrogen or SHBG for example.

10
Treatment differs person to person, we all have differing endocrine systems and we all respond differently to differing medications.  What may work for one man wont work for another and vice verse- it is very much a case of horses for courses. Hence the long winded explanation below

e.g

10 men could all be placed onto testosterone;  

The first man might find his testosterone levels at 750gn/dl and feel great.  

The second man may find his testosterone has actually decreased due to suppression of his own endogenous production and be down to 200ng/dl and feel pretty terrible.  

Man three might have testosterone levels of 900ng/dl and feel no better than before because his SHBG has increased so much that all his testosterone is bound in the blood and he has the same level of free/bioavailable testosterone.  

Man four might have a testosterone of 450ng/dl and a nice free/bioavailable  and feel awful because his estradiol is independently high and causing him to have emotional problems- and possibly gynecomastia.  

Man five might have a tiny increase in total testosterone and no subsequent rise in estradiol and having a low SHBG might see a large rise in free/bioavailable testosterone and feel fantastic.  

Man six might feel awful no matter what the differing levels but feel great when put on a differing form of treatment- fromm Androgel to 100mg ethanate per week injections.

Man seven might be the same as man six but go from ill to well when going from 100mg ethanate per week injections to Androgel- or pellets or testosterone undecanoate tablets or to nebido long term testosterone undecanoate injections etc etc

Man eight may feel awful on all treatments because he has another underlying disorder that is going untreated.  This can happen more often when the nature of deficiency is hypothalamic/pituitary based.  So treating hypogonadism with testosterone doesn't clear up hypopituitary problem that is resulting in growth hormone, thyroid or adrenal problems etc

Man nine might have a genetic disorder that ensures that the testosterone cannot work in the body and so may have a complete or partial lack of response despite any testosterone level.

Man 10 might have a genetic disorder that results in a lack of response to the conversion of testosterone to dihydrotestosterone- a metabolite and equally important androgen- and have certain poor responses irrespective of the numbers.

I could go on but I think I have gave you an idea of just how much people can differ in their individual responses to medications- hormones etc.

11
All the above said there are some general tendencies that affect the majority of sufferers, so it can be a mine field- but it might not be.

12
Some men start out on testosterone replacement therapy and for the first few days, weeks or months they feel great and then sink!

Some men feel as bad as before treatment or worse.  Such men are often told that it must be a placebo effect.  The placebo effect does cause this to happen for some men or women given treatment for any and all conditions.  However the rate at which this is reported is far greater than can be accounted for by the placebo effect.  The fact is this is very often not a placebo effect but a very real alteration in endocrine balance.

Hormones act synergistically like an orchestra and if one of them starts playing a dud note you as the patient go down hill.  Too often when this is reported the endocrinologist or gp is logically myopic and only looks at testosterone and so doesn’t believe his own patients/ that any adverse factual effect is occurring.  Somewhat similar to a concert hall of music fans booing and yelling that the orchestra is awful, whilst the conductor sees only the end of his nose and the impeccable first violinist as opposed to the terrible musician’s further a-field ruining the whole synergy and well-being.

13
If your gynecomastia is increasing, that could potentially tie in with feeling worse than pre-treatment- perhaps more tired- maybe more emotionally liable…..sometimes that goes hand in hand with increases in estrogen.

please excuse any typos.

I’ll leave it there- check out the sites- educate yourself on the condition and get well.

All the best.





« Last Edit: November 01, 2006, 04:21:52 PM by Hypo-is-here »

Offline knightboat

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When you went to the plastic surgeon did you have Liposuction only? what was the liposuction he used?
That is also important to know.


didn't know there were dif types of liposuction, he did the incision around the nipple with a stick that sucked the fat out

Offline knightboat

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thank you very much hypo for your detailed response, i just have one question for you.....you mentioned about endocronologist and finding one that has a good history of specializing with hypogonadism, how would i go about screening out for one, since i got a feeling when i call dif doctors in the area the nurses or receptionists won't be too reliable.....i want to find another endocronogist as the one i went to handles diabetes almost exclusively

Offline Hypo-is-here

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thank you very much hypo for your detailed response,



Happy to help.

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i just have one question for you.....you mentioned about endocronologist and finding one that has a good history of specializing with hypogonadism, how would i go about screening out for one, since i got a feeling when i call dif doctors in the area the nurses or receptionists won't be too reliable.....i want to find another endocronogist as the one i went to handles diabetes almost exclusively


Try the forum I mentioned and see if you can get a personal recommendation.


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Did your Dr just look at your T level and stick you on Androgel or did he try to restart your system first ?  Chances are your E2 is very high and that's why the Gyno is growing.  

Since you are young and your hypoG is most likely from doing steroids without proper (or any) PCT you can most likely start your own sytem again.

Answer those questions and I can steer you in the right direction


You are winging it with limited knowledge- it is simply not possible to answer things as you have suggested.  He is better of getting a good personal recommendation to see a specialist who can investigate properely and in the meantime taking on board the advice of experienced hypogonadism sufferers.




Offline Paa_Paw

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knightboat,

After that response from Hypo, There is nothing I could add. You did ask a specific question though. It was why the level of DHT might be important.

Testosterone is converted into other forms and used in different ways. It is converted into both DHT and various Estrogens for example.

Your hormones do not play solo, they play a concert. How they relate to each other is more important than their individual numbers.

If you would care to reread through what Hypo wrote; You 'll find that he also stressed this same point, but in more academic terms.
« Last Edit: November 01, 2006, 04:06:39 PM by Paa_Paw »

Offline knightboat

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Did your Dr just look at your T level and stick you on Androgel or did he try to restart your system first ?  Chances are your E2 is very high and that's why the Gyno is growing.  You need to have it cut out not just lipoed and even then there is a chance it can grow back

A very good Gyno Dr with Q and A's  is ricksilverman.com


Since you are young and your hypoG is most likely from doing steroids without proper (or any) PCT you can most likely start your own sytem again.

Answer those questions and I can steer you in the right direction


from what she presented to me she saw my test level then put me on the androgel(first she put me one packet a day then after 3 months got my results checked again then put me on 2 a day)

Offline Paa_Paw

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In defense of Hypo, Some instances of drug induced HypoGonadism prove to be very difficult to treat.

This is an area where you would want the most competent Endocrinologist who has specialized in this kind of treatment.  

It naturally follows that in order to recieve the best treatment, you must provide the Endocrinologist with a history that is full and honest. Omit Nothing!

This is no place for any attempt at Do-it-Yourself Medicine.

Offline knightboat

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So did you use any PCT after your cycle ?  If so what and for how long.  What steroids did you use. dose/duration ?


from what i remember(since it was 7-8 yrs ago) i used nolvadex for about 3 wks

Offline Hypo-is-here

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Well that is just wrong.  You need to find a DR who specializes in HypoG and tell him you used steroids.  Chances are your sytem can be restarted.  Go to mesorx.com and join the mens health board.  Look (or ask someone) for an article by Dr Scally on reversing ASIH (anabolic steroid induced hypogonadism).  You are most likely not in the same boat as most people who have secondary or primary HYPOG.  Several drugs such as Clomid, Tamoxifen and HCG can restart your HPTA.

I was in the same situation you are and it worked for me


A) you have repeated some of the information that I have presented and then tried to suggest that I said something different.  

B) What worked for you doesn’t equate to what will necessarily work for someone else.  You have jumped the gun and presumed too much from limited information.  

With the information we have been given you could be correct,but equally you could be wrong.  I could just have easily suggested the same likelihood, but unlike you I didn’t want to jump the gun.

You have been given ZERO information which excludes; A) a pre-existing condition, B) a predisposition to secondary or primary hypogonadism or C)  the independent development of hypogonadism at a latter date.

You must admit there simply is no information from which to make you jump so far as to say that it is probably XYZ and you can probably restart the HPTA.  

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Hypo,

While i respect your knowledge chances are he is not in the same boat as most people with HYpoG.  His was most likely caused by steroids and it is possible to reverse that.  I know it worked for me and Dr Scally is one of the few Dr's who treat ASIH.


The cause of his hypogoandism has not been diagnosed and you have not conducted dynamic/evocative pituitary testing to ascertain the cause of his hypogonadism so you can’t really say what boat he is in without guessing.  I admit that there is some well founded reasoning to the guess work and you could be right.  But guess work, even good guess work based on experience still isn’t good enough- because you could easily be wrong.  

I respect the fact that you are saying that you have been treated for steroid induced hypogonadism and that your HPTA was re-started and to reiterate I admit it is possible that Knightboat is in the same situation.  But you have gone too far in jumping to conclusions and you are transposing your own situation onto him.

If you keep a lid on the urge to jump to conclusions your experience and information could be really helpful to people here, as few people have actual experience in these matters.
 
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So did you use any PCT after your cycle ?  If so what and for how long.  What steroids did you use. dose/duration ?


Reasonable question….


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In defense of Hypo, Some instances of drug induced HypoGonadism prove to be very difficult to treat.

This is an area where you would want the most competent Endocrinologist who has specialized in this kind of treatment.  

It naturally follows that in order to recieve the best treatment, you must provide the Endocrinologist with a history that is full and honest. Omit Nothing!

This is no place for any attempt at Do-it-Yourself Medicine.


Thanks Paw Paw, you know exactly where I am coming from.  I certainly have never said or suggested that Knightboat should not tell the relevant specialist the full picture.  If anyone thinks I have they should quote me.

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from what i remember(since it was 7-8 yrs ago) i used nolvadex for about 3 wks


If and it is a big if knightboats hypogonadism was caused by steroid use and resulting hypothalamic/pituitary dysfunction- would he be likely to recover function after 7-8 years?

Mmm   Even if it was the cause many people do not recover such function.

Also don’t forget that many, many guys who have used steroids end up with testicular failure as opposed to hypothalamic/pituitary failure and this can be permanent too.


I tell you what this conversation has brought to the fore.  The fact that your (knightboats) current endocrinologist is incompetent.  

How so?

Well;

When an endocrinologist or andrologist finds that a man is hypogonadal, he is NOT supposed to put that man on treatment.  He is supposed to try and ascertain why that man has hypogonadism to start with- with dynamic/evocative testing of the hypothalamus/pituitary and a view of said area via an MRI or CT scan.  

By finding out why a man has hypogonadism the aforementioned specialist can decide upon what is the most appropriate form of treatment.

A full diagnosis allows the doctor to attempt to re-start the HPTA via clomid, HCG, GnRH therapy etc if that is appropriate, use one of the said treatments to treat general hypogonadotropic conditions, whether in combinations with TRT or alone.  The cause can even offer an indication as to which form of TRT is most likely to help if replacement is the way to go.

Kightboat- you need to register with the forum, so you can get support whenever you need it.  It is  a very helpful sounding board that is always there.

You need to get a personal recommendation for a new and competent endocrinologist or andrologist.

You can get one A) possibly via the forum  B) You might want to consider the specialist mentioned by damngyno12 then C) if a and b fail you I can get you contact details for endocrinologists in your area- though I am thousands of miles away and the I could offer no personal recommendation.

As well as the above you need to educate yourself on issues of hypogonadism- unless you somehow escape the condition.  

Startingplaces would be Eugene Shippens Testosterone Syndrome and Malcolm Carruthers Androgen Deficiency In The Adult Male.
« Last Edit: November 02, 2006, 11:57:47 AM by Hypo-is-here »

Offline knightboat

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What drugs did you use and for how long. Dosages ?


i was on for 8 wks and it was deca....i was supposed to be doing 300mg a wk, but its a long story and i ended up taking 900mg a wk for 3-4 wks of the 8 wks

Offline knightboat

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of the information i have from blood work i had done a few months ago:

total testosterone:  465ng/dL
free testosterone%: 2.40%
free testosterone:  111.6pg/mL

i'm going to my regular doctor on tues to get test checked again along with what is recommended to be tested by the AACE

I'm also still looking for an endo that deals with hypogonadism in the central fl area


 

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