From the Guidelines
The most effective treatment for gynecomastia is addressing the underlying cause, and if caused by medications like spironolactone, discontinuing the medication is the first step, as seen in patients where spironolactone may need to be stopped if painful gynecomastia develops 1. When considering treatment options for gynecomastia, it's essential to evaluate the cause, duration, and severity of the condition.
- For recent-onset gynecomastia, discontinuing contributing medications is crucial.
- For idiopathic or pubertal gynecomastia, observation is often recommended, as many cases resolve spontaneously.
- Medical therapy, such as tamoxifen or anastrozole, can be effective for recent-onset cases.
- Surgical options, including liposuction or surgical excision, may be considered for persistent gynecomastia or cases causing significant distress. It's also important to consider the potential side effects of medications and the patient's individual circumstances when choosing a treatment approach, as some medications like bicalutamide may require preventive measures such as breast bud irradiation to prevent painful gynaecomastia 1. Discontinuing the offending medication, such as spironolactone, is the most straightforward approach to managing gynecomastia caused by medication use 1.
From the Research
Treatment Options for Gynecomastia
- Medical therapy: Estrogens stimulate the growth of breast tissue, whereas androgens inhibit it; most cases of gynaecomastia result from deficient androgen action or excessive estrogen action in the breast tissue 2.
- Anti-estrogen therapy: Tamoxifen has been shown to be effective in reducing the size of gynecomastia and alleviating symptoms in some patients 3, 4, 5.
- Surgery: May be necessary when gynaecomastia does not resolve spontaneously or with medical therapy 2, 4.
Specific Treatment Studies
- Clomiphene citrate: Was found to be ineffective in reducing the size of persistent pubertal gynecomastia in a study of 12 boys 6.
- Tamoxifen: Has been shown to be effective in reducing the size of gynecomastia and alleviating symptoms in several studies 3, 4, 5.
- Radiotherapy: Has been suggested as a possible therapeutic option for the treatment of gynecomastia in patients with prostate cancer and hormone deprivation therapy 4.
Patient Outcomes
- A study of 81 patients with idiopathic gynecomastia found that 90.1% had a complete response to tamoxifen therapy 5.
- Another study found that seven out of ten patients experienced a decrease in the size of their gynecomastia due to tamoxifen 3.
- A study of patients with prostate cancer and hormone deprivation therapy found that tamoxifen was effective in reducing the size of gynecomastia and alleviating symptoms 4.