Endocrinologist

[Anonymous_Man]

I made an appointment to see an Endocrinologist next week.  

What, specificly, will happen and what should I know before I go in?

Linkback: https://www.gynecomastia.org/forum/index.php?topic=1518.0

[nukem2k5]

The endo will ask you questions regarding your health and your family's health history.  You should expect to have an exterior genetalia exam, where you'll take off your pants, lay on a table, and he/she will examine your penis and testicles (I had this done and my endo was a woman).  You will also be asked to remove your shirt for an examination of your chest.  Blood will probably be drawn for lab testing.

You should know that gynecomastia can exist because of a low ratio of estradiol (estrogen) to testosterone, which may be caused by a number of things (namely your testes or your pituitary gland).  By checking your LH, FSH, SHBG, Testosterone Serum, and Estradiol (perhaps more, but these should be pretty much what you may need initially) your endocrinologist can begin to assess what your situation is.  Do not accept results like "normal."  Ask for a copy of your quantitative results and have the endo explain what each of them means in regards to your body.

The pituitary gland sends a signal to your testes to produce testosterone, and thus a negative signal is sent back to the pituitary.  A low testosterone count with a high LH (the signal back to the pituitary) and high estradiol means that there may be a problem with your testes.  If your testosterone is low and your LH is also low, there may be a problem with your pituitary gland.  

Testosterone deficieny has a number of symptoms including low sex drive, loss of energy, loss of hair growth (facial / body hair), inability to gain muscle / mass, loss of concentration, and underdeveloped genetalia, among other things.

It's late and I'm tired so if any of this is incorrect, anybody may feel free to correct me.  If I can think of anything else I'll post again.

[hypo]

Just to add to what Nukem has said;

You can have low testosterone and have some of those symptoms and not others.

My only symptoms for a long time were gynecomastia, poor stamina/fatigue, poor concentration and back pain.

I had no loss of libido until the last year before I was treated and my Ahem my parts were not an issue.

Some people have a low libido as the first symptom, others poor concentration and depression.

Just differs person to person and can relate to the underlying cause of the testosterone deficiency.

Also your endocrinologist may also check you thyroid function and liver and kidney tests are possible.

Low testosterone accounts for 10% of gynecomstia sufferers, liver problems accounts for 8% of gynecomstia sufferers (though usually older men) Renal problems and thyroid problems account also account for a small percentage.

Routinely breast and testicular cancer are considered as well- just to rule such issues out.

[Anonymous_Man]

Thank you both very much.  Now I have an idea of what to expect.  The thought of getting naked and having the Dr examine me makes me cringe though.

I saw an urologist several years ago.  It was for problems maintaining an erection.  He did say that my testosterone was low.  I had several shots in the hip over the next few weeks or months, I forget.  Things didn't really improve at that time.  He said that it could just be in my head.  

2-3 years after that is when I developed gyne.  So that's been 4 years with a big boob that has really eaten away at what little self esteem I had to begin with.

I saw a DR 6 or so months after I got gyne.  Had an X ray and an ultra sound.  They didn't know what it was.  Then they sent me to a plastic surgeon.  I didn't have surgery because I was hoping it would go away on its own.  It hasn't.  

I am nervous about going thru this but it's been eating away at me for 4 years.  I just hope that this is something that can be cured without going thru surgery.  

I will let you all know what happens.

[hypo]

Make sure you get a copy of the actual results and reference ranges for each of the tests as opposed to just accepting words like normal.

post them here and i'll give you the percpective from someone who has hypogonadism.

[Anonymous_Man]

Okay Hypo, I will.  Thank you.

[Anonymous_Man]

Saw the Endo today.  No genetalia exam.  He didn't say anything about it and I didn't bring it up.

He said he was familiar with gynecomastia.  At least he knew what it was.  Some drs do not.

Had a blood test.  Some blood had to be sent out for testing.  What I did get today concerned my blood sugar and cholesteral.

I don't remember exactly eveverything he said because we did talk for quite a bit.  But I believe he said that I may be in a pre diabetic stage.  My blood sugar is normal.  Glucose is normal.  But anyway, he said that if I am in a pre diabetic stage that may be why I have had some problems.  Something like if my body was producing too much glucose that that may be a reason for my body converting testosterone to endrogen.  

My results say the Ref. Range for glucosmine is 70-110.  Mine is 101.  He gave me a prescrip for METFORMIN to lower that.  Now that I think about it, I am not sure why because I was within the Ref. Range.

My cholesterol was okay but the TRIG and C-LDL was a little high.  Gave me Lipitor for that.

I am overweight and he said it would be a good start to continue to get my weight under control.  I agree and have been trying to do this.

Won't know the Testosterone results until late this week or early next week.

My thyroid is okay.  Ref. Range 4.5-12.1 ug/dL.  My T4 checked at 5.7

My TSH is okay.  Measured at 2.75.  Ref. Range 4.2-6.5%.

This is all I have for now.  Not scheduled to go back until June 28th.  Does anything I've said make sense to you guys?  I need all the help and info I can get and I appreciate the help that you've given me so far.

[shakamunya]

Not that I'm a medical doctor or that I know your situation, but starting you on two prescription drugs for values that are slightly out of range (or even in range!) sounds excessive when both could be controlled with nutrition.

[hypo]

Other than the thyroid this doctor hasn't looked at the real issues at all.

If he does not covered the basics, (certainly possible if he does not have a specific interest in reproductive endocrinology) then I will get you the details of someone appropriate should it look like that is someone you need to see.

But let’s give him the benefit of the doubt and see what he has tested for when he comes back with rest of your results.

[JeffJ]

It seems like an almost total waste of money to see an endocrinologist.
How many cases of Gyne. are actually solved by going to see one?? I dont recall reading about any here... it seems everyone needs the surgery no matter what. Or am I wrong??
Jeff

[HEG]

It seems like an almost total waste of money to see an endocrinologist.
How many cases of Gyne. are actually solved by going to see one?? I dont recall reading about any here... it seems everyone needs the surgery no matter what. Or am I wrong??
Jeff

I don't believe that is the reason for seeing one. I for one do not want to drop thousands of dollars for surgery only to have it come back due to some sort of hormonal imbalance I wasn't aware of because I didn't visit an endo.

[JeffJ]

Well then how many men are found to have hormonal imbalances by the endo.??
I personally havent read about any here who were "cured" by their endocrinologist who found these imbalances...
Jeff

[hypo]

Gynecomastia can be a symptom of more serious problems that need to be diagnosed and treated.

25% of all gynecomastia sufferers have an underlying and continuing cause for their gynecomastia.

10% of which have low testosterone and 8% of which have liver problems.

With low testosterone the idea is to recify the hormonal imbalance and then rectify the gynecomastia via surgery.

That way it doesn't come back.

If someone who has an underlying condition whatever the cause just goes ahead with surgery they are often back at square one having gone through surgery- with a lot less money!!!

Can you see the point?

[JeffJ]

I get it now. Thanks very much for explaining

Jeff

[Anonymous_Man]

It's been two weeks since my appointment.  They just now, today, got my test results back from the lab.  I now have an appointment on Friday so the Dr can explain things to me.

I talked to the nurse today and she said that my testosterone results were "normal".  I am really frustrated now.  And I have to wait 2 more days to find out more.

She did say my insulin level was high.  And c-peptide or pepcide or whatever was 6.1.  What that has to do with my gyne, I DO NOT KNOW.

I'll have more Friday.