What Is The Root Cause of Gynecomastia & Potential ‘Cure’? Follow Up
This is a follow up to What Is The Root Cause of Gynecomastia & Potential ‘Cure’?. Given the high volume of gyno related posts in /r/peds it's clearly a topic that concerns many.
As I was looking about for information about how quickly gyno takes effect, I came across this article by Eric Potratz. I would link the original article, but I can't find it in amongst the many articles that Eric has written and I don't want to give traffic to the forum I did find it on... so...
It's quite a long read, so I've shortened it somewhat. And to be clear, none of this is my own work. I shamelessly using what others smartter than I have already created.
During mammary tissue growth (the onset of gyno), you may notice the following symptoms:
- Puffy or swollen nipples
- Overly sensitive nipples
- Itchiness around the nipples
Now, just because you may have these symptoms does not mean you have gyno. It simply means that you have gyno symptoms. Remember, it is normal to have a small flat pea sized lump under the nipple. This is NOT gyno.
Now, if you allow these above symptoms to progress for several weeks then you may develop gyno. So if you are experiencing any of the above symptoms then you are smart to take action before it’s too late – But please stop emailing me saying you “have gyno” after 3 days on a cycle – this is physiologically impossible.
The good news is that even if you do have a slight case of gyno that you developed from a cycle, it’s probably 100% reversible. Read on…
No level of gyno is “permanent”. Any level of gyno can be reversed by dietary, supplemental and/or hormonal intervention. Mammary tissue (gyno) can be catabolized like any other tissue in the body. It’s just a matter of creating the right physiological environment within your body. Therefore, as far as I’m concerned, all gyno is temporary or semi-permanent at worse.
Here are the basic levels of gyno:
- Level 1 – A dime sized glandular lump – which can emerge as soon as 2-3 weeks after “gyno symptoms” appear. This type of gyno can transform into a more serious level 2 gyno if left untreated for more than 4-6 weeks. In most cases, this initial level 1 gyno disappears once the hormonal environment improves, which is generally 2-3 weeks after the inflicting steroids clear the system.
- Level 2 – A quarter sized glandular lump. This type of gyno does not completely disappear on its own, but may gradually shrink to “Level 1” size after discontinuing the inflicting steroids. Completely reversing level 2 gyno requires aggressive dietary and supplemental intervention in conjunction with prescription grade drugs.
Be warned, if gyno is allowed to grow large enough, the cost of surgery may be more cost efficient than trying to battle the gyno through drug and lifestyle changes – which could otherwise take months or years of intervention.
Consider all the following points. Remember, there are many factors that can contribute to gyno and performing just a handful of the points below may be the key to avoiding gyno all together.
-1. Your naturally occurring 5a-reduced metabolites are your friends in preventing and reversing gyno. 5a-reduced metabolites include androsterone, androstanedione, androstanediol and dihydrotestosterone (DHT) as the most powerful 5a-reduced hormone. These hormones help prevent gyno by lowering estrogen and blocking the effect of estrogen at the hormone receptor. (1-8) Unless you have serious androgen related hair loss you want to keep your 5a-reduced metabolites relatively high to avoid gyno. Methods for increasing 5a-reduced metabolites (DHT) are listed in preferred order –
- Topical testosterone applied to the scrotum will rapidly increase DHT levels with minimal estrogen conversion. (for more information on topical steroids, read this article)
- Use a DHT pro-hormone such as androsterone, found in AndroHard. This will raise DHT with zero risk of estrogen conversion.
- Injectable testosterone along with an AI to prevent excessive estrogen conversion.
- High dose oral 4-DHEA or DHEA along with an AI to prevent excessive estrogen conversion.
-2. If you are concerned about gyno, avoid finesteride at all costs. It lowers all 5a-reduced metabolites to undesirable levels and has an extremely long half-life which continues to suppress DHT levels long after discontinuing the drug. (9) Progesterone would be a better anti-DHT alternative if you are concerned with hair loss. Plus, progesterone can clear the system within 24hrs making a mistake in dosing much less risky.
-3. Almost all sources of gyno can be linked back to having insufficient levels of 5a-reduced metabolites in the body. In theory, any amount of estrogen/progesterone can be blocked by sufficient DHT. (10-14) Also, high DHT and enlargement of the prostate is a myth, however high estrogen and high DHT can lead to an inflamed prostate, so you want to at least make an effort to keep estrogen in a normal range. (14)
-4. Trenbolone, TREN, Nandrolone can cause gyno because they lack a potent 5a-reduced metabolite (dihydronandrolone is weaker than dihydrotestosterone). (15) If you are worried about gyno from progestational steroids you should consider boosting your 5a-reduced metabolites during the cycle (mentioned above). This can avoid most if not all of the gyno problems associated with progestational hormones. I should mention here that aromatase inhibitors alone (AI’s) will not help prevent gyno from progestational compounds. It is the antagonistic action of 5a-reduced hormones that is required.
-5. Nothing is going to antagonize estrogen at the estrogen receptor (ER) better than actual DHT. While DHT derivatives or analogs such as Anavar, Winstrol, Masteron, Epistane, Superdrone, ect may be 5a-reduced, they cannot convert to actual DHT and thus cannot directly inhibit gyno at the receptor level (since they lack the ultra-high binding affinity for the AR that true DHT possesses). (16)
-6. Natural anti-estrogens (resveratrol, chrysin, I3C, DIM, ect) are great for PCT and can stimulate the HPTA and manage healthy estrogen metabolism, but they are not strong enough to prevent aromatization from high doses of aromatizing steroids. Don’t rely on these to prevent gyno during a cycle.
-7. Reducing prolactin will reduce the overall stimulation on mammary growth. Suppressing prolactin is useful as a temporary method to help slow or stop gyno growth. However, continuing anti-prolactin treatment is not recommended to be continued beyond 8 weeks. Methods of suppressing prolactin include –
- Vitex at 460mg/day
- Vitamin B6 at 200-400mg/day
- Mucuna Pruriens (15%-20% L-Dopa) 4-6g/day
- Increasing DHT may also lower prolactin release (17)
-8. Don’t fiddle with your nipples. This increases prolactin release which can make gyno worse.
-9. IGF-1, GH, insulin and prolactin are all potent growth factors in gyno growth. Limiting these hormones will reduce the likelihood of experiencing gyno symptoms. “Bulking” (aka., eating-a-****load-of-everything) will increase most of the growth factors listed above. Cutting calories (especially carbohydrates) will suppress insulin and IGF-1 therefore reducing the overall stimulatory effect on mammary growth. Ketogenic diet = less risk of gyno.
-10. Body fat (adipose tissue) is the main site for androgens to convert to estrogens. Therefore, being overweight or having high body fat increases your gyno risk. This is another good reason to go on a cutting cycle if you are gyno prone. Reducing body fat will lower your rate of estrogen conversion from aromatizing steroids. (18)
-11. Caffeine consumption can inhibit clearance of estrogen from the liver by competing for the P-450 oxidase system. Avoid caffeine if you are concerned about high estrogen levels.
-12. Avoid supplements containing forskolin if concerned about gyno. Forskolin increases aromatase activity via cAMP modulation and can increase formation of estrogen. (23,24)
-13. Increasing fiber intake (both soluble and insoluble) can enhance clearance of estrogens from the intestines. Research shows that increasing fiber intake in humans can reduce estrogen levels by up to 22%. (19)
-14. Reducing estrogen below the normal range (such as over dosing arimidex, letrozol, aromasin or formestane) can eventually reduce SHBG levels, thus allowing more estrogen to freely circulate (by offsetting it from SHBG). Higher levels of freely circulating estrogen can amplify breast tissue growth (20). SHBG also appears to have anti-estrogenic effects at the cell receptor level. (21, 22) Avoiding over suppression of SHBG will reduce your gyno risk.
-15. Don’t be afraid to lower the dose mid cycle. People have a tendency to panic at the first sign of gyno and drop everything. Generally, just lowering the dose of the afflicting steroid can offer gyno relief within 4-5 days.
-16. Save SERM’s as your last resort against gyno. You do not need a SERM (tormifene, clomid or nolva) to avoid gyno from a properly planned cycle. If you are still having gyno problems after following the above points, consider the fact that you have a poorly planned cycle and you need to revaluate the compounds you have chosen.
- Dihydrotestosterone may inhibit hypothalamo-pituitary-adrenal activity by acting through estrogen receptor in the male mouse. Lund TD, et al. Neurosci Lett. 2004 Jul 15;365(1):43-7.
- Androgen-induced inhibition of proliferation in human breast cancer MCF7 cells transfected with androgen receptor. Szelei J, et al. Tufts University School of Medicine, Department of Anatomy and Cellular Biology, Boston, Massachusetts 02111, USA.
- The non-aromatizable androgen, dihydrotestosterone, induces antiestrogenic responses in the rainbow trout. Shilling AD, et al. Agricultural and Life Sciences Building, room 1007, Oregon State University, Corvallis, OR 97331, USA.
- The androgen 5alpha-dihydrotestosterone and its metabolite 5alpha-androstan-3beta, 17beta-diol inhibit the hypothalamo-pituitary-adrenal response to stress by acting through estrogen receptor beta-expressing neurons in the hypothalamus. Lund TD, et al. J Neurosci. 2006 Feb 1;26(5):1448-56.
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- Successful percutaneous dihydrotestosterone treatment of gynecomastia occurring during highly active antiretroviral therapy: four cases and a review of the literature. Benveniste O et al. Clin Infect Dis. 2001 Sep 15;33(6):891-3.
- Gynecomastia: effect of prolonged treatment with dihydrotestosterone by the percutaneous route. Kuhn J et al. Presse Med 12;21-25. (1983)
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- Dietary fiber intake and endogenous serum hormone levels in naturally postmenopausal Mexican American women: the Multiethnic Cohort Study. Monroe KR et al. Nutr Cancer. 2007;58(2):127-35.
- Williams Textbook of Endocrinology. Wilson, et al. 9th ED. Philadelphia: Saunders, 1997
- Sex steroid binding protein receptor (SBP-R) is related to a reduced proliferation rate in human breast cancer. Catalano MG, et al. Breast Cancer Res Treat. 42(3):227-34, 1997
- Biological relevance of the interaction between sex steroid binding protein and its specific receptor of MCF-7 cells under SBP and estradiol treatment. Fissore F, et al. Steroids, 59(11):661-7, 1994
- Progestin-dependent effect of forskolin on human endometrial aromatase activity. Tseng L, Malbon CC, Lane B, Kaplan C, Mazella J, Dahler H, Tseng A. Hum Reprod. 1987 Jul;2(5):371-7.
- Forskolin up-regulates aromatase (CYP19) activity and gene transcripts in the human adrenocortical carcinoma cell line H295R. Watanabe M, Nakajin S. J Endocrinol. 2004 Jan;180(1):125-33.