Drugs That Cause Gynecomastia in Men

Did you know that almost 10% to 25% of gynecomastia cases develop due to the consumption of certain medicines? These medicines interfere with the normal hormonal balance of estrogen and testosterone levels in the body. The chemical composition of these drugs interacts with the hormones in the body and results in either the increase in estrogen level or the decrease in testosterone level.

The drugs increase the likelihood of gynecomastia developing in the following ways:

Reduce the testosterone levels in the body
Increase estrogen-like activities in the male body, mainly by overproduction of estrogen
Anti-androgenic effects
Increase the prolactin levels
Hypogonadism

List of Drugs That Cause Gynecomastia in Men

Antipsychotics- Chlorpromazine, Fluphenazine, Haloperidol, Perphenazine, Thioridazine, Trifluoperazine, Cimetidine, Aripiprazole, Asenapine sublingual tablets, Clozapine, Iloperidone, Finasteride, Olanzapine, Ziprasidone, Paliperidone, Quetiapine
Aldosterone Antagonists-Spironolactone, Eplerenone
Alpha-blockers
Calcium channel blockers- Verapamil, Nifedipine, Diltiazem
Digoxin
Estrogen use
Ethanol
Efavirenz
Methadone
Nitrates
Ketoconazole
Reserpine
Saw Palmetto

According to an article published in the “New Zealand Medicines and Medical Devices Safety Authority”, the following commonly prescribed medicines account for high chances of gynecomastia developing.

Quality of Evidence*	Examples of Medicines and/or Medicine Classes [in alphabetical order]
Good	Bicalutamide, cyproterone, dutasteride, finasteride, flutamide, goserelin, ketoconazole, leuprorelin, oestrogens, spironolactone
Bad	Alkylating agents, anabolic steroids, efavirenz, nifedipine, omeprazole, opioids, risperidone, verapamil

*Classification of evidence according to medicine strength.

Good- Based on randomized controlled trials, randomized placebo controlled trial, or prospective cohort studies

Fair- Retrospective studies, case-control studies or cases with good pathophysiological explanation

In another study with the title, “Drug-induced gynecomastia in children and adolescents”, the researchers found that there are several other drugs that have a close association with gynecomastia.

Antibiotics- ketoconazole, metronidazole, and isoniazid
Antiulcer drugs- cimetidine, ranitidine, omeprazole
Growth hormones
Chemotherapy medications- methotrexate and alkylating agents

The study also states that adolescents who use anabolic steroids or who abuse alcohol, marijuana, heroin or amphetamines are at a higher risk of developing gynecomastia.

Not only orally administered medications, topical use of medicines that can lavender oil or tea tree oil are also responsible for gynecomastia during puberty.

Causes of Gynecomastia Other Than Drugs

Medicines are not the only cause of gynecomastia men. There are other factors too that can disrupt the hormonal balance in men. These are as follows-

Age- Age is a crucial factor for risk of gynecomastia. As males reach puberty, they are prone to developing gynecomastia due to hormonal changes. However, these subside over time. Again when they reach their mid-40s, the condition can occur due to lower testosterone production.
Suffering from certain medical problems- Suffering from some particle medical illness results in the swelling of the breasts as a symptom. Some of these health problems include- a tumor in the testicles, cirrhosis and liver ailments, kidney failure and hyperthyroidism or hypogonadism.
Taking herbal products- Using certain herbal products that are rich in phytoestrogens are also likely to increase the chances of gynecomastia. Moreover, certain essential oils such as lavender or tea tree oil are also responsible for gynecomastia.

Also Read: Causes of Gynecomastia in Men

Medicines That Can Treat Gynecomastia

There are certain medicines that can curb the swelling by bringing the hormonal changes back to normal. With a proper prescription, these medicines are easily available in a pharmacy.

Testosterone Replacement Therapy (TRT)- These medicines aim to replace the testosterone in the male body which the patient is unable to synthesize on their own. Once the testosterone level increases, the hormonal imbalance gets corrected. TRT medicines include Danazol.
Selective Estrogen Receptor Modulators (SERMs)- These types of medicines increase the body’s ability to metabolize estrogen faster. The SERMs include Clomiphene and Tamoxifen.

Also Read: Pills That Can Treat Gynecomastia

Both the medicines work to either increase the testosterone or decrease the estrogen level in the male body.

What Is The Best Treatment for Gynecomastia?

The treatment of gynecomastia depends on the severity of the swelling, the age of the patient and the underlying cause. In case the swelling doesn’t subside after giving up the gynecomastia-inducing drugs or medicines to curb the swelling, the patient should consider a surgical option.

The gynecomastia surgery generally involves two steps- liposuction followed by gland excision surgery.

Liposuction- Liposuction is the removal of the stubborn fat around the abdomen, thighs, underarms, armpits, face, etc. The doctor makes several incisions through which they insert chemicals to disintegrate the fat cells and channel them out through a tube. Remember, don’t confuse it with a weight loss procedure.
Gland excision surgery- This is the surgery that aims to flatten the chest and enhance its contour. In this surgery, the doctor takes out extra tissue from the breasts through the nipples to reduce the swelling.

Both the procedures for gynecomastia are carried out under the influence of anesthesia. Hence, the patient is unable to feel any pain or discomfort.

Recovery After Gynecomastia Surgery

The primary tip to keep in mind is to take necessary precautions after the surgery as recommended by the doctor. Here is a checklist of do’s and don’ts to follow after gynecomastia surgery.

Do’s	Don’ts
Wear only loose clothing made up of comfortable fabric.	Avoid drinking alcoholic beverages to prevent dehydration.
Wear the compression garment at least for 21 days to make sure faster healing of wounds and long-lasting results.	Quit smoking to reduce the chances of delay in recovery.
Control the urge to itch around the wound.	Do not take supplements with vitamins and minerals without proper consultation with the doctor.
Apply cold compresses to the chest to reduce swelling and pain.	Do not forget to follow-up with the doctor after the surgery.
Hydration is an important part of recovery. Hence, drink lots of water on a daily basis.	Avoid eating food that are difficult to digest such as low-fiber food, fatty food, processed or canned items.
Get enough sleep. This is so because this allows the body to heal more quickly.

Conclusion

There are certain drugs and medicines whose prolonged use can cause gynecomastia in men. The first step is to stop using these medicines and finding an alternative after consulting with the doctor. However, in case the enlargement of breasts doesn’t reduce even after not using these medicines, then surgery is the only option. Pristyn Care offers both Vibration Amplification of Sound Energy at Resonance or liposuction and gland excision surgery. The doctors can clarify any doubts that you may have regarding any of these procedures. Book an appointment today with one of the doctors to know more about the same.