Gynecomastia medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Gynecomastia}} | {{Gynecomastia}} | ||
{{CMG}} | {{CMG}} {{AE}} {{HS}} | ||
==Overview== | ==Overview== | ||
Gynecomastia is usually a self-limited condition, reassurance and follow- | 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|Pharmacologic therapy]] is beneficial for the first several months until [[fibrous tissue]] replaces the [[glandular tissue]]. [[Pharmacologic]] options include [[Selective estrogen receptor modulator|SERMs]], [[androgens]] and [[aromatase inhibitors]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Asymptomatic gynecomastia usually does not require treatment; reassurance is all that is required. | *[[Asymptomatic]] gynecomastia usually does not require treatment; reassurance is all that is required. | ||
*Treatment of symptomatic gynecomastia (discomfort, tenderness, psychological | *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. | *In gynecomastia with the identifiable underlying cause, treatment of that underlying cause can address the symptoms. | ||
*If the gynecomastia is believed to be | *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 therapy === | === Pharmacologic therapy === | ||
Pharmacologic medical therapies for gynecomastia include:<ref name="pmid17543732">{{cite journal| author=Narula HS, Carlson HE| title=Gynecomastia. | journal=Endocrinol Metab Clin North Am | year= 2007 | volume= 36 | issue= 2 | pages= 497-519 | pmid=17543732 | doi=10.1016/j.ecl.2007.03.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17543732 }} </ref><ref name="pmid17881754">{{cite journal| author=Braunstein GD| title=Clinical practice. Gynecomastia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 12 | pages= 1229-37 | pmid=17881754 | doi=10.1056/NEJMcp070677 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17881754 }} </ref><ref name="pmid2137877">{{cite journal |vauthors=Biro FM, Lucky AW, Huster GA, Morrison JA |title=Hormonal studies and physical maturation in adolescent gynecomastia |journal=J. Pediatr. |volume=116 |issue=3 |pages=450–5 |year=1990 |pmid=2137877 |doi= |url=}}</ref><ref name="pmid6772358">{{cite journal |vauthors=Friedman NM, Plymate SR |title=Leydig cell dysfunction and gynaecomastia in adult males treated with alkylating agents |journal=Clin. Endocrinol. (Oxf) |volume=12 |issue=6 |pages=553–6 |year=1980 |pmid=6772358 |doi= |url=}}</ref><ref name="pmid21209041">{{cite journal| author=Carlson HE| title=Approach to the patient with gynecomastia. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 1 | pages= 15-21 | pmid=21209041 | doi=10.1210/jc.2010-1720 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21209041 }} </ref> | [[Pharmacologic]] medical therapies for gynecomastia include:<ref name="pmid17543732">{{cite journal| author=Narula HS, Carlson HE| title=Gynecomastia. | journal=Endocrinol Metab Clin North Am | year= 2007 | volume= 36 | issue= 2 | pages= 497-519 | pmid=17543732 | doi=10.1016/j.ecl.2007.03.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17543732 }} </ref><ref name="pmid17881754">{{cite journal| author=Braunstein GD| title=Clinical practice. Gynecomastia. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 12 | pages= 1229-37 | pmid=17881754 | doi=10.1056/NEJMcp070677 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17881754 }} </ref><ref name="pmid2137877">{{cite journal |vauthors=Biro FM, Lucky AW, Huster GA, Morrison JA |title=Hormonal studies and physical maturation in adolescent gynecomastia |journal=J. Pediatr. |volume=116 |issue=3 |pages=450–5 |year=1990 |pmid=2137877 |doi= |url=}}</ref><ref name="pmid6772358">{{cite journal |vauthors=Friedman NM, Plymate SR |title=Leydig cell dysfunction and gynaecomastia in adult males treated with alkylating agents |journal=Clin. Endocrinol. (Oxf) |volume=12 |issue=6 |pages=553–6 |year=1980 |pmid=6772358 |doi= |url=}}</ref><ref name="pmid21209041">{{cite journal| author=Carlson HE| title=Approach to the patient with gynecomastia. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 1 | pages= 15-21 | pmid=21209041 | doi=10.1210/jc.2010-1720 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21209041 }} </ref><ref name="pmid21479145">{{cite journal| author=Johnson RE, Kermott CA, Murad MH| title=Gynecomastia - evaluation and current treatment options. | journal=Ther Clin Risk Manag | year= 2011 | volume= 7 | issue= | pages= 145-8 | pmid=21479145 | doi=10.2147/TCRM.S10181 | pmc=3071351 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21479145 }} </ref> | ||
==== Androgens ==== | ==== [[Androgens]] ==== | ||
*Testosterone replacement can improve gynecomastia in hypogonadism of short duration, but it can worsen gynecomastia in eugonadal men due to aromatization to estradiol. | *[[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 inhibitors]] ==== | ||
*Aromatase inhibitor (anastrozole) is useful in aromatase excess syndrome cause of gynecomastia. | *[[Aromatase inhibitor]] ([[anastrozole]]) is useful in [[aromatase]] excess syndrome cause of gynecomastia. | ||
==== Selective estrogen receptor modulators (SERMs) ==== | ==== [[SERM|Selective estrogen receptor modulators (SERMs)]] ==== | ||
*Selective estrogen receptor modulators (tamoxifen, raloxifene) have been used with varying degree of success with tamoxifen better than raloxifene. | *[[Selective estrogen receptor modulator|Selective estrogen receptor modulators]] ([[tamoxifen]], [[raloxifene]]) have been used with varying degree of success with [[tamoxifen]] better than [[raloxifene]]. | ||
==References== | ==References== | ||
Latest revision as of 16:52, 28 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]
Overview
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.
Medical Therapy
- 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 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.