Progesterone and prolactin induced gynecomastia

[D7M]

More from Nandi....

PROGESTERONE AND PROLACTIN INDUCED GYNECOMASTIA


Before delving into this subject, I’d like to say first and foremost, that in users of anabolic /androgenic steroids (AAS) the first step in combating the development of gynecomastia, or male breast enlargement, is to eliminate the causative agent: the anabolic steroid . Drug-induced gynecomastia almost invariably resolves on its own when a person quits taking the drugs responsible for it, if caught before permanent fibrosis develops. Unfortunately, most AAS users don’t want to employ this simple approach, for obvious reasons, so the foregoing will all be under the assumption that a person wants to prevent or treat gyno and still continue steroid use .

In the belief that certain anabolic steroids increase prolactin levels as well as act as agonists at the progesterone receptor, some have advocated the use of antiprolactin agents, like bromocriptine, or progesterone receptor blockers like RU-486 to treat AAS related gynecomastia, in lieu of more traditional drugs like tamoxifen .

In truth, the etiology of gynecomastia is unknown and a number of agents including estrogens, progestins, GH, IGF-1, and prolactin may be involved. However, most authorities believe that a decreased (T+DHT)/E ratio is central to the development of gyno, and that blocking the effects of estrogen, or increasing T + DHT levels, is central to ameliorating the problem.

Regarding prolactin, androgens decrease prolactin levels whereas estrogens increase prolactin. Non-aromatizing androgens have never been shown to elevate prolactin levels in humans, but testosterone has, due to its aromatization to estradiol (19). Prolactin secreting tumors, or prolactinomas, are often associated with gyno. But in these cases the prolactin is believed to induce gyno by suppressing testosterone production: “Prolactinomas that are sufficiently large to cause gynecomastia do so as a result of impairment of gonadotropin secretion and secondary hypogonadism”. (20). However, this is a moot issue in AAS users whose gonadotropin secretion is already blunted.

According to research cited in (20), prolactin may have a direct stimulatory effect on mammary tissue development, but only in the presence of high estrogen levels:


The presence of mild hyperprolactinaemia is therefore not uncommon in patients with estrogen excess. Significant primary hyperprolactinaemia, on the other hand, may directly stimulate epithelial cell proliferation in an estrogen-primed breast, causing epithelial cell proliferation and gynaecomastia.

So rather than focusing solely on lowering prolactin levels which may be elevated in users of aromatizing androgens, attacking estrogen should be the first line of action.

GH and IGF-1 are considered critical to the proliferation of mammary tissue. An excellent review of the role played by these hormones, as well as a general overview of gynecomastia can be found here:




Since elevated GH and IGF-1 are considered important to the anabolic effect of AAS, it would be impractical and counterproductive to attempt to prevent gynecomastia by blocking GH/IGF.

Progesterone acts in concert with estrogen to promote breast development, and at least part of any role played by synthetic progestins may be to stimulate IGF-1 production in the breast. But again, blocking the action of progesterone or synthetic progestins is not practical. Specific progesterone receptor antagonists like RU-486 block not only the progesterone receptor, but the androgen receptor as well, and have actually been associated with the development of gynecomastia (21). In any case, progesterone is thought to act on the breast to enhance the effects of estrogen (22) so once again, attacking estrogen is the easiest and most logical approach.

DHT gel (Andractim) or a generic knockoff might help as well. DHT is thought to act as an aromatase inhibitor (23) and perhaps compete directly with estrogen for binding at the estrogen receptor (24). DHT has been used in several case reports and controlled trials to successfully treat gynecomastia. So perhaps a viable strategy would be to combine DHT gel with tamoxifen. I would recommend tamoxifen rather than an aromatase inhibitor due to the simple fact that tamoxifen has been widely used in numerous controlled studies to succesfully treat gynecomastia, whereas the evidence to support the efficacy of aromatase inhibitors is scanty at best.

[D7M]

References:

(1) Price TM, O'Brien SN, Welter BH, George R, Anandjiwala J, Kilgore M. Am J Obstet Gynecol 1998 Jan;178(1 Pt 1):101-7

(2) Bjorntorp P. Hum Reprod 1997 Oct;12 Suppl 1:21-5

(3) Ramirez ME, McMurry MP, Wiebke GA, Felten KJ, Ren K, Meikle AW, Iverius PH Metabolism 1997 Feb;46(2):179-85

(4) Zmuda JM, Fahrenbach MC, Younkin BT, Bausserman LL, Terry RB, Catlin DH, Thompson PD. Metabolism 1993 Apr;42(4):446-50

(5) Tomita T, Yonekura I, Okada T, Hayashi E
Horm Metab Res 1984 Oct;16(10):525-8

(6) Mystkowski P, Seeley RJ, Hahn TM, Baskin DG, Havel PJ, Matsumoto AM, Wilkinson CW, Peacock-Kinzig K, Blake KA, Schwartz MW. J Neurosci 2000 Nov 15;20(22):8637-42

(7) Greer,M. N Engl J Med 244:385, 1951

(8) Vagenakis AG, Braverman LE, Azizi F, Portinay GI, Ingbar SH. N Engl J Med 1975 Oct 2;293(14):681-4

(9) Krugman LG, Hershman JM, Chopra IJ, Levine GA, Pekary E, Geffner DL, Chua Teco GN J Clin Endocrinol Metab 1975 Jul;41(1):70-80

(10) Liva SM, Voskuhl RR J Immunol 2001 Aug 15;167(4):2060-7

(11) Ulloa-Aguirre A, Blizzard RM, Garcia-Rubi E, Rogol AD, Link K, Christie CM, Johnson ML, Veldhuis J Clin Endocrinol Metab 1990 Oct;71(4):846-54

(12) Hochman IH, Laron Z Horm Metab Res 1970 Sep;2(5):260-4
.
(13) Steinetz BG, Giannina T, Butler M, Popick F
Endocrinology 1972 May;90(5):1396-8

(14) Ferrando AA, Sheffield-Moore M, Yeckel CW, Gilkison C, Jiang J, Achacosa A, Lieberman SA, Tipton K, Wolfe RR, Urban RJ.
Am J Physiol Endocrinol Metab 2002 Mar;282(3):E601-7

(15) Sheffield-Moore M, Urban RJ, Wolf SE, Jiang J, Catlin DH, Herndon DN, Wolfe RR,
Ferrando AA
J Clin Endocrinol Metab 1999 Aug;84(8):2705-11

(16) Doumit ME, Cook DR, Merkel RA..Endocrinology 1996 Apr;137(4):1385-94

(17) Bricout VA, Germain PS, Serrurier BD, Guezennec CY.Cell Mol Biol (Noisy-le-grand) 1994 May;40(3):291-4

(18) Ferrando AA, Sheffield-Moore M, Yeckel CW, Gilkison C, Jiang J, Achacosa A, Lieberman SA, Tipton K, Wolfe RR, Urban RJ.
Am J Physiol Endocrinol Metab 2002 Mar;282(3):E601-7

(19) Nicoletti I, Filipponi P, Fedeli L, Ambrosi F, Gregorini G, Santeusanio F
Acta Endocrinol (Copenh) 1984 Feb;105(2):167-72

(20) Ismail AA, Barth JH.Ann Clin Biochem 2001 Nov;38(Pt 6):596-607

(21) Grunberg SM, Weiss MH, Spitz IM, Ahmadi J, Sadun A, Russell CA, Lucci L, Stevenson LL J Neurosurg 1991 Jun;74(6):861-6

(22) Nomura K, Suzuki H, Saji M, Horiba N, Ujihara M, Tsushima T, Demura H, Shizume K
J Clin Endocrinol Metab 1988 Jan;66(1):230-2

(23) Perel E, Stolee KH, Kharlip L, Blackstein ME, Killinger DW
J Clin Endocrinol Metab 1984 Mar;58(3):467-72

(24) Casey RW, Wilson JD.
J Clin Invest 1984 Dec;74(6):2272-8

[D7M]

I've highlighted some parts in bold for those of you who have trouble reading several paragraphs

[D7M]

^^^^^^

[marcus300]

Excellent read D7M, many dont know the first port of call should be to attack estrogen and see if that reduces the complaint of Prg,

Thanks D7M keep them coming




Keep bumped

[FuzzyPeaches o.O]

Good post! Hopefully this will cut down on the "can I use nolva while using a 19nor?" threads.

[HawaiianPride.]

[D7M]

Up for the morning crowd....

[Swifto]

I've been saying this for ages.

Estrogen is the regulator of prolactin. If you want more information, research the 'Long Feedback Mechanism'.

Only compounds that aromotase and interect with the ER can increase PRL.

AI's will help control PRL.

[tballz]

Great read....

[Charlie6]

can we put this in the educational section as well?

[jojomcgo]

Talk about package delivery.

[Bonaparte]

I've been saying this for ages.

Estrogen is the regulator of prolactin. If you want more information, research the 'Long Feedback Mechanism'.

Only compounds that aromotase and interect with the ER can increase PRL.

AI's will help control PRL.

?
I thought estrogen directly regulated progesterone, not prolactin. Oh Christ...

[Matt]

Great thread....

[Aizen Sosuke]

D7M thanks for digging this up. We should sticky this. HP that is the pic of the day.

[HawaiianPride.]

It fits this thread perfectly.

[Bertuzzi]

Bump....

[SomeLiveForTheBill]

Is the original post suggesting use of tamoxifen over anastrozole during cycle to combat estrogen sides?

[D7M]

Is the original post suggesting use of tamoxifen over anastrozole during cycle to combat estrogen sides?

Yes, but only secondarily.

Of primary note is that one should seek to control elevated PrL levels by first controlling Estrogen levels.

And the author recommends Tamox for this, yes.

[SomeLiveForTheBill]

Yes, but only secondarily.

Of primary note is that one should seek to control elevated PrL levels by first controlling Estrogen levels.

And the author recommends Tamox for this, yes.

So, use A-dex from day 1? If you see estrogen sides, switch to Tamox?

[D7M]

If you're using Adex from day one you shouldn't be having and Estrogen sides.

Both Adex (AI) and Tamox (SERM) are effective for controlling Estrogen.

The author was suggesting the use of Tamox.

[Hazard]

I recently had a bad bout of 19-nor induced gyno..... I immediately used Exemestane and nolva with a bit of caber and now no more problems. Only a maintenance dosage once or twice a week now.....

~Haz~

[40plusnewbie]

I'm on cyp and tren and have a higher than recommended bf so am at greater risk of estro issues. i have adex and letro both on hand. i've been taking a little letro as a precaution every 3-4 days. Is this a reasonable approach (assuming i don't want to just wait to see if I have symptoms or stop my cycle)? or switch to the adex? I felt like the letro was more of an estro killer than adex or nolva (I have nolva and torem on hand too). My plan OK or sugggsted changes with the pct drugs I have on hand. I'm also taking HCG 250iu 2x/week.

[songdog]

great thread

[HawaiianPride.]

Bump.

[sms]

If you're using Adex from day one you shouldn't be having and Estrogen sides.

Both Adex (AI) and Tamox (SERM) are effective for controlling Estrogen.

The author was suggesting the use of Tamox.

D7M,

please correct me as Im newbie but wouldnt an AI be better to use to combat Estrogen as first port of call as it stops the Aromatization to Estrogen rather than a SERM as its a blocks the recptor sites not the conversion to estrogen?? good damn I'm confused now??

[blizzard]

Bump

[baseline_9]

Nice read

[Matt]

D7M,

please correct me as Im newbie but wouldnt an AI be better to use to combat Estrogen as first port of call as it stops the Aromatization to Estrogen rather than a SERM as its a blocks the recptor sites not the conversion to estrogen?? good damn I'm confused now??

Yes it would be better to use and ai like adex or stane to control estrogen in the first place...

Sometimes though people will use nolva, i like using nolva because i don't mind the slightly elevated estrogen levels. Just don't like gyno, and yes we use nolva to stop estrogen from binding to breast receptors...

[2jz_calgary]

great thread. Ive read swiftos advice on all this earlier. I used to think prolactin could cause gyno as well as nolva will make it worse...both myths.

[jimmyinkedup]

Shame this man is no longer with us...
You know the only things I ever read that were written by that POS A. Roberts that were true - were the things he down right plagerized /stole from this man. Everytime i see anything Nandi wrote ..it makes me hate roberts more and more....
Anyway Im real familair with this post, its great info..as was always the case coming from this guy.

[2jz_calgary]

bump

[Swifto]

?
I thought estrogen directly regulated progesterone, not prolactin. Oh Christ...

Bonaparte,

Nandi is spot on.

http://forums.steroid.com/showthread...s-sex-problems

[Nebuchadnezzar]

thank u so much
i had so many questions regarding prolactin and u answered everything beautifully
thanx man

[yungone501]

I recently had a bad bout of 19-nor induced gyno..... I immediately used Exemestane and nolva with a bit of caber and now no more problems. Only a maintenance dosage once or twice a week now.....

~Haz~

Wow, if you had some man-boobs, you'd look very close to a competitive female bodybuilder! :-)

[denzel]

why is there 100 posts throughout different forums/internet saying serms/ai will not help progesterone induced gyno...i thought it was not estrogen related so serms/ai could not help?!

[Lemonada8]

Cuz there is no such thing as progesterone induced gyno... :-P

and its all about estrogen control... the main hormonal difference between men and women is the levels of estrogen, yet we can change sexes through hormonal therapy... so other horomones begin to react with elevating estrogen when estrogen gets high enough

[sizzlechest]

Tren E gave me Gyno.

[Swifto]

Cuz there is no such thing as progesterone induced gyno... :-P

and its all about estrogen control... the main hormonal difference between men and women is the levels of estrogen, yet we can change sexes through hormonal therapy... so other horomones begin to react with elevating estrogen when estrogen gets high enough

Progesterone shows to speed breast cell proliferation in primates. But this is in the presence of estrogen. Never seen anything alone.

Tamox is the key here, as in most cases. Whether is estrogen alone or a combination of estorgen+progesterone, doesnt matter.

[Cwired]

So what should you take or do if you already have gyno?