When there is significant tenderness or psychosocial morbidity, pharmacological agents can be tried. In a few published reports, the selective estrogen receptor antagonist tamoxifen has been shown to be safe and effective in reducing the size of glandular tissue in persistent pubertal gynecomastia. Lawrence et al. demonstrated a decrease in breast size in 20 out of 22 patients with use of tamoxifen, with 40% showing greater than 50% size reduction. In the same study, the selective estrogen receptor modulator raloxifene achieved an impressive 86% response rate of more than 50% reduction in breast size.[21] Similarly, Derman et al. showed reduction in pain and breast size in all of the 37 boys administered 20 mg per day of tamoxifen.[22] However, despite these positive encouraging results, the studies are difficult to interpret because of the small sample size and absence of a placebo-treated control arm. The experience with aromatase inhibitor anastrozole has been disappointing in persistent pubertal gynecomastia and is not recommended at present.....
It is unclear as to why aromatase inhibitors have not been very successful in the management of gynecomastia. This could be due to the fact that excessive aromatization of androgens to estrogens is not the only cause of relative or absolute excess of estrogens levels in such patients.
Reply With Quote