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    Moderator Austinite's Avatar
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    Do I have Gynecomastia? If you're asking this question, read this thread.
    Introduction

    So you're worried about getting gynecomastia. You're posting thread after thread until someone on the internet diagnoses you. Sound silly? It should. No one on the internet can positively diagnose you. Nothing wrong with getting opinions, but there's no need to keep posting threads about it or keep that one thread alive forever. Hopefully this article can shed some light into the signs and symptoms that everyone seems to complain of. So let's get started...

    What exactly is gynecomastia?

    Gynecomastia is the enlargement of male breasts by increase in breast tissue development. Not to be confused with fat. This is actual breast tissue. In cases of steroid users, this is due to developing female characteristics from excess estrogen in the body. This can also occur in infants and adolescents due to hormonal imbalances. In some cases, old gynecomastia from a young age may go away on its own. But some folks retain it throughout their lifetime unless treatment is implemented.

    There are several types of gynecomastia:

    1. Gynecomastia: Enlargement of adult male breast tissue.
    2. Pubertal Gynecomastia: Same as above, but develops during puberty.
    3. Pseudogynecomastia: This is fatty tissue, not breast tissue.

    It's entirely important to identify what you have. There's no reason to attempt treating pseudogynecomastia with SERMs, it will do nothing and could possibly do harm. You just need to lose weight, period. Nothing else to it. The leaner you become, the more it will dissipate.

    Common concerns from members:

    1. My nipples are puffy:

    While puffy nipples may be a sign of beginning stages of gynecomastia development, it most certainly is not a diagnosis. Further testing would be needed to confirm this. However, in most cases, puffy nipples are merely due to a hormonal imbalance (even if estrogen is in range) and in most cases, goes away with time. It could be water retention, fat increase or simply a reaction to the drugs you're taking.

    Furthermore; it could be due to your tissue surrounding the nipple lacking fat. Yes, low fat can cause a puffy nipple, too. It causes the gland to protrude more, giving the effect of a puffy nipple. So you see, there are plenty of reasons why your nipples could get puffy. Surely there's more than the mentioned, so don't panic just yet and post a million threads about it. I get puffy nipples every single time I cycle and it goes away, every time.

    2. My nipples are sensitive:

    This would be an endless topic, frankly, I'm not going to delve into every cause of sensitive nipples because it would be a never ending post. The fact is, we tend to panic when we have sensitive nipples on cycle because we are super extra concerned about gynecomastia development, so we are looking for any and every possible sign. You probably had sensitive nipples off cycle at one point, but didn't give it much thought because you're not on cycle and the chances of it being gynecomastia are slim to none.

    Sensitive nipples can be caused by running, from different types of shirt materials used that you're sensitive to as well. Could be a cyst that has developed from an infection. Heck, even fluctuation in body temperature could cause nipples to become slightly sensitive. Now, the panel that most people fail to get is a Comprehensive ********* Panel (CMP), which would indicate any concerns that deserve investigating the liver. Liver diseases such as cirrhosis can cause breast tenderness and sensitivity as well. Again, this could be a sign, not a diagnosis so further testing is required.

    3. My nipples are leaking:

    Well, if you're lactating then your prolactin levels are high. This is generally observed in the presence of progestins such as nandrolone and trenbolone. High prolactin levels will lead to lactating males. Again, do not squeeze your nipples to reproduce the issue, ever. You're making things worse. There is no such thing as prolactin-gynecomastia. So while you're lactating, it does not mean your breast tissue has developed and growing. It merely means that you're lactating. That's your condition: Male Lactation. Not gynecomastia. Similar to folks who suffer Hyperprolactinaemia.

    Now, it's important to note that you'll need to have both your progesterone and prolactin tested to see where you're at. High progesterone can certainly aggravate the issue and result in gynecomastia. This is generally in the presence of excess estrogen.

    So there you have it. There's a million and one reasons why your nipples may be puffy and sensitive. Sure, it's a good chance that the cause is your steroid use, but the chances of those signs being diagnosed as gynecomastia is slim when compared to developing an actual lump.

    Enlargement of breast tissue is very unnatural in men and you'll likely develop a lump, or a hardened spot behind or immediately around your nipple area. This hard spot tends to get bigger if it remains untreated. This is the biggest sign you need to be looking for. You can feel a lump with the slightest touch. There is never a need to "squeeze" your nipples. Do not ever do this as it will cause more damage.

    LUMP = GYNECOMASTIA! Remember that. Nothing else is really an indicator, only signs that may lead to gynecomastia. CHECK YOUR BLOOD WORK AT THIS STAGE!

    Stop playing the guessing game:

    I get it, you want someone on an internet forum to tell you that what you have is not a case of gynecomastia. You and I both know that is simply not possible. You're going to keep asking and keep posting until that one person gives you some peace of mind. Forget about it, you're wasting your time. There isn't anyone on earth, not even the best doctors in the world that can positively identify and diagnose gynecomastia over the internet. Not going to happen.... EVER.

    You need to legitimately find out what you have. The only way to do this is to see a doctor. Some of you folks are spending ridiculous amounts of money on gear, food, gym memberships, etc... but you won't give the time to see a doctor. This is just mind boggling to me. I don't really care if you don't have insurance. I don't care if you're broke. I've mentioned in many threads the importance of blood work pre, mid and post cycle. This should be part of your cycle budget and is the ONLY way to prevent these issues. If you failed to manage your estrogen and you're too broke to see a doc because you've spent all your money on gear, well that's just unfortunate. You should have never cycled, because surely... you did your research and understood the risks.

    Don't cycle at high body fat:

    Just because your internet tells you that your 20% body fat is normal for a male your age, does not mean it's safe to cycle. Forget those ratings. Anything above 15 or 16% is TOO OVERWEIGHT to cycle. There are general health ratings, and then there are steroid-user ratings. I'm telling you, that if you're above 16%, you're carrying too many aromatase enzymes. This will lead to higher testosterone-to-estrogen conversion and will make it very difficult to manage. It's no surprise that most of the folks posting gynecomastia threads are overweight for steroid use.

    Furthermore; you better not be bulking at 15 or 16% BF either. Bulking should never be done, in my opinion, until you're at 13% or less. You can get there with diet alone, and if you can't, you shouldn't be considering steroids.

    How do I reverse gynecomastia?


    Letrozole is an aromatase inhibitor. One of the most powerful aromatase inhibitors available today. Far too many people are considering this method because many moons ago it was touted as a good tool for reversal. We've learned a lot since then and Selective Estrogen Receptor Modulators (SERM) studies on gynecomastia reversal are readily available for confirmation.

    I did a short experiment myself recently when my E2 came back at 46 pg/mL (Range < 29 for a sensitive E2 assay). I did not experience gynecomastia, but I wanted to bring that down back to range. The increase was likely due to switching my Testosterone Therapy administrations from subcutaneous (SubQ) to intramuscular (IM). IM injections have more of an impact on E2 due to faster absorption. This result came about on July 2nd. I had a Letrozole prescription laying around and figured I'd give it a go. It's been so long since I've used Letrozole. My prescription was for 100 microgram capsules.

    I administered 100 mcg. (Micrograms) daily. After the 10th day I felt miserable and so I discontinued use. One week after I stopped, I tested E2 again and it came back 2 pg/mL. Remember, this is a full week after Letrozole was discontinued. So it had to be at zero, or "too low to count" for several days. I was bedridden for several days. Completely useless and couldn't find a reason to get up and about. If you've killed your E2 before, you know exactly what I mean. I don't wish this on anyone. Really amazes me that some folks are running this thing using milligram after milligram several times per week. And these "Gynecomastia Reversal" threads using these astronomical doses are just mind boggling. Pretty eye opening once again. Anyway, I waited a while and got back on DIM.

    The entire letrozole for gynecomastia reversal came about in 2001 when a study was published. This study was done on mice, not humans. So don't be a mouse, be a man. PMID: 11850204 if you want to look it up.

    To give you an example of how low this drug is supposed to be dosed, it was studied in extremely obese hypogonadal men. Overweight men convert far more estrogen than non-overweight men. This is because they carry far more aromatase enzymes. Using Letrozole, these highly aromatizing men were treated with doses of 2mg to 2.5mg once per week. If we break that up, you're looking at about 285 micrograms per day. That's it. This powerful drug never, under any circumstances should be used in a milligram + basis on a daily administered protocol. It is simply outrageous. Reference here.

    Let's look at some more recent studies:

    Dated: 2011 - Effects of aromatase inhibition on male breast

    Tamoxifen was much more effective, however, in the prevention of gynecomastia in these men. Due to these disappointing results, aromatase inhibitors are not recommended as a first-line treatment for gynecomastia in men.

    ^ Click here for the source of the excerpt above.

    Dated: 2004 - Beneficial effects of raloxifene and tamoxifen in the treatment of pubertal gynecomastia

    Inhibition of estrogen receptor action in the breast appears to be safe and effective in reducing persistent pubertal gynecomastia, with a better response to raloxifene than to tamoxifen. No side effects were seen in any patients.

    ^ Click here for the source of the excerpt above.

    Dated: 2004 - Management of physiological gynaecomastia with tamoxifen

    Thirty-six men accepted tamoxifen for physiological gynaecomastia. They were offered oral tamoxifen 20mg once daily for 6-12 weeks. Oral tamoxifen is an effective treatment for physiological gynaecomastia, especially for the lump type.

    ^ Click here for the source of the excerpt above.
    So we've learned a couple things here. We know that an Aromatase Inhibitor is a poor choice, and we also learned that SERM's are more effective, safer and with no side effects. Lastly, we learned that while Tamoxifen is effective, it is superseded by the superior SERM; Raloxifene.

    Aromatase inhibitors are not selective and will demolish your estradiol levels with prolonged use, rendering you miserable and useless. In the case of Letrozole, you could deplete your E2 levels to nothing in no time. SERMs like Tamoxifen and Raloxifene are pure antagonist in the E receptor in breast tissue. This is what mainly makes a SERM the clinically preferred drug for gynecomastia reversal.

    TO REVERSE GYNECOMASTIA WITH SERMS:

    Raloxifene: 60mg daily for 10 days, then 30mg daily util reversed. You should see improvement in approx. 4 to 6 weeks. If you choose to run 60 mg daily until it's gone, do not exceed 60 days.

    Tamoxifen: 40mg daily for one week. Then 20mg daily until gynecomastia is reversed.

    Both protocols above will take time. This is not a 2 week process. Reversal will require patience. But it most certainly is effective, side-effect-free and cost incredibly effective when compared to surgery.If you're too lazy to follow the links and read... Raloxifene is the superior compound today for reversing gynecomastia. It can be dosed on or off cycle at 60mg daily up to 80mg daily until your gynecomastia is reversed. I will not be answering any questions that have already been answered in this thread, or in the threads linked above.

    Frequently Asked Questions:

    1. Can I use Letrozole to reverse gynecomastia?
    --- No. This is a very old school method and should never be attempted. We've advanced and we know better today.

    2. What should I use to reverse gynecomastia?
    --- See the links above. Raloxifene or Tamoxifen are the 2 proven SERMs to work.

    3. Can I develop gynecomastia even if I've had the surgery in the past?
    --- Yes, you most certainly can. Having surgery is not a reason to ignore signs and estrogen management.

    4. How is gynecomastia diagnosed?
    --- Physical examination, blood tests, mammograms, chest x-rays, CT scans, MRI, biopsy, etc...

    5. Can I get gynecomastia even if estrogen is in check?
    --- Not likely, but again, hormonal imbalances and ratios that are way off can cause issues. Get diagnosed.

    6. Can gynecomastia develop on one side only?
    --- Not likely, it's probably already in both, but only one side is affected worse, so you get signs from that one side.

    7. Why are Selective Estrogen Receptor Modulators (SERM) better than Aromatase inhibitors (AI)?
    --- Both have been studied and SERMs are proven effective. AI's are proven ineffective. SERMs bind to E receptors at breast tissue strongly, unlike AI's.

    8. Can SERMs reverse pubertal gynecomastia?
    --- Pubertal gynecomastia has been studied as well, and SERMs have been proven effective.


    Have a powerful day,

    ~ Austinite

  2. #2
    Jacked and Tan MeatHead96's Avatar
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    Thanks for posting, you always bring a wealth of knowledge to this forum. I know what its like to crash e2. It suckkkks. And I do have a little gyno. I'm just taking a tiny dose of letro and some nolva and caber right now myself to keep it at bay.

  3. #3
    Moderator Austinite's Avatar
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    Quote Originally Posted by MeatHead96 View Post
    Thanks for posting, you always bring a wealth of knowledge to this forum. I know what its like to crash e2. It suckkkks. And I do have a little gyno. I'm just taking a tiny dose of letro and some nolva and caber right now myself to keep it at bay.
    It's ok if you're experienced with Letro. I'm not knocking the compound, heck, it's the only one that can help with intratesticular E2. Caution and blood work is certainly advised. But experienced users shouldnt have issues.
    MeatHead96 likes this.

  4. #4
    Throwing Cookies ozzyozzy21's Avatar
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    Quote Originally Posted by Austinite View Post
    It's ok if you're experienced with Letro. I'm not knocking the compound, heck, it's the only one that can help with intratesticular E2. Caution and blood work is certainly advised. But experienced users shouldnt have issues.
    BOOM! ANOTHER GREAT POST!More reps on the way from me. Nice thread as always!
    Last edited by ozzyozzy21; 11-21-2013 at 10:46 PM.

  5. #5
    I like bananas SilverBackGorilla's Avatar
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    Top notch post!

  6. #6
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    Awesome post as always Austinite!

  7. #7
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    WOW Austinite a mod ? gratz man, I've been gone a few weeks, due to moving/no net, It's really nice you've taken the well earned mod status up in here, it's these kinds of threads and all the knowledge you've have contributed all across several threads/post that make you an excellent candidate for the job, congratulations again bro, cant say I am really shocked by it since you've clearly have demonstrated you have experience to be one.

    Great read here, lots of good info, thanks agian for your contributions to the forum!

  8. #8
    Moderator Megatron28's Avatar
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    Thanks Austinite!

    What's the potential harm that can come from using raloxifene or tamaxofin on psuedogynocomastia?

  9. #9
    Moderator Austinite's Avatar
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    Quote Originally Posted by Megatron28 View Post
    Thanks Austinite!

    What's the potential harm that can come from using raloxifene or tamaxofin on psuedogynocomastia?
    None really. Some might experience elevated e2. Long Term use can demineralize bones.

  10. #10
    Moderator Mad- scientist's Avatar
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    I love these articles you write! I had every single one in my favorite bar.

  11. #11
    Moderator Austinite's Avatar
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    Shouldn't be using anything for pseudo, though.

  12. #12
    Moderator Megatron28's Avatar
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    I know. Just wondering what the harm was that you referenced in the post.

  13. #13
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    Thank you for sharing U R THE GURU of this forum.

  14. #14
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    If I could I would bestow you an a Doctorate in Steroidology...but only Professor STC NTO..the beauty is you don t pull all your data off sites and paste.

    I look forward to learning from you.

    I did the Cliff notes as I have no mammaries left....but still..


    Awesome...fkn Texas huh ? We southerners are under rated..
    Charles Bronson likes this.
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    Thanks austinite. Great info as always

  16. #16
    Waiting to die. 71Avido's Avatar
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    Quote Originally Posted by Austinite
    Don't cycle at high body fat:

    Just because your internet tells you that your 20% body fat is normal for a male your age, does not mean it's safe to cycle. Forget those ratings. Anything above 15 or 16% is TOO OVERWEIGHT to cycle. There are general health ratings, and then there are steroid-user ratings. I'm telling you, that if you're above 16%, you're carrying too many aromatase enzymes. This will lead to higher testosterone-to-estrogen conversion and will make it very difficult to manage. It's no surprise that most of the folks posting gynecomastia threads are overweight for steroid use.

    Furthermore; you better not be bulking at 15 or 16% BF either. Bulking should never be done, in my opinion, until you're at 13% or less. You can get there with diet alone, and if you can't, you shouldn't be considering steroids.
    I have a question on this.
    The stated reason for not bulking above 16% BF is because of carrying too many aromatase enzymes.
    Couldn't that be managed with an Aromatase inhibitor (AI) or SERM or is there more to it than that?

  17. #17
    Moderator Austinite's Avatar
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    Quote Originally Posted by 71Avido View Post
    I have a question on this.
    The stated reason for not bulking above 16% BF is because of carrying too many aromatase enzymes.
    Couldn't that be managed with an Aromatase inhibitor (AI) or SERM or is there more to it than that?
    Correct, but there's more to high body fat. I only mentioned relevant side effects since this is gynecomstia related. But you'll suffer blood pressure issues and several other problems that can't quite be managed easily by an average user.

  18. #18
    Waiting to die. 71Avido's Avatar
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    Quote Originally Posted by Austinite View Post
    Correct, but there's more to high body fat. I only mentioned relevant side effects since this is gynecomstia related. But you'll suffer blood pressure issues and several other problems that can't quite be managed easily by an average user.
    Very interesting, I'm assuming bulking over 16% on AAS makes it even more difficult to manage.

    Regarding the use of SERMS/AI's, are there long term effects from crashing your E2?

    Could one ever get themselves to a state where they crashed E2 so low for so long that they wouldn't recover?

  19. #19
    Moderator Austinite's Avatar
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    ^ This is dose dependant mostly, but yes, e2 can crash if not monitored. 16% is not the magic number as it can be individualistic. This is however, my recommendation.

    You'll always recover because aromatase enzymes are generated, not static where they would die and never return. How long it takes to recover varies.
    71Avido likes this.

  20. #20
    Waiting to die. 71Avido's Avatar
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    Quote Originally Posted by Austinite View Post
    ^ This is dose dependant mostly, but yes, e2 can crash if not monitored. 16% is not the magic number as it can be individualistic. This is however, my recommendation.

    You'll always recover because aromatase enzymes are generated, not static where they would die and never return. How long it takes to recover varies.
    Good info bud, thanks for clearing it up.

    I too have crashed my E2 before, I've never experienced joint pain like that in my life.

  21. #21
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    Good post man. Just curious for the Raloxifene might see results in 4-6weeks. What bout the nolva? How long will i need to see results? Also will nolva clear away to gyno or just prevent it from growing?
    Last edited by MrMuscle97; 11-25-2013 at 04:52 AM.

  22. #22
    Moderator Austinite's Avatar
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    ^ Please edit and remove the quote. No need to quote the original post.

    Same with Nolvadex. You should see a difference in 4 to 6 weeks.

  23. #23
    LIVING THE DREAM barrysanders's Avatar
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    Solid post. Rep due

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    Rookie Greatful's Avatar
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    So what I am taking away from this is to use Nolva in the initial controlling of Gyno if there are ALREADY symptoms, then transition into an Aromatase inhibitor (AI) for general management afterwards?
    Or are there benefits to taking both a SERM and an Aromatase inhibitor (AI) during cycle?
    The Nolva (or SERM) for it's direct and efficient ability to prevent E2/Gyno developing directly at the source, and an Aromatase inhibitor (AI) to keep E2 in check in the body for general overall health purposes if necessary?

    Would there be any harm in taking both if done at reasonable levels (whatever that might be, perhaps the over all dose of each would be adjusted since taking both)?
    Last edited by Greatful; 11-24-2013 at 05:23 PM.

  25. #25
    Moderator Austinite's Avatar
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    Quote Originally Posted by Greatful View Post
    So what I am taking away from this is to use Nolva in the initial controlling of Gyno if there are ALREADY symptoms, then transition into an Aromatase inhibitor (AI) for general management afterwards?
    Or are there benefits to taking both a SERM and an Aromatase inhibitor (AI) during cycle?
    The Nolva (or SERM) for it's direct and efficient ability to prevent E2/Gyno developing directly at the source, and an Aromatase inhibitor (AI) to keep E2 in check in the body for general overall health purposes if necessary?

    Would there be any harm in taking both if done at reasonable levels (whatever that might be, perhaps the over all dose of each would be adjusted since taking both)?
    AI should be used at ALL times on cycle, from day 2 until the last injection, or up to PCT. Nolvadex can be used on cycle if gynecomstia has developed.
    Greatful likes this.

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