Gynecomastia

[Trewargas]

This request for some experiences regarding gynecomastia.

As such it is probably initially directed at the guys on this brillant forum.

But if there are any lady carers/partners of cirrhosis patients with experiences, please assist as well, if you can.

My 1st decompensated hospital episode was 9+ years ago.

Since then I have been on Spironolactone and Furosemide at various strengths.

This was to combat ascites, which was refractory for 12 months, and edema.

My heptology team have tried reducing both Spironolactone and Furosemide at various times, but the current levels I'm on are required to manage both types of fluid retention.

Over the past few years my gynecomastia has been increasing. This obviously isn't a direct physical health concern, but as a guy, it is something I really feel uncomfortable with on so many levels, and would like to explore possible options.

My understanding is that the Spironolactone may be contributing to this, through a rather complex hormone imbalance alteration process.

My most recent bloods confirmed a high oestradiol level which I think is to be expected in someone in my position.

Strangely my testosterone levels are also high, but probably unrelated to the gynecomastia.

So is there anyone in a similar situation?

I have heard that some male patients have tried other diuretics to replace the Spironolactone, whilst still combating the fluid retention problems.

I would greatly appreciate any comments covering experiences with gynecomastia with cirrhosis, to see what potential options I may have, if any.

Thanks for taking the time to read this.

Taking this journey "one day at a time".

Kind thoughts to you all.

Richard.

[Fibro2021]

Gynecomastia developing in the context of cirrhosis may be linked to several factors, including long-term use of spironolactone. This medication affects hormonal balance by increasing estrogen levels in the body, which can contribute to breast enlargement in men.

Additionally, cirrhosis impairs the metabolism and clearance of steroid hormones, which can also impact levels of progesterone, prolactin, and SHBG (sex hormone-binding globulin). For example, elevated progesterone or prolactin levels can exacerbate gynecomastia, while decreased SHBG levels may increase free estrogen and androgen levels, further raising the risk of developing gynecomastia.

It’s important to note that it's not just the absolute levels of estradiol and testosterone that matter, but rather their ratio. A high ratio of estradiol to testosterone can significantly increase the likelihood of gynecomastia, even if both hormones are within normal or high ranges.

To address this issue, it is important to discuss with your doctor the possibility of replacing spironolactone with another diuretic (if it possible) that has a lesser impact on hormonal balance, as well as undergoing testing to assess the levels of all key hormones (estrogens, testosterone, progesterone, prolactin, and SHBG). Based on these results, your doctor can suggest strategies to correct hormonal imbalances and minimize side effects, including gynecomastia.

[Trewargas in reply to Fibro2021]

Hi Fibro2021.

Thank you for your thoughtful and considered reply and suggestions, which I read with interest.

As well as high testosterone, my SHBG level is high as well.

Progesterone and prolactin were not tested, therefore levels are unknown currently.

Thank you for your useful information. I'll bare it in mind for my next review.