Q&a

[Marc]

I have questions about my medical history.Also, I'm looking for advice on possible future medical procedures.I hadn't mentioned this in previous posts because I didn't realize, until reading other peoples' histories, that it was related.
When I was about nine years old, I had difficulty in urinating.It was very painful, like a burning sensation, also the frequent urge to go but nothing would come out.I remember my parents taking me to the hospital where I recall being told that it was a urinary infection.I do remember being wheeled into surgery and waking up hours later with blood on my genitals and a tube from my penis to a bag. I haven't thought about this in a long time. I was wondering if anyone would know how this might relate to my current condition?
Moving on to the future, I have gynecomastia, which I'm very self conscious about and embarassed.Especially in the summer when wearing a t-shirt or going to the beach is out of the question for me.I did go to a plastic surgeon who said he could perform a breast reduction.My insurance wouldn't cover it and I can't afford the thousands of dollars I was told it would cost.
Does anyone know anything about this procedure and if there is any circumstances where an insurance company will cover it?
Next up is the testosterone injections I 've been taking for quite a while.I
am always uncertain that I'm administering it incorrectly.I know it's supposed to be injected into the muscle but have had a few mishaps with blood spurting out.I was always concerned whether this are the Androderm patches where more effective.Another concern is if I am able to have the surgery for the gynecomastia, would the testosterone treatment cause the gynecomastia to return?
The very last question.Since puberty red stretch marks appeared on various parts of my body which are still as noticeable today.I've read about creams and different surgeries, but nothing that is really effective.Any suggestions on this would be helpful to.I'm aware that these treatments would be considered cosmetic and insurance coverage would be unlikely.
I think that if any of these concerns I have are treated, it would help with my self esteem and confidence.Any advice would be truely appreciated.

[Morgan]

Hi Marc

One of the best places to go to for information on gynaecomastia is http://www.gynecomastia.org - there's lots of information, plus a bulletin board and also a number of mailing lists.

I prefer the mailing lists, not because they're busy (they're not) but largely because the bulletin board is populated by adolescent boys with a tendency to believe that every possible example of a male chest put forward has gynecomastia. It's unhealthily pro-surgery, in my opinion. I feel that very few people there have a genuine condition and it's definitely not representative of people with a more severe condition. But you will get information on surgeons and insurance.

I'd also say that I have major problems with my own surgery and deeply wish that I hadn't gone through it. I don't know how big you are, but scarring, loss of sensation, poor shape and an overly zealous surgeon have all been issues that I've had to deal with. I doubt I'll _ever_ go topless on a beach now. I'm sticking with the UV tops I wore before.

Testosterone replacement does seem to exacerbate gynaecomastia in some situations. Injections and implants can cause a hormonal rollercoaster, with too much and too little testosterone, and apparently this can result in conversion of testosterone into estrogen, or other imbalances.

I've tried patches - they give me a rash, which limits absorbancy, but you might find them better. I use small dosages of the gel - it's easier to use and gives a stable daily dosage.

The following Yahoo group used to give good information on hypogonadism: http://health.groups.yahoo.com/group/hypogonadism2/

[Morgan]

I don't know how big you are, but the place that I found real information on the breast surgeries that I went through is here:
http://www.breasthealthonline.com/
and the breast reduction board:
http://www.breasthealthonline.org/cgi-bin/mwf/board_show.pl?bid=3

The sites are for women, but the risks and results were more relevant in my case. I had a mastectomy and revision.

Morgan

[MelissP]

Dear Marc,

I wonder if perhaps your testosterone injections are the reason behind
your gynecomastia. It's a possible hazard to body-builders, if they stack
steroids. Once they've saturated their bodies with androgens, their own
self-produced androstenedione tends to aromatize into estrogen instead
of being used at the testes. They might need to take too much for this to
happen, but they probably don't have IHH either. If your andro wasn't
being used because of a lack of GNRH, then outside testosterone might
bring about aromatization at a much lower total androgens level. Have
you considered Clomiphene? It's suppose to be a very good Gnrh-stimulator,
which might relieve some of your problems. Also, builders tend to take
various amino-acids etc which suppress the aromatization processs.

If you could bring down your natural estrogen level, your gynecomastia
could easily be reduced, though probably not eliminated. A problem for
older women sometimes, perhaps an improvement for you?

- Melissa