In regard to Tamoxifen

[GynoUser]

I wanted to ask you some questions regarding the use of Tamoxifen and the possibility of it removing gyne. Before anything i want to specify that i have been living with this problem since i started puberty, at the age of 10, and the problem hasn't solve yet (i'm 19 years old, turning 20 soon). Every time i went to the doctor when i was in the mid-puberty they said me the exact same thing, that the problem would solve itself in an interval of 1-2 years, but that hasn't been true in my case.

So this year i went to consultation demanding for solutions, and they sent me to breast pathology. I forgot to said that i have type one gynecomastia or "puffy nipples", so when i went there i thought that they would sent me packing since this problem is sometimes underestimated by doctors, even more if they are just puffy nipples (at least it's here in Spain or i feel like it's like this). But to my suprise, the doctor sent me to have a sonogram (to see the mammary glands) and a blood test to see how my hormones are doing. The blood test didn't show anything unusual and the sonogram displayed i have an asymmetrical gynecomastia (bilateral).

So the doctor prescribed me with Tamoxifen. I asked her what is the success rate, saying, if i remember correctly, that studies provided a success rate of 80% or plus of eliminating or reducing gynecomastia and she told me that she had prescribe this medicine to other patients of her and it succeeded (i don't know if these patients were in the same situation as me, i mean, gynecomastia of pubertal origin). So i started taking it everyday since 6th november; the first two weeks i had to take only the minimun dose, 5 mg, and up to now 10 mg. The recommended dosage for my height and weight is 20 mg a day, but i suffer from Gylbert's syndrome (a mild liver disorder) so she wanted to be cautious about it, but i haven't had any problems in regard to the treatment.

But, having in mind that i haven't been taking the right dosage for my height and weight like i said before, i haven't seen any improvement so far. I know i have been doing this treatment for a short period of time, but when i search for information about Tamoxifen and gynecomastia on the internet i always found bad opinions about it, that it never works and the only solution feasible is surgery.

What i'm supposed to believe? I don't want to think that the doctor was wrong prescribing me Tamoxifen, because she is a specialist and have manage cases like mine before, but also reading on the internet, i have found that the most possible scenary is that i have fibrosis on my mammary glands and the drug won't work in this case (established gynecomastia).

Thank for your attention and time and sorry for the grammar mistakes in advance.

[Dr. Elliot Jacobs]

Your story is sadly common to me.  

Myth #1  Many young boys who have gynecomastia are reassured by their pediatricians to hold out and wait because it will disappear by the magical age of 18.  I am still holding my breath, waiting for the one young man whose gynecomastia disappeared overnight when he turned 18.  Bottom line:  if a young man has gynecomastia which hasn't improved to some extent within two years of appearance, then it will remain and would require surgery to remove it.

Myth #2  Surgery done during teen years may result in recurrence in later years.  Absolutely wrong:  I have performed gyne surgery on teens for over 20 years and have yet to see a recurrence.

Myth # 3  Surgery done during teen years may result in unknown illnesses in the future. Hogwash!

Myth #4  Tamoxifen can get rid of gynecomastia.  Established gynecomastia does not respond to Tamoxifen.  If it did, then most guys with gyne would be on it.  Tamoxifen may help with growing gynecomastia in its most early stages -- but this has not been scientifically studied.

Sorry, your doctor is plain wrong.  Seek an experienced gynecomastia surgeon and get it done right the first time.

Dr Jacobs

[DrPensler]

I have written about this numerous times in the past but will give you a quick recap. Tamoxifen is an anti-estrogen typically used in certain types of breast cancer that are sensitive to estrogen. Years ago   I think around 2000 working with a group of endocrinologists  and basic scientists we looked into estrogen and progesterone receptors in gynecomastia patients. The thinking was that if idiopathic gynecomastia is due to either an increase in estrogen or progesterone  receptor number or increase in estrogen  or progesterone receptor binding ( how tightly the receptors hold on to estrogen ) there would be a basis for anti estrogens in the treatment of specific types of gynecomastia. In idiopathic gynecomastia serum estrogen levels are not elevated. There are not increased numbers or binding capacity of estrogen or progesterone receptors in patients with idiopathic gynecomastia. Tamoxifen has side effects ,obviously for some patients with breast cancer the benefits out way the risks. For patients with idiopathic gynecomastia tamoxifen is not effective and has no mechanism for positive benefit.

[Litlriki]

Agree with the previous replies. Studies of "medical treatment" of gynecomastia show that even in patients considered to be treated "successfully," a large percentage went on to have surgery anyway, because they weren't satisfied with the appearance in spite of what was deemed to be successful treatment. If it's not resolved within three years of onset, it's not going to resolve. 

[GynoUser]

Thanks for your replies, doctors. I have to visit my doctor soon in January and i will express my dissatisfaction about the treatment. I think i will have to search for an experienced gyne surgeon, because the most probable thing that it's going to happen it's that they will send me to a general surgeon instead of a plastic surgeon.

Thanks again for your replies and hope this 2019 is the year in which i'll get rid of this problem.