Anti-estrogen drugs seem to work very well.

[aux513s]

I was reading an article about gynecomastia on eMedicine:

http://www.emedicine.com/med/topic934.htm

and I was surprised at the sucess rate given for anti-estrogen drugs.

It says 80% of patients report partial-to-complete resolution of gynecomastia when tamoxifen is used. This percentage was way higher then I expected.

It also says that 90% of pubertal gynecomastia resolves itself on it's own, so there's some good news for all the fifteen year olds on this forum.

[hypo]

Part of the actions of anti-estrogens and aromatase inhibitors do not work or only work in a limited manner in those who have primary hypogonadism and might not work in those with hypogonadism that originates in the hypothalamus.

The reason is that they not only reduce estrogen but also increase testosterone levels as explained below;

Anti-estrogens lower the effects of estradiol and aromatase inhibitors lower estradiol levels.  This lowering of estradiol is recognized by the Hypothalamus which increases the release of GnRH (maybe not if the hypothalamus is the problem) and this in turn increases the release of LH which tells the testicles to produce more testosterone (something that the testicles cannot do in primary hypogonadism).

So for those who have primary hypogonadism or hypothalamus based secondary hypogonadism part of the actions of these drugs are redundant.

For these people these drugs may still have a part to play alongside TRT therapy but are unlikely to be of significant benefit on their own.

The article quoted is not a study of these men.

[aux513s]

The article was written by a real doctor though, and I assume he didn't just come up with the statistics out of thin air.

[hypo]

Correct.

Incidentally all the statistics that I have produced for this website are from real doctors and are vallidated where possible and are indicated as not being vallidated when data is in question.

If you were to do a search, it could be found that I posted this 80% success rate data with Tamoxifen many months ago, but with reservations.  

I too came across that article about a year ago.  The statistical success rate of 80% as I say does not come from men with hypogonadism but eugonadal/healthy men.  It is therefore inappropriate to apply this statistical success rate to hypogonadal men.

This fact maintains the importance for people of the need to see an endocrinologist to rule out hormone problems and shows that self medication with Tamoxifen is not the way to go.  

Furthermore this 80% success rate is mentioned in other papers that I have viewed and is from an  uncontrolled trial with a small number of participants and has not been vallidated by larger control studies, so it is very debatable as to whether its success rate is as good as that trial would suggest.

[Paa_Paw]

Very Good Point Hypo!

Lacking a control group, The results would need to be considered anecdotal rather than objective.

Given the high incidence of resolution in the age group indicated and taking into account the role of estrogen in epiphyseal closure and bone maturation; I would be concerned about the safety of anti estrogen treatment vs expected benefits.

[hypo]

Tamoxifen 'may' be very successful and a correct therapy for some people in the future and even now if part of a trial/study or under expert guidance.

Who knows?

In view of its good safety record, If an endocrinologist has advised its use then fine, as you would be under expert medical supervision and the dosage controlled etc

But it needs more studies to be fully validated and it should never be self medicated given the issues that relate to it.

Only a couple of days ago I was conversing with a man on this site when they told me that their gp had prescribed Tamoxifen prior to pathology investigations with an endocrinologist.  

I told them I thought that to be remise of their gp and that was in spite of a high estadiol level that looked like it might need that very drug.  

The reason was that this man had not been investigated as to why he had high estradiol and was due for investigations with an endocrinologist.

I thought this was likely to skew this mans investigations with his endocrinologist and hinder this mans diagnosis and in view of that thought that the endocrinologists might have to tell the man in question that his appointment would have to be put back around three months.

When he saw the endocrinologist he had pathology- the appointment was put back three months.

The gp had taken a decision that made the endocrinologist’s job impossible at that time-

Self medication can of course do the same thing and make new endocrine investigations very difficult.