Gynecomastia medical therapy
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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.