Can trazodone cause gynecomastia?

Trazodone and Gynecomastia

Trazodone does not cause gynecomastia based on available evidence. While many medications can cause gynecomastia, trazodone is not listed among medications with established or probable associations with this condition.

Evidence Assessment

FDA Drug Label Information

• The FDA drug label for trazodone does not list gynecomastia as a reported adverse effect in either clinical trials or post-marketing surveillance 1
• The label lists numerous adverse reactions affecting various body systems, including reproductive system disorders such as breast enlargement, clitorism, lactation, and priapism, but notably does not mention gynecomastia 1

Medications Known to Cause Gynecomastia

• Medications with definite associations to gynecomastia include spironolactone, cimetidine, ketoconazole, human growth hormone, estrogens, human chorionic gonadotropin, anti-androgens, GnRH analogs, and 5-α reductase inhibitors 2
• Medications with probable associations include risperidone, verapamil, nifedipine, omeprazole, alkylating agents, HIV medications (particularly efavirenz), anabolic steroids, alcohol, and opioids 2
• Spironolactone is specifically noted in clinical guidelines to have a greater risk of gynecomastia compared to eplerenone when used as aldosterone antagonists 3

Antidepressants and Gynecomastia

• While some antidepressants have been associated with gynecomastia in case reports, trazodone is not specifically identified as a causative agent 4
• The American Urological Association specifically states that trazodone is not recommended for erectile dysfunction treatment but does not mention gynecomastia as a concern 3

Clinical Implications

Differential Diagnosis for Gynecomastia

• When evaluating gynecomastia, clinicians should consider medications with established associations, particularly spironolactone, which is documented to cause this side effect 3
• Gynecomastia occurs in approximately 10-25% of cases due to medications, with the remainder due to physiological causes, hormonal disorders, or idiopathic factors 2
• Male breast enlargement may also represent pseudogynecomastia (fatty tissue deposition without glandular proliferation), especially in patients with elevated BMI 3

Monitoring and Management

• If a patient develops gynecomastia while taking trazodone, clinicians should investigate other more likely causes, including other medications the patient may be taking 2, 5
• Gynecomastia is often transient and may resolve spontaneously even with continued use of the suspected medication 6
• For patients requiring medication for conditions like heart failure or hypertension who develop gynecomastia on spironolactone, switching to eplerenone may be beneficial as it has a lower risk of this side effect 3

Conclusion

Based on current evidence, trazodone is not associated with gynecomastia. If a patient taking trazodone develops gynecomastia, other causes should be investigated, including other medications with known associations to this condition.