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Treatment for Gynecomastia
June 2000

Q. I am an 18-year-old male, and have had gynecomastia since I was 12. In these six years, I have only been offered only two options: an expensive surgical procedure or "living with it." I did some research of my own, and heard that certain anti-estrogens, like Teslac, have proved effective in reducing the breast tissue. Why has this not been presented as a treatment alternative? Can a physician prescribe these drugs? It just seems like a better option than cutting open my chest.

A. Gynecomastia, enlargement of the male breast tissue, is quite common, especially in adolescence, the obese and in older men. It usually is benign without a clear cause (idiopathic). In a small percentage of cases, there can be other causes such as tumors of the adrenal gland, testicles or pituitary gland. Certain drugs such as Tagamet, estrogen, Valium and alcohol can cause gynecomastia. I assume you have been evaluated by your doctor for such other causes, and likely, none were found.

The treatment for idiopathic gynecomastia usually does involve making a decision between leaving it alone or surgery to remove the excess breast tissue. There have been some studies looking at drugs that block estrogen production or that block estrogen receptors, such as Teslac (testolactone) and Tamoxifen. These drugs do seem to have some beneficial effects in reducing gynecomastia, but they also can have adverse effects such as hypertension (increased blood pressure) with Teslac, and increasing the risk of blood clots with Tamoxifen. Neither of these drugs are FDA approved for treatment of gynecomastia. In fact, in the PDR (Physicians Desk Reference), Teslac is contraindicated in the treatment of Breast Cancer in Males. I believe more studies would be needed to prove the effectiveness and safety of these drugs in treatment of gynecomastia before they should be FDA approved.

In summary, I would not recommend either of the above prescription drugs for treatment of gynecomastia. Certainly, measures such as trying to obtain ideal body weight and avoiding alcohol are recommended. However, the final choice in management was pretty well summed up by you; learning to accept it versus surgical treatment.

Good Luck.

Reference: Aromatase and gynecomastia. Endocrine Relat Cancer 1999 Jun;6(2):314-24 UI: 20193391

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