Re: Re: Real gynecomastia vs psuedo gynocomastia--big difference

[Guest guest]

If you dont mind I'll add some info based upon my experience with this

condition.   I developed gynecomastia as pubescent teenager with primary

hypogonadism.    It had a devastating effect on my self esteem since I received

a lot ot teasing from others.   " with Boobs "    " y Teats "  , it is a

wonder I didnt blow my brains out.    Anyway,  doctors I had seen during that

time said I would outgrow it.  Finally at age 33 I had the correct diagnosis

from a qualified plastic surgeon that said it was truly gynecomastia, not fat

deposits that would go away with exercise ( which I had already been doing and

to this day continue) Other doctors believed it was fat although I was 5'8 " and

160lbs. with a 32 " waistline.   These numbers dont really matter but the fact is

I had gyne.   I went thru hell fighting my insurance provider with pre

authorization for surgery.    They were of the belief it was for cosmetic /

vanity reasons and had no

medical reason.   After enough written documentation by the doctor they finally

approved it.    The surgeon used liposuction and incisions around the areola to

remove breast tissue, fat and a breast bud .     The breast bud was the medical

proof of true gynecomastia , not false gyne.    I recovered and have been able

to go shirtless for 18 years now.   It is a great feeling.    Anyone that has or

had gynecomastia knows the embarrassment of the condition.   It destroys your

self esteem.   Find a good surgeon to do it for you.   

From: chis_az <chis_az@...>

Subject: Re: Real gynecomastia vs psuedo gynocomastia--big

difference

Date: Friday, December 12, 2008, 5:08 PM

> First off, your definition of gynecomastia is not correct. By the

> roots of the words themselves, gynecomastia refers to the

> development of male BREAST TISSUE an not fat deposits in the male

> breast/chest area.

**********

This is incorrect gynecomastia is the appearance of female like breasts.

The distinction between pseudo gynecomastia and gynecomastia is often truly

impossible to make even by highly qualified plastic surgeons who deal with

nothing other than gynecomastia procedures.

This is because gland can appear soft more typical of fat and fat can appear

hard more typical of gland. Also you have differing levels of glandular density

and you can have diffuse glandular gynecomastia where fingers of glandular

tissue are interspersed between fat.

The ONLY true way a plastic surgeon can know the true extent of the issue and

the tissue make-up is once he has opened the patient up and has cut the tissue

out and has it in their hand.

ALL of this is explained repeatedly by world leading gynecomastia surgeon Dr

Berment at gynecomastia. org.

Also from the point of view of the patient the exact make-up of the gynecomastia

is often academic. Very often those who are not excessively overweight who have

pseudogynecomastia cannot diet in order to remove the issue/tissue, bar dieting

to become dangerously underweight. Remember you can't localise fat loss.

The bottom line is that apart from those who have pseudogynecomastia from excess

weight there is very little difference between pseudogynecomastia and glandular

gynecomastia patients. Both suffer from the psychological distress of

female-like breasts.

************ *

Simple fat deposits around the male areola is

> more accurately called psyuedo gynecomastia, and it can be removed

> via liosuction.

Irrespective of the form of gynecomastia baring pseudogynecomastia due to excess

weight ALL types of gynecomastia require a surgical procedure whether you term

it simple or not.

Because it is IMPOSSIBLE to accurately ascertain the exact make-up of

gynecomastia until a surgeon has removed it and can view it liposuction alone is

a VERY poor procedure for almost all gynecomastia patients.

Only via excising the tissue around the areola and the chest can a surgeon know

if some glandular tissue was present.

When surgeons assume on the basis of palpably feeling the chest that

gynecomastia is non glandular and perform a liposuction only procedure on

patients. You VERY often find that the patients are unhappy with their results

post-op (I know this from experience of seeing this reported on gynecomastia.

org for over 4 years).

Patients often find that the chest is not flat once the swelling from the

operation goes down, they often find that they still have female-like breasts

due to the fact that glandular tissue was often present and is left behind and

now revealed by the liposuction.

Remember liposuction does NOT remove glandular tissue.

Becauce of the above for 4 years on gynecomastia. org I recommended that ALL

gynecomastia sufferers undergoing a surgical procedure should undergo

liposuction with glandular excision.

************ *

Loosing weight will often help. Some use andractim

> to help treat general puffiness of the male nipples.

************ *

Losing weight does NOT often help. It ONLY tends to help a minority of men who

have pseudogynecomastia due to obesity.

Andractim ONLY helps reduce glandular gynecomastia, it has ZERO impact on fat.

Andractim is the potent male hormone/androgen dihydrotestosterone . The ONLY way

it acts is by altering the endocrine balance in favour of androgens over

estrogens.

If the gynecomastia has some glandular component and it is in the developmental/

proliferation stage (within 2 years of development) then that tissue can

shrink/atrophy as a result of the change in the endocrine environment.

If the gynecomastia has some glandular component to it but that has been in

existance and present for over two years, it is unlikely to be positively

affected (shrink/atrophy) . This is because glandular tissue becomes fibrus and

often very resistant to positive endocrine changes.

Andractim and dihydrotestosterone has ZERO affect upon localised fat loss, it

has ZERO mechanism to impact on pseudogynecomastia with no glandular component.

************ *

> True gynecomastia requires actual breast tissue development, and

> once glandular development and duct development has taken place, you

> can not reverse it.

************ *

Factually INCORRECT.

First of all you mention duct development. You get dense and diffuse glandular

gynecomastia with and without duct development. Many poorly educated

endocrinologists and surgeons often think that if they cannot feel duct

development that the patient doesn't have glandular gynecomastia. Duct

development usually feels like a palpable mass behind the areola/nipple and is

often described as a rubber-like disc. When an ultra sound is performed on male

duct development glandular tissue is often found.

MANY a mis-diagnosis has been made due to the above ignorance in making a

diagnosis.

MANY men have diffuse glandular gynecomastia with no significant duct

development. Such men do not have a palpable rubber-like discs behind the

areola/nipple and an ultrasound will not reveal glandular tissue but will often

assist in misdiagnosis (ultrasound is a wholly inappropriate tool when

considering male breast development, and should only be used in viewing the

female breast or in considering cancer in the male breast).

I myself was told by two plastic surgeons that I did not have glandular

gynecomastia because I did not have duct development or palpable rubber-like

discs behind my areola/nipples.

I had an ultrasound and glandular tissue did not appear and I was told by a

plastic surgeon that it was therefore just fat.

I explained that the gynecomastia only developed when I went on testosterone

replacement and that the breasts developed in the space of 3 weeks when my

weight did not increase.

I saw a 3rd plastic surgeon and explained the above and they agreed to performe

surgery which was glandular excision via the areole and then liposuction.

My operation took 3 and a half hours as I had large breasts. My endocrine

surgeon said they removed extensive/significa ntly large amounts of glandular

tissue that was diffuse and spread widley throughout the chest.

The palpable examinations of two surgeons and their respective diagnosis were

WRONG. The ultrasound helped to MISDIAGNOSE and was wrongly applied.

World leading gynecomastia surgeon Dr Bermant was and continues to be proved to

be perfectly correct in how gynecomastia develops in men and in how it is

impossible to differentiate between fat and gland until a patient is opened up

and the tissue can be viewed by the surgeon.

************ *****

Surgery is your only option to truly get rid of

> true gynecomastia and this is more involved that just sucking out

> fat. The actual glandular tissue has to be removed, and if this is

> not done right, the man is left with indentions in the nipple area

> and deformed nipples.

Incorrect.

Surgery offers the greatest level of success in treating gynecomastia of all

types but;

There have been a whole range of endocrine altering medications that have been

successfull in treating gynecomastia that has some glandular component. How

successfull such medications are relates very often to the time frame of the

condition. Endocrine medications offer the highest levels of success the sooner

they are used after gynecomastia has developed.

SERMs (Selective Estrogen Receptor Modulators) have offered fairly good rates of

success in treating gynecomastia in many studies and so too has

dihydrotestosterone both injectable forms and Andractim.

Prior to surgery Andractim reduced my gynecomastia by about a third and made it

easier for me to deal with the condition until surgery.

I have seen studies where Andractim reduced gynecomastia in 75% of those treated

and resolved gynecomastia in 25% of those in that 75% group.

I have also seen studies with Clomiphene Citrate and Tamoxifen that had success

rates up and around the 70-90% mark.

I have the studies on this that I obtained for free on behalf of a gynecomastia

charity.

The New England Journal of Medicine sent me them and I can dig them out and

detail them precisely if you wish?

************ *****

> Gynecomastia is caused by excess amounts of estradiol that end up

> locking into the receptors in male breast tissue, and prolactin can

> contribute to gynecomastia as well. Low T by itself does not cause

> gynecomastia. Rather it is a higer E(excess estrogen in the male

> body) to T ratio than is appropriate for the male system.

************ ******

Try and obtain the 2002 white paper written by biochemists Ishmail and Bath. I

think it is entitled the aetiology of Gynecomastia.

************ ******

> Once the T to E ratio has been rectified and proper T levels have

> been maintained the feminine like fat deposits caused by male

> hypgonadism usually start to correct themselves. However, in my

> case as like many other men it has taken more time than i would like

> it to, and the results are slow and subtle in deveoping.

************ ******

Gynecomastia once it has developed often does NOT resolve. It only resolves IF

the change in the endocrine environment occurs before the gynecomastia has

reached the fibrus stage. Even when the endocrine environment has been

positively rectified when the gynecomastia is in the developmental/

proliferation phase the extent of the gynecomastia is also a factor in how

likely it is for the condition to be reduced or resolved.

You are completely wrong to speak of fatty deposits whilst referring to hormone.

When gynecomastia develops due to hormonal imbalance then the tissue is

uneqivically NOT fat, it is glandular.

An imbalance of androgens in favour of estrogen can and often does cause female

pattern of weight distribution, but this is NOT the issue when considering

gynecomastia.

Gynecomastia as a result of an imbalance of androgens to estrogens is via its

mechanism IS glandular in origin.

In fact the body type of such imbalances is often referred to as a gynecoid body

habittus.

>

> >

> > It seems a common perception that gyne can be reduced by

> increasing

> > anti estrogen supplements like DIMM or Arimidex. This is not my

> > understanding. Gyne develops because of a lack of testosterone,

> as

> > much as an excess of estrogen. It can be significantly reduced

> only by

> > liposuction. Gyne is FAT, and yes diet and aerobics can help with

> some

> > reduction, but almost always not satisfactorally to the sufferer.

> > I tried everything, and only surgery resulted in the desired

> effect.

> > There is also a significant danger in trying to reduce Gyne by

> upping

> > arimidex because if one drives their estrogen level too low,for

> perhaps

> > too long, one could be risking long term damage to their libido

> and

> > sexual organs. Not a good idea. Please help stamp out dangerous

> myths.

> >

>