Treatment for Gynecomastia in men on Testosterone Therapy
Keywords: Estradiol, E2, Arimidex, Tamoxifen, Clomid, Testosterone, Obesity, Male Breast Tissue, Testosterone Enanthate, Liposuction, Plastic Surgeon,
Gynecomastia is an enlargement of male breast tissue and can be secondary to a variety of medical conditions. Medications such as statins, proton pump inhibitors, Lasix diuretics and HIV medication are associated with enlargement of male breast tissue. Nutraceuticals, alcohol and marijuana use can enlarge the fatty tissue of the male breast. Many men who are planning to undergo testosterone replacement therapy (TRT) do ask about the risk of getting male breast tissue growth while on therapy. Gynecomastia is an estrogen mediated phenomenon. In men who are on high dose anabolic androgenic steroids the development of gynecomastia is 20-30%. Men who undergo TRT may experience a rise in the E2 ( Estradiol) levels and subsequent enlargement of breast tissue. Gynecomastia is often more common in men who are undergoing testosterone replacement with testosterone enanthate compared to testosterone cypionate. The most significant risk factor for gynecomastia development is a low testosterone level and obesity. For men with Low T and pre existing gynecomastia, testosterone therapy can improve gynecomastia by altering the estradiol/ testosterone ratio.
For male patients who find themselves observing male breast enlargement, the addition of Arimidex (anastrozole), to reduce estradiol levels can prevent gynecomastia while on TRT. For patients who develop or have preexisting gynecomastia, combination use of Arimidex and Tamoxifen is useful to shrink and target male breast tissue. Tamoxifen is also useful to combat the discomfort that accompanies enlargement of male breast tissue. The standard dosing is often 10-20mg/day for three to six months. Pain improvement is often experienced in the first month. 90% reduction in male breast size is often experienced by 3-6 months of therapy. Gynecomastia refractory to medical treatment may necessitate surgical intervention with a plastic surgeon to perform a liposuction with possible mastectomy.
Male patients who are on a SERM, such as Clomid (Clomiphene Citrate), will experience a rise in Estradiol concomitantly with a rise in total testosterone. Use of Arimidex can be advised during Clomid use as well.
In men who are on Testosterone therapy, commonly an estradiol level rise above 40, should prompt the clinician to consider the use of an anti-estrogen.
Elevated estradiol levels can negate the effects of an elevated testosterone level.
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