Gynecomastia medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Gynecomastia is usually a self-limited condition, reassurance and follow-up are recommended. If found causative medication or underlying condition should be address. Pharmacologic therapy is beneficial for the first several months until fibrous tissue replaces the glandular tissue. | Gynecomastia is usually a self-limited condition, reassurance and follow-up are recommended. If found causative medication or underlying condition should be address. [[Pharmacologic]] therapy is beneficial for the first several months until [[fibrous tissue]] replaces the [[Glandular tissue|glandular tissue.]] | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Asymptomatic gynecomastia usually does not require treatment; reassurance is all that is required. | *[[Asymptomatic]] gynecomastia usually does not require treatment; reassurance is all that is required. | ||
*Treatment of symptomatic gynecomastia (discomfort, tenderness, psychological stresses) is guided by the patient's goal. | *Treatment of [[symptomatic]] gynecomastia (discomfort, [[tenderness]], [[psychological]] stresses) is guided by the patient's goal. | ||
*In gynecomastia with the identifiable underlying cause, treatment of that underlying cause can address the symptoms. | *In gynecomastia with the identifiable underlying cause, treatment of that underlying cause can address the symptoms. | ||
*If the gynecomastia is believed to be due to a use of a medication, withdrawal of that medication should lead to improvement over a period of a few months. | *If the gynecomastia is believed to be due to a use of a medication, withdrawal of that medication should lead to improvement over a period of a few months. | ||
=== Pharmacologic therapy === | === Pharmacologic therapy === | ||
Pharmacologic medical therapies for gynecomastia include:<ref name="pmid17543732">{{cite journal| author=Narula HS, Carlson HE| title=Gynecomastia. | journal=Endocrinol Metab Clin North Am | year= 2007 | volume= 36 | issue= 2 | pages= 497-519 | pmid=17543732 | doi=10.1016/j.ecl.2007.03.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17543732 }} </ref><ref name="pmid17881754">{{cite journal| author=Braunstein GD| title=Clinical practice. Gynecomastia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 12 | pages= 1229-37 | pmid=17881754 | doi=10.1056/NEJMcp070677 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17881754 }} </ref><ref name="pmid2137877">{{cite journal |vauthors=Biro FM, Lucky AW, Huster GA, Morrison JA |title=Hormonal studies and physical maturation in adolescent gynecomastia |journal=J. Pediatr. |volume=116 |issue=3 |pages=450–5 |year=1990 |pmid=2137877 |doi= |url=}}</ref><ref name="pmid6772358">{{cite journal |vauthors=Friedman NM, Plymate SR |title=Leydig cell dysfunction and gynaecomastia in adult males treated with alkylating agents |journal=Clin. Endocrinol. (Oxf) |volume=12 |issue=6 |pages=553–6 |year=1980 |pmid=6772358 |doi= |url=}}</ref><ref name="pmid21209041">{{cite journal| author=Carlson HE| title=Approach to the patient with gynecomastia. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 1 | pages= 15-21 | pmid=21209041 | doi=10.1210/jc.2010-1720 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21209041 }} </ref><ref name="pmid21479145">{{cite journal| author=Johnson RE, Kermott CA, Murad MH| title=Gynecomastia - evaluation and current treatment options. | journal=Ther Clin Risk Manag | year= 2011 | volume= 7 | issue= | pages= 145-8 | pmid=21479145 | doi=10.2147/TCRM.S10181 | pmc=3071351 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21479145 }} </ref> | [[Pharmacologic]] medical therapies for gynecomastia include:<ref name="pmid17543732">{{cite journal| author=Narula HS, Carlson HE| title=Gynecomastia. | journal=Endocrinol Metab Clin North Am | year= 2007 | volume= 36 | issue= 2 | pages= 497-519 | pmid=17543732 | doi=10.1016/j.ecl.2007.03.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17543732 }} </ref><ref name="pmid17881754">{{cite journal| author=Braunstein GD| title=Clinical practice. Gynecomastia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 12 | pages= 1229-37 | pmid=17881754 | doi=10.1056/NEJMcp070677 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17881754 }} </ref><ref name="pmid2137877">{{cite journal |vauthors=Biro FM, Lucky AW, Huster GA, Morrison JA |title=Hormonal studies and physical maturation in adolescent gynecomastia |journal=J. Pediatr. |volume=116 |issue=3 |pages=450–5 |year=1990 |pmid=2137877 |doi= |url=}}</ref><ref name="pmid6772358">{{cite journal |vauthors=Friedman NM, Plymate SR |title=Leydig cell dysfunction and gynaecomastia in adult males treated with alkylating agents |journal=Clin. Endocrinol. (Oxf) |volume=12 |issue=6 |pages=553–6 |year=1980 |pmid=6772358 |doi= |url=}}</ref><ref name="pmid21209041">{{cite journal| author=Carlson HE| title=Approach to the patient with gynecomastia. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 1 | pages= 15-21 | pmid=21209041 | doi=10.1210/jc.2010-1720 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21209041 }} </ref><ref name="pmid21479145">{{cite journal| author=Johnson RE, Kermott CA, Murad MH| title=Gynecomastia - evaluation and current treatment options. | journal=Ther Clin Risk Manag | year= 2011 | volume= 7 | issue= | pages= 145-8 | pmid=21479145 | doi=10.2147/TCRM.S10181 | pmc=3071351 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21479145 }} </ref> | ||
==== Androgens ==== | ==== [[Androgens]] ==== | ||
*Testosterone replacement can improve gynecomastia in hypogonadism of short duration, but it can worsen gynecomastia in eugonadal men due to aromatization to estradiol. | *[[Testosterone]] replacement can improve gynecomastia in [[hypogonadism]] of short duration, but it can worsen gynecomastia in eugonadal men due to [[aromatization]] to [[estradiol]]. | ||
==== Aromatase inhibitors ==== | ==== [[Aromatase inhibitors]] ==== | ||
*Aromatase inhibitor (anastrozole) is useful in aromatase excess syndrome cause of gynecomastia. | *Aromatase inhibitor ([[anastrozole]]) is useful in aromatase excess syndrome cause of gynecomastia. | ||
==== Selective estrogen receptor modulators (SERMs) ==== | ==== [[SERM|Selective estrogen receptor modulators (SERMs)]] ==== | ||
*Selective estrogen receptor modulators (tamoxifen, raloxifene) have been used with varying degree of success with tamoxifen better than raloxifene. | *Selective estrogen receptor modulators ([[tamoxifen]], [[raloxifene]]) have been used with varying degree of success with [[tamoxifen]] better than [[raloxifene]]. | ||
==References== | ==References== |
Revision as of 13:43, 16 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Gynecomastia is usually a self-limited condition, reassurance and follow-up are recommended. If found causative medication or underlying condition should be address. Pharmacologic therapy is beneficial for the first several months until fibrous tissue replaces the glandular tissue.
Medical Therapy
- Asymptomatic gynecomastia usually does not require treatment; reassurance is all that is required.
- Treatment of symptomatic gynecomastia (discomfort, tenderness, psychological stresses) is guided by the patient's goal.
- In gynecomastia with the identifiable underlying cause, treatment of that underlying cause can address the symptoms.
- If the gynecomastia is believed to be due to a use of a medication, withdrawal of that medication should lead to improvement over a period of a few months.
Pharmacologic therapy
Pharmacologic medical therapies for gynecomastia include:[1][2][3][4][5][6]
Androgens
- Testosterone replacement can improve gynecomastia in hypogonadism of short duration, but it can worsen gynecomastia in eugonadal men due to aromatization to estradiol.
Aromatase inhibitors
- Aromatase inhibitor (anastrozole) is useful in aromatase excess syndrome cause of gynecomastia.
Selective estrogen receptor modulators (SERMs)
- Selective estrogen receptor modulators (tamoxifen, raloxifene) have been used with varying degree of success with tamoxifen better than raloxifene.
References
- ↑ Narula HS, Carlson HE (2007). "Gynecomastia". Endocrinol Metab Clin North Am. 36 (2): 497–519. doi:10.1016/j.ecl.2007.03.013. PMID 17543732.
- ↑ Braunstein GD (2007). "Clinical practice. Gynecomastia". N Engl J Med. 357 (12): 1229–37. doi:10.1056/NEJMcp070677. PMID 17881754.
- ↑ Biro FM, Lucky AW, Huster GA, Morrison JA (1990). "Hormonal studies and physical maturation in adolescent gynecomastia". J. Pediatr. 116 (3): 450–5. PMID 2137877.
- ↑ Friedman NM, Plymate SR (1980). "Leydig cell dysfunction and gynaecomastia in adult males treated with alkylating agents". Clin. Endocrinol. (Oxf). 12 (6): 553–6. PMID 6772358.
- ↑ Carlson HE (2011). "Approach to the patient with gynecomastia". J Clin Endocrinol Metab. 96 (1): 15–21. doi:10.1210/jc.2010-1720. PMID 21209041.
- ↑ Johnson RE, Kermott CA, Murad MH (2011). "Gynecomastia - evaluation and current treatment options". Ther Clin Risk Manag. 7: 145–8. doi:10.2147/TCRM.S10181. PMC 3071351. PMID 21479145.