Gynecomastia medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Gynecomastia is usually a self-limited condition, reassurance and follow-ups are recommended. Causative medications should be withheld and any underlying condition leading to gynecomastia should be thoroughly investigated and treated. Pharmacologic therapy is beneficial for the first several months until fibrous tissue replaces the glandular tissue. Pharmacologic options include SERMs, androgens and aromatase inhibitors.

• Asymptomatic gynecomastia usually does not require treatment; reassurance is all that is required.
• Treatment of symptomatic gynecomastia (discomfort, tenderness, psychological stress) 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 a medication effect, withdrawal of that medication should lead to improvement over a period of a few months.

Pharmacologic medical therapies for gynecomastia include:^{[1][2][3][4][5][6]}

• Testosterone replacement can improve gynecomastia in hypogonadism of short duration, but it can worsen gynecomastia in eugonadal men due to aromatization to estradiol.

• Aromatase inhibitor (anastrozole) is useful in aromatase excess syndrome cause of gynecomastia.

• Selective estrogen receptor modulators (tamoxifen, raloxifene) have been used with varying degree of success with tamoxifen better than raloxifene.

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