I (Male, 26) have had slowly-worsening puffy nipples for over a year now and recently I was sufficiently motivated to go to an endocrinologist and see what can be done to reverse it. I also told the Doc about my hypothyroid symptoms including low motivation/energy/libido, fatigue, cold hands/feet and constipation. Some related issues I also have: male pattern balding (the kind where the vertex goes bald first) and a varicocele.
The endo said it's not gynecomastia. He says that because there is no "gland"/lump underneath my nipple. There is just nipple puffiness and and some of what I'm guessing is something like ductal tissue underneath the skin towards the outer part of the areola. There is also tenderness and weird sensations sometimes.
Unfortunately, a combination of nervousness and it being cold in the office made it so my nipples were hard and so the puffiness was not noticeable at all in that state. I was insistent, but he pretty much dismissed my concerns and said it could be a "skin issue". He might have just thought I was paranoid or had no idea what I was talking about it. Here is a photo album of a male actor on a TV show that has a puffy nipple problem similar to mine. My nipples were not like this two years ago so I know there is definitely something wrong/different.
I had bloodwork done privately before going to the endo and got these results (with reference ranges appended):
Testosterone 438 | 348–1197 ng/dL
Estradiol 21.7 | 7.6–42.6 pg/mL
LH 6 | 1.7–8.6 mIU/mL
FSH 4.4 | 1.5–12.4 mIU/mL
TSH 4.6 | 0.45–4.50 uIU/mL
T3 3.1 | 2.0–4.4 pg/mL
T4 1.08 | 0.82–1.77 ng/dL
Prolactin 14.8 | 4.0-15.2 ng/mL
After getting that bloodwork, but before going to the endo, I started taking thyroid I bought online. I experienced noticeable improvements in the areas of coldness and constipation.
I showed those results to the endo and he also ordered new bloodwork which was done the day after my consultation. When he got the results, the only actual numbers I got him to tell me were these:
Testosterone 328 ng/dL
Prolactin 32 ng/mL
Based on that he recommended an MRI to look for a Prolactinoma. Long story short: I got that MRI and it came back normal. No prolactinoma.
He mentioned at one point that touching/squeezing nipples can raise prolactin and there was a lot of that done on the day of my exam (which was the day before my bloodwork) mostly it was done by me at various points throughout the day trying to prove to myself that there was tissue underneath my nipples. I think that is the likely cause of the 2x increase in prolactin. I wish he would have suggested I get bloodwork done again instead of encouraging an MRI but that's a rant for another day.
When we found out it was not a prolactinoma, he prescribed a low dose of bromocriptine (2.5mg/day) and told me to take it for 2 months and then we'd get bloodwork again. He said it would lower my prolactin and he thinks that's what's keeping my testosterone low. He did not want to prescribe me thyroid even though I asked for it.
I took the bromocriptine for a month. In the first few days I thought my nipples might have been de-puffying a little, but after that I didn't notice any changes. I did not notice any other affects either except maybe the vivid dreams side effect.
I am unsatisfied with this approach for several reasons.
I think that my prolactin was in the 30s because of all the "playing with my nipples" and that it will have gone back down to about 14 or 15 like it was before. And that's in or near the normal range, so he probably won't want to do anything about it, but I think it has been slowly causing my puffy nipples, probably in concert with my low testosterone.
Also, it's not a viable long-term strategy and I don't think using a dopamine-agonist is a wise strategy when I have many of the signs of someone with low dopamine / downregulated dopamine receptors (low motivation/libido, depression, etc).
TL;DR
I have low testosterone, high prolactin, and slightly high TSH ("subclinical hypothyroid").
Symptomatically, my most psychologically-bothersome issue is puffy nipples, but I also have typical hypothyroid/low testosterone symptoms like low motivation/energy/libido, cold hands/feet, depression and constipation.
I've seen an endocrinologist and so far his solution is a prescription for bromocriptine to lower my prolactin, which I think was just temporarily high. Overall, I think his advice is lacking.
I'm seeking effective and sustainable ways to lower prolactin and raise testosterone, which I think will have the biggest effect on improving my symptoms.
Thanks for reading. Any feedback will be greatly appreciated.
The endo said it's not gynecomastia. He says that because there is no "gland"/lump underneath my nipple. There is just nipple puffiness and and some of what I'm guessing is something like ductal tissue underneath the skin towards the outer part of the areola. There is also tenderness and weird sensations sometimes.
Unfortunately, a combination of nervousness and it being cold in the office made it so my nipples were hard and so the puffiness was not noticeable at all in that state. I was insistent, but he pretty much dismissed my concerns and said it could be a "skin issue". He might have just thought I was paranoid or had no idea what I was talking about it. Here is a photo album of a male actor on a TV show that has a puffy nipple problem similar to mine. My nipples were not like this two years ago so I know there is definitely something wrong/different.
I had bloodwork done privately before going to the endo and got these results (with reference ranges appended):
Testosterone 438 | 348–1197 ng/dL
Estradiol 21.7 | 7.6–42.6 pg/mL
LH 6 | 1.7–8.6 mIU/mL
FSH 4.4 | 1.5–12.4 mIU/mL
TSH 4.6 | 0.45–4.50 uIU/mL
T3 3.1 | 2.0–4.4 pg/mL
T4 1.08 | 0.82–1.77 ng/dL
Prolactin 14.8 | 4.0-15.2 ng/mL
After getting that bloodwork, but before going to the endo, I started taking thyroid I bought online. I experienced noticeable improvements in the areas of coldness and constipation.
I showed those results to the endo and he also ordered new bloodwork which was done the day after my consultation. When he got the results, the only actual numbers I got him to tell me were these:
Testosterone 328 ng/dL
Prolactin 32 ng/mL
Based on that he recommended an MRI to look for a Prolactinoma. Long story short: I got that MRI and it came back normal. No prolactinoma.
He mentioned at one point that touching/squeezing nipples can raise prolactin and there was a lot of that done on the day of my exam (which was the day before my bloodwork) mostly it was done by me at various points throughout the day trying to prove to myself that there was tissue underneath my nipples. I think that is the likely cause of the 2x increase in prolactin. I wish he would have suggested I get bloodwork done again instead of encouraging an MRI but that's a rant for another day.
When we found out it was not a prolactinoma, he prescribed a low dose of bromocriptine (2.5mg/day) and told me to take it for 2 months and then we'd get bloodwork again. He said it would lower my prolactin and he thinks that's what's keeping my testosterone low. He did not want to prescribe me thyroid even though I asked for it.
I took the bromocriptine for a month. In the first few days I thought my nipples might have been de-puffying a little, but after that I didn't notice any changes. I did not notice any other affects either except maybe the vivid dreams side effect.
I am unsatisfied with this approach for several reasons.
I think that my prolactin was in the 30s because of all the "playing with my nipples" and that it will have gone back down to about 14 or 15 like it was before. And that's in or near the normal range, so he probably won't want to do anything about it, but I think it has been slowly causing my puffy nipples, probably in concert with my low testosterone.
Also, it's not a viable long-term strategy and I don't think using a dopamine-agonist is a wise strategy when I have many of the signs of someone with low dopamine / downregulated dopamine receptors (low motivation/libido, depression, etc).
TL;DR
I have low testosterone, high prolactin, and slightly high TSH ("subclinical hypothyroid").
Symptomatically, my most psychologically-bothersome issue is puffy nipples, but I also have typical hypothyroid/low testosterone symptoms like low motivation/energy/libido, cold hands/feet, depression and constipation.
I've seen an endocrinologist and so far his solution is a prescription for bromocriptine to lower my prolactin, which I think was just temporarily high. Overall, I think his advice is lacking.
I'm seeking effective and sustainable ways to lower prolactin and raise testosterone, which I think will have the biggest effect on improving my symptoms.
Thanks for reading. Any feedback will be greatly appreciated.
franko
