T Nation

Gyno with Normal Labs? What Am I Missing?


#1

Ive never had an gyno problems in my life and noone in my family does. After two months of TRT its been a battle that im losing. After balancing all my levels i’m still having an issue and cant figure out why. Ill post all my tests and any input would be greatly appreciated:

Prior to starting TRT

9-27-2016
Testosterone 337 (Range 348-1197)
Free test 9.2 (Range 8.7-25.1)
Prolactin 7.4 (Range 4.0-15.2)

Started TRT 10-16-2016 (200mg dosed at 100 twice a week)
Ran out on 12-28-16 and doctor couldn’t see me so next shot was 1-10-17

1-7-17 (after missing shot for 13 days)

Testosterone 445 (range 249-836)
Free test 92.63 (range 48-250
% Free Test 2.08 (range 1.29-2.87)
SHBG 31.1 (range 19.3-76.4)
PSA 0.590 (range 0-4.0)
Hematocrit 49.7 (range 39-52)
Estradiol- doc said no need to test even though I specifically said I felt every symptom of high E2

1-31-17 (still 100mg twice per week=200)

Testosterone 1226 (range 249-836) HIGH
Free Test 23.28 (range 4.25-30.37)
DHT 929 (range 106-719) HIGH
Progesterone 0.30 (range <0.16) HIGH
PSA 0.62 (range <4)
SHBG 19 (range 10-57)
Estrdiol Sensitive 49.5 (range 8-35) High red flag
*Showed doc gyno seems to be forming for week or two and E2 slightly high, she said I cant give you breast cancer meds (AI’s). Ordered them online but didnt have till 2-20-16 ). DHT high, Progesterone high, Estradiol high

2-20-17 Lowered Test dose to 130mg (65 twice per week)
10mg Aromasin every day
20mg Nolvadex everyday
Gyno seemed to almost regress then come back for a week or two. Now it always looks evident and growing

2-28-17 Ultrasound showed no gyno but they said it wont def show. Possible mammogram or surgeon consult needed to confirm. But I am sure, I have pictures I can share showing def gyno and have always been lean and cut since I was a kid never any pre gyno or chest fat.

3-16-17 (Test dose 130, 65 twice per week, for a month now)

Testosterone 770 (range 249-836)
Free Test 16.05 (range 4.25-30.37)
Progesterone 0.13 ( range <0.16) Borderline high still
DHT 632 (range 106-719)
SHBG 19 (10-57)
Estradiol 10.46 (7.02-49.06)

So now my numbers are all in range but again I am still on 10mg Aromasin Everyday and 20mg Nolvadex everyday and my gyno problem is still getting worse instead of better or stable. I just don’t understand why. I have read some things about prolactin and only have that first test but from most information out there everyone focuses on estrogen when dealing with testosterone and mine was never very high and is actually too low right now. Except the ratio of T to E was bad fort two weeks when I had no shot for 13 days. 430 test to 50 E2. I am not on nor have I ever done any AAS and this is doctor prescribed cypionate in cottonseed oil. Anyone have any info to possibly add or other things to look at?? Thanks for your time


#2

Anastrozole is not a cancer med. It is an aromatase inhibitor that reduces T–>E2 and that action is useful in treating estrogen positive breast cancers. You doc simply need to wear a functional medicine hat and get the job done, or get an different doc, see the sticky for that.

Your TRT dose is way too high and creating your high T levels.

2-20-17 Lowered Test dose to 130mg (65 twice per week)
10mg Aromasin every day
20mg Nolvadex everyday
E2=10
Change to aromasin 10mg EOD
Taper off and stop Nolvadex. 20mg/day can create a lot of T–>E2 inside the testes. With E2 near 22pg/ml, you do not need a SERM/

FT=16 is too low. Should do labs halfway between injections, always, to reduce lab timing artifacts. You may have a low SHBG+T clearance rate in the liver and may be hypermetabolizing T. I would like to see dose increased to get FT near high normal.

Start injecting SC, use #29 1/2" 0.5ml syringes.

Manage E2 well and give gyno time to resolve, throwing labs+money at the problem will not change the outcome.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Thanks for the fast response. I did read the stickies but figured id go the most simplistic way first. I did switch docs but the new one that actually takes interest is a $400/hr wellness doc and ive seen a highly rate endo that basically said im on steroids of course im growing breast and wouldn’t help. Two general docs that dont know anything. And spoken to a HRT clinic which just gave me access to what i know already and some of the blood tests that i did have done as i live in NY and cant use online labs and things like that. I am a little confused about the dose. I do and always have done 29Gx1/2" but into deltoid im not sure if you would consider that sub q as some people say it is like 50/50. Do you mean to squeeze stomach fat and inject straight into there? Also are you saying my 200 dose with 1255 test was too high but my 130 dose with 755 but lower free test is too low. Should i do say 160mg(80 2x per week) and see where that lands my results?
Now to respond to your other questions i have much of the info minus the oral temps which I will do over the next couple of days as ive read your posts and know you hate asking(my apology, just didnt know if relevant to this particular situation). I do suspect a thyroid issue and have been searching for answers the past six months. Do you think that could be related? Ive bounced between the estrogen vs. liver vs. kidney vs. thyroid vs. progesterone vs. prolactin. I have no clue. I will post those labs. My TSH has been high since first tested and Test was low, But my primary refused to acknowledge(still under 4 the range they use even though we and they know people should be around 1) the thyroid and to treat the low T. The endo i did see did give me synthroid but my wellness doctor said lets figure out why before throwing drugs at it. So i had a series of other take home tests done. I did have a 24 hour iodine test done and you are supposed to remove out 90-95% through urine and i only removed 65% showing im most likely deficient and possibly that could be causative of my high TSH. He gave me an iodine supplement (Iodine 7.5mg as potassium iodine and 5 mg as molecular iodine) to take once a day which i started two weeks ago. I have alot of blood tests if you need anymore relevant info but i will post some for now:

2-9-2016

TSH 3.74 (0.45-4.5)
Bilirubin 0.9 (0-1.2)
AST 19 (0-40)
ALT 26(0-44)
EGFR 0.9 (0.76-1.27)

5-12-2016

TSH 3.92 (0.45-4.5)
AST 24 (0-40)
ALT 39 (0-44)
Bilirubin 1.5 (0-1.2)

9-27-16

TSH 3.99 (range 0.450-4.5 ulU/ml)
T3 Free 3.8 (range 2.0-4.4pg/ml)
T4 Free Direst Dialysis 1.39 (range 0.82-1.77 ng/dl)
Thyroid Peroxidase Ab 8 (0-34 iu/ml)
Thyroglobulin Antibody <1.0 (range 0-0.9 iu/ml)
AST 22 (0-40 IU/L)
ALT 30 (0-44 IU/L
Bilrubin 1.1 (0-1.2 mg/dl)
EGFR 115 (>59)

2-7-2017

TSH 3.58 (0.18-4.53)
T3 Uptake (T3U) 34 (24.3-39)
Free T3 3.7 (2.0-4.7)
Reverse T3(RT3) 14.6 (7.5-19)
Free Thyroxine(FT4) 1.31 (0.8-1.73)
Anti-Thyroglobulin <20 (<40)
Anti-TPO Ab 13 (<35)
ANTI-NEUTRO CYTO Ab <1.20 (<1.20)
Selenium 127 (63-160)
Bilirubin 1.4 (<1.2)
AST 23 (<40)
ALT 32 (<41)
EGFR 109 (>60)


#4

I had felt really bad for a year before looking for answers. This has left me feeling worse as I now am facing a 10K surgery if I dont figure it out and the last thing i want to try is a HPTA restart just to further mess me up. And just for the record im not talking about swollen nipples or being paranoid view attached pic. Both sides are developing. Thanks again for your time.


#5

Give it time to see how low estrogen affects things.

TSH 3.58 (0.18-4.53)
T3 Uptake (T3U) 34 (24.3-39)
Free T3 3.7 (2.0-4.7)
Reverse T3(RT3) 14.6 (7.5-19)
Free Thyroxine(FT4) 1.31 (0.8-1.73)
T4 Free Direst Dialysis 1.39 (range 0.82-1.77 ng/dl)

TSH says that your do not have enough fT3.
fT3 is well above mid-range.
rT3 is not above mid-range but probably causing problems. Some labs have lower upper ranges.
fT4 is good. Perhaps T4–>T3 conversion is poor.
Some T4 is lost to fT4–>rT3

fT is odd, that is why I was wondering if the reading could be low from lab timing effects. Yes, there are uncertainties there and my concern re lab timing and consistency. Your labs provide the inconsistencies. You have to run your own science experiment. I try to launch guys on the learning curve, but can’t follow cases after the post counts get high as I try to intercept the new guys, and do my own life and file taxes etc. ;}

HPTA restart? You have not even provided your age. There is a lot of info you should provide in the advice for new guys sticky.


#6

Thanks. Im 36 5’9 165lb. I dont want to do a restart as i had low T to begin with I just meant I didnt have any gyno-like problems pre TRT, so some people suggest the only solution is to stop but if i was fine my whole life and had some sort of balance i just want to make sure i keep that balance while on TRT to remain healthy and not have any issues. The wellness doctors interpretation was basically spot on with yours and no total conclusion as the numbers dont point to a specific cause although all of my testing is basically done. He wants to see if the iodine effects things. I just dont want to get stuck in a $ loop with the guy as i want to figure it out, remedy the problem and move on with life. Ill raise my T dose to 160(+30 per week) and that should put me back in the upper range and will ask him to prescribe aromasin 10mg eod and switch to that. I also have raloxifene but that is probably just a stronger nolva and in the same family. My estradiol has been low for a month i guess ill keep monitoring it with the changes and try to get it to the low 20’s and keep it there. Any thoughts on if i should get my prolactin checked as i have not since starting TRT or if my progesteron could be bad in some way. It was high on higher T and is still border high with the 130/week. Cant seem to find any info on the significance of that or where peoples levels normally are. I feel like everyone should have all of these things checked prior to HRT to see where esradiol is etc as a comparative for when issues arise.


#7

Typically we do not see a concern with prolactin increase caused by any TRT.

SQ injection on upper leg are good because you can be relaxed and use both hands and avoid any obvious veins. I find that IM makes my muscles hard and massage therapist could not overcome that. So there are issues of scaring and for me muscle rigidity; which was a really a true pain for swats and similar training.


#8

I saw a gynecomastia specialist/surgeon today and it is confirmed to be gyno. Im still concerned theres something im missing besides estradiol. I will be seeing my wellness doc over the next couple of weeks and he will run any tests i want ( cause hes a cash doctor). Anything else I should have checked? Its like the doc said today if i never had the problem as a child or adult and am getting it now from TRT then if i stop TRT it should stop. And if i continue and the cause isnt addressed then it will just progress and if i had surgery it would just come back.
The only other thing ive seen is IGF-1 and prolactin.


#9

Gyno is promoted by estrogens and prolactin [if high]. If you get E2 down, then you need to see what the gyno does. If it has not been around not, it has not matured and prospects of shrinkage are better. I think that I am repeating myself…

TRT can and does increase E2 if E2 is not managed properly.
There is no reason to suspect any linkage for increased prolactin with TRT.

Did gynecomastia specialist/surgeon ask that you give this problem time to resolve?

As for IGF-1, we all need good IGF-1 levels to stay healthy and to maintain vitality. You would never want to wish low IGF-1 on anyone. You can test IGF-1 which is a proxy for GH levels. You should never test GH by itself as it is released in pulses and has a short half life, making results rather useless. GH can be tested as part of a GH stimulation test.


#10

Body temps have all been coming up 97.7. Upon awakening, afternoon, three hours later, basically anytime i check. Ive had one or two 97.6 and one or two 97.8. This is over the past two days


#11

Did the gland show up on ultrasound ?


#12

No the ultrasound came back as normal. It did say on the bottom of the report that a mammography is sometimes necessary for further evaluation


#13

that’s weird… ultrasound should had caught mammary gland.
who said it was gyno? doctors? in which phase? how did you notice it ? is it noticeable throw shirts (pointy nipples) or a knot under the nipple ? do you noticed fat increase on chest ?
btw… i am facing similiar situation … gyno is growing and dunno the exact reason… i am having surgery … i lost my patience… in my case i think is low test. (estrogen is 30) … when i was on tamoxifen it didnt grew but it didnt srink
my prolactin is normal low, IGF1 is above limite (but not that high)… Urin Cortisol is high (basal is ok).
i know i have gyno (confirmed by ultrasound, and pointy nipples thrpw t shirts) , fat content is increaasing aswell and losing chest muscle aswell…


#14

If you scroll up and read through the thread there are pictures and to the outside of both of my nipples there is a bulge sticking out. I could tell something was happening just from getting out of the shower daily and looking in the mirror. I did have a surgeon confirm it yesterday but I don’t have a certain stage diagnosis or anything like that although I know what you are talking about. I’m confused by your post. Are you just speculating that you have low-T. My chest was normal my whole life until I started TRT and this problem became evident after two months on 100mg twice per week.

If you think lowT is causing it you should have bloodwork done to check it because I had a T of 330 (considered low)before I started and didn’t have any gyno problem. I only had my testosterone checked because I was feeling tired all the time and brain fog, gaining stomach fat etc. Are you on TRT? Did you do a cycle. Or it is just happening out of nowhere. If you have some sort of imbalance causing it and get surgery it will just grow right back as surgery leaves gland behind the nipple and puts you right back to where you were before you had the problem, so you are still at risk for reoccurrence.


#15

no sorry, not speculating nothing at all… just surprised your ultrasound dont identify gyno.
yes, i am having surgery and then go for a SERM or TRT. i will not wait for it to grew again.


#16

Did your sono show increase in breast tissue or just the glandular tissue? Did you have it done at zwanger or by a surgeons lab? Did they diagnose the stage based up the look of it or the sono. I’m just curious also why nothing would show on mine. I’m not sure how bad yours is that they were able to give you all that info, is it extremely large?


#17

not at all. very mild… my nipples are not enlarged… i feel a lot of lumpls (fatty or gland i dunno) and i have some kind of pointy nipples on tshirts. never had that before. i am in this situation for 1 year. tamoxifen didnt solve it.
some surgeons even say its not gyno, other say yes.
my glands measure 1,6 and 1,1 cm… they are small. but enough to ruin my physique. i think the gland also atract more fatty tissue.
for what ive read in gyno foruns, each gyno is different. mine was not directly caused by AAS, but by the somekind of imbalance afterwards… test on 370 and estrogen on 25… it should not be happening… but it is! after surgery i am going directly to a SERM or TRT. Having tits growing its very very very very disturbing


#18

btw, 125 mg of test made my lump behind thenipple grow a lot and started to ache, and nipples got itchy… i probably aromatize too much
this ocurred 4 weeks a go and it was the first time i could actually feel the lump behind the nipple.


#19

I’ve never had pain any of the time. Also tissue has accumulated on my lower chest slightly I guess fatty tissue from this as my definition is gone. My test was 330 before trt and I had no issues whatsoever. My test was 1255 and estrogen 50 when I realized there was a problem. Had a very bloated face also. Some people say there’s a t to e ration but my numbers would put that to being false. It’s insane to me to think that if I ever have to miss a shot or run out of AI’s which I had to but illegally, or got a fake batch that it would start this issue immediately. I still feel there is more to it. Are you def having surgery? Which surgeon,price, aren’t you worried it will just happen again? I tried to private message you but didn’t see an option


#20

Hi, i am 2 days pos surgery (lipo + excision) . 5k. It’s done.
My labs from 5 days ago said: e2 17, TT 454 , ft 12,6
@KSman what do you think of these values ?
I am going for low dose tamoxifen or low dose clomid in 3 days for long term TRT terapy. ivent decide yet.
i dont understand why my gyno was growing… and obviously i am scared it grows again… it was mild but large enough to disturb me… i must go for one of these meds
where are you from ? if you are from USA check www.gynecomasty.org … silverman is a good option.
how is your igf1? mine was high probably because of BCAA
and your cortisol (basal and urine) ?