Two years ago I developed gynecomastia due to applying a potent anti-androgen topically. Although this incident triggered my gynecomastia, it was further enforced through my use of finasteride and topical spironolactone. The former is well known to cause problems relating to lowering DHT and they are both known to cause gynecomastia. However, a recent DHT test revealed the following:

DHT: 1704 217-1650 pmol/L

I stopped using finasteride two years ago when I realized that it was antagonizing my gyne. At the time, I thought that it was the only culprit. I only recently stopped using topical spironolactone on April 20, 2006.

Pathology taken in March '05 revealed the following:
FSH: 1.3 1-11 IU/L
LH: 2.9 1-8 IU/L
Prolactin: 8 3-13 ug/L
Total Test: 19.0 10-28 nmol/L
SHBG: 39 11-52 nmol/L
Free Androgen Index: 0.49 0.25-1.00
Estradiol: 95 50-218 pmol/L
Prog Serum: 2 1-5 nmol/L

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Although my serum testosterone level looked ok, my SHBG, which binds testosterone with greater affinity than estradiol, was high normal. A friend of mine then calculated my free testosterone via the method employed by Schering as opposed to the FAI (which apparently is diagnostically flawed).

My CT level was low (although this was theoretical).

My friend asked me to get a free testosterone test on the basis of the above.

The result was the following:
Free Testosterone: 38.6 31.0-94.0 pmol/l (10am)

This would appear very low on the reference range for a young man so my friend offered me a symptomatic testosterone test. He took the one from Malcom Carruthers book "The Testosterone Revolution". He told me that I scored highly on the test, the results of which indicated it was `Very Likely' that I was testosterone deficient.

In March '06 I was diagnosed with hypothyroidism.

I still have various symptoms that have not responded to thyroid medication.

Below are my thyroid tests from May `06:
Free t3 5.0 3.5-6.5 pmol/l
Free T4 17 9-23 pmol/l
TSH 1.67 0.35-5.00miu/l

It was concluded on a hypogonadism board by several knowledgeable hypogonadism suffers that my relatively high SHBG is at least partially the cause of my low normal free testosterone.

My most recent pathology (2006 05 23) 7:57am

Free Testosterone 47.6 31.0-94.0 pmol/l
DHEA-S 3.5 7.6-17.4 umol/l
TSH 0.66 0.35-5.00 miu/l
Anti-TPO <10 Less than 35 iu/ml
Anti-TG <20 Less than 40 iu/ml
Ferritin 50 22-322 ug/l
Progesterone 1.2 0.9-2.9 nmol/l
Estradiol-17 Beta <100 Up to 206 pmol/l ("Test repeated and results confirmed")
Insulin: fasting 25 Up to 210 pmol/l
Total HCG (Oncology) <2 LO Less than 2 iu/l (Ref. range for non-pregnant adult)
Cortisol: 481 nmol/l AM: 170-720
Glucose Tolerance Dosage 75 G
Glucose-Fasting 4.1 mmol/l
2 HR 2.0 mmol/l


Estrogen Metabolism Ratio (urine sample from May 22/06):

[2-hydroxyestrogrn Within range 5.8 1.0-60ng/ml Male: all ages
16-hydroxyestrone Within range 4.4 1.0-60ng/ml Male: all ages
Estrogen Metabolism Ratio (EMR) 1.3 See interpretation

….EMR in males rises with age, increasing from around 0.5 at age 20 to roughly 2.0 at age 55.

Saliva Hormone Test results (May 23/06):
Cortisol AM Below range 1.0 2.0-11ng/ml Sampled within 1 hour of waking
Cortisol Noon Within range 2.6 1.0-7.0ng/ml Noon cortisol
Cortisol PM Within range 1.2 0.5-3.5ng/ml Sampled prior to evening meal
Cortisol HS Low end of range 0.4 0.2-2.2ng/ml Bedtime Sample
DHEAS High end of range 9.6 2.0-11ng/ml Male DHEAS endogenous –

(DHEAS was done by two different labs.)

Glucose Tolerance Dosage 75 G
Glucose-Fasting 4.1 mmol/l
2 HR 2.0 mmol/l

Hemaglobin 141 135-175g/L
Hematocrit 0.43 0.40-0.50
White Blood Cell Count 6.7 4.0-11.0 x E9/L
Red Blood Cell Count 4.74 4.5-6.00 x E12/L
MCV 89.7 80-98 fL
MCH 29.7 27.5-33.0 pg
MCHC 332 320-360 g/L
RDW 12.4 11.5-14.5
Platelet count 221 150-400 x E9/L
Absolute Neuts 3.1 2.0-7.5 x E9/L
(A) Lymph 2.9 1.0-3.5 x E9/L
(A) Mono 0.6 0.0-0.8 x E9/L
(A) EOS 0.1 0.0-0.5 x E9/L
(A) Baso 0.0 0.0-0.2 x E9/L


What is the best option for treatment in my case?

To lower my SHBG and increase my free testosterone would I want to start off with DHEA?
How about using proviron?
Would Danazol be too strong of a med for my case?

Any advise is greatly appreciated