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Treatment for Gynecomastia
May 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. I am not familiar with Teslac, but I can understand why your physicians would not have prescribed an anti-estrogen for you. Put simply, your gynecomastia will either "runs it course" and resolve on its own, or you will have it forever. If it resolves on its own, no treatment (even surgery) is needed. If it doesn't resolve on its own, then the anti-estrogen won't cure it, the medication will just keep the symptoms under control. That means you would need to take the medication for your entire life. Taking an anti-estrogen for the next 70 years could carry significant adverse effects, and it simply is not worth the risk.

Since you have had the problem now for 6 years, it seems less likely (but still possible) that it will regress on its own. It surprises me that you call the surgery expensive...while I don't want to minimize any cost, it seems that this should be a fairly straight-forward (and relatively inexpensive) outpatient surgery. If you have received only one surgical opinion, you might ask around.

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