Gynecomastia in men: causes, symptoms, diagnostics, Tamoxifen treatment, Clomiphene

Gynecomastia is an enlargement of the breast tissue in men.. How is gynecomastia usually treated and what are the different options for this??

Basically, gynecomastia treatment methods can be divided into two categories. One side, have endocrine treatment , intended to regulate the relative or absolute excess of estrogen, On the other hand, surgical removal , is used, when the enlargement of the glands can no longer be changed, or the patient suffers from permanent shifts in hormonal balance. Below we will discuss both methods and then, how to make sure, that this problem can be avoided from scratch, if possible.

Selective estrogen receptor modulators bind to estrogen receptors and prevent, so that estrogens themselves can develop their effect in the cell. According to scientific research, there are three different methods, which are suitable for the treatment of gynecomastia. These methods consider taking the drug, called selective estrogen receptor modulator (SMRE). Most studies have considered gynecomastia or pubertal gynecomastia as part of antiandrogen therapy in patients with prostate cancer.. We will discuss all three treatments below..

Tamoxifen in the treatment of gynecomastia

Studies have shown, what 10-20 mg tamoxifen, also known by the brand name Nolvadex, taken daily, in 90 percent of cases leads to a reduction in gynecomastia within three to nine months. A preliminary review indicated a partial reduction 80% cases and a complete decrease in 60% cases. Recent Research, conducted on 81 patients, revealed the level of success 90,1 percentage after admission 10 mg tamoxifen daily. This study also indicates that, that the dosage of the drug determines the success of the treatment, not the length of time, when gynecomastia persisted before treatment. On average, it took about seven months to achieve the desired success, but the standard deviation was quite high – ±4.8 months.

In the medical treatment of gynecomastia, male breast enlargement is reversed by taking SERMs.. In most cases, tamoxifen is the appropriate agent..

However, it should be noted, that the situation is changing, as soon as anabolic steroids entail the development of a problem. Unfortunately, there is little data on the treatment of gynecomastia with steroids. The studies used doses up to 600 mg testosterone enanthate per week for 20 weeks at the same time, but the development of gynecomastia was not even noted in the side effects. However, in another large-scale study, this phenomenon was clearly noted. 271 person for at least six months 200 mg taken testosterone enanthate per week . Of these, only nine developed gynecomastia., representing three percent of study participants.

six solid, round chest muscles - this is what the ideal image of the male upper body looks like, replicated by the media. But let's be honest: very few men meet this ideal. Approximately one third of all men develop disproportionately large male breasts during their lifetime., enlarged breasts or gynecomastia.

If estrogen levels rise significantly above normal, due to anabolic steroids, often need a large dose of tamoxifen, than described above. Quantity of 30 to 40 mg per day should be sufficient to treat gynecomastia in most cases.

Clomiphene in the treatment of gynecomastia

Klomyfen – this is SMRE, which, in addition to tamoxifen, is very often used in the so-called post-cycle therapy (PCT), which is used to stimulate the body's own production of testosterone after steroid treatment. As a matter of fact, Clomiphene is considered the most commonly prescribed drug for the treatment of infertility.. However, there is surprisingly little evidence for the treatment of gynecomastia.. Gynecomastia, associated with puberty, treated with 50 mg clomiphene citrate daily for one to three months.

These results are not particularly promising for the use of clomiphene in the treatment of gynecomastia in bodybuilding..

Raloxifene in the treatment of gynecomastia

Raloxifene is a relatively new drug, and differs in its chemical structure from tamoxifen and clomiphene. There is a study 2004 year, which has never been reproduced, and, Consequently, has much less evidence, than all the studies on the use of tamoxifen for the treatment of gynecomastia.

Endocrine treatment of gynecomastia with aromatase inhibitors

Due to the central role of estrogens in the development of gynecomastia, aromatase inhibitors seem to be a very attractive treatment option for gynecomastia . They inhibit the enzyme aromatase, which converts androgens to estrogens and is responsible for the absolute excess of estrogen, especially for bodybuilders. However, there is little scientific evidence on the treatment of existing gynecomastia..

Aromatase inhibitors inhibit the enzyme aromatase and, Consequently, production of estrogen from androgens.

A double-blind control study compared the use of one milligram of Anastrozole (arimidex) daily versus placebo for gynecomastia, associated with puberty. Six months later, a positive change was found in 38,5 percentage of participants, while in this part there was a decrease of more than 50 percent from subsequent 31,4 the percentage. However, the difference between the groups did not reach statistical significance.. Despite, that anastrozole significantly improved the testosterone/estrogen ratio, approximately half of the participants had had gynecomastia for at least two years, which reduced the chances of success in treatment regardless of the drug used.

Another study compared the effectiveness of one milligram of anastrozole against 20 mg of tamoxifen in the development of gynecomastia in patients with prostate cancer. In 73 percent of patients in the placebo group, 10 percent of patients in the tamoxifen group and 51 percent of the anastrozole group developed breast enlargement. Therefore, tamoxifen was much more suitable for the prophylactic treatment of gynecomastia., than anastrozole. However, it should be noted, that it was not the absolute excess of estrogen that led to the side effects, but rather a reduced androgen/estrogen ratio due to administration of antiandrogens. Basically it's the opposite, what is often responsible for the development of gynecomastia.

Therefore, these two studies describe scenarios, of little practical importance. In a recent review of gynecomastia treatment and management, the authors conclude, that anastrozole is a very good option for treating gynecomastia, associated with puberty, and has also been successfully used to reduce excess estrogen and breast enlargement, if it is genetically there is a conditional excess of aromatase. In an experiment on two testosterone-deficient men, treated with an exogenous supply of male sex hormone, anastrozole has been successfully used to prevent the development of gynecomastia.

Preventive treatment of gynecomastia in bodybuilding

Exogenous intake of high doses of androgens is the most common cause of gynecomastia in bodybuilding.. Some of the supraphysiological androgens are converted into estrogens and provide the man with an absolute excess of female sex hormones. . This can lead not only to an increase in the mammary glands, but also to increase the accumulation of water under the skin. Therefore, it is common practice to test estrogen levels by a physician while taking anabolic androgenic steroids and adjusting the dose of an aromatase inhibitor., such as anastrozole, letrozole or exemestane, thus, to keep estrogen levels within normal limits.

For the preventive treatment of gynecomastia and other estrogen-related side effects in bodybuilding, aromatase inhibitors are very suitable.. Unlike the SMRE, they lower estrogen levels and, thus, also circulate less free estrogen in the blood and, respectively, maintaining higher androgen levels.

Conclusion and summary on the treatment of gynecomastia

If we look at the gynecomastia treatment study, it tamoxifen, seems, is the most common and proven method to date. However, these studies are mainly concerned with breast enlargement due to a decrease in the ratio between androgens and estrogens.. In case of an absolute excess of estrogen, how this can happen due to exogenous use of androgenic steroids for performance enhancement in bodybuilding and weight training, you should first try to lower your estrogen levels to the physiological range with an aromatase inhibitor. If gynecomastia is irreversible, despite months of medication, surgical removal is the only way to permanently remove enlarged breast tissue.

Sources

• Braunstein GD. Gynecomastia. N Engl J Med. 2007;357:1229-37.
• Allee M. R, Baker M. Z. Gynecomastia http://emedicine.medscape.com/
• Eckman A, Dobs A. Drug-induced gynecomastia. Expert Opin Drug Saf. Nov 2008;7(6):691-702.
• Neuman J. F. Evaluation and treatment of gynecomastia. Am Fam Physician. 1997;55(5):1835-44, 1849-50.