Drug Therapies an Option........

[folkers]

Wanted to hear anyone's thoughts on this..........Here's an excerpt from an article posted in the Cleveland Clinic Journal of Medicine (http://www.ccjm.org/PDFFILES/Bembo604.pdf):

"Even with exhaustive evaluation, no underlying cause is identifiable in about 25% of patients.15 In these cases, no treatment is necessary, unless the condition causes pain, embarrassment, or psychological discomfort. In these patients, drug therapy may be tried. Options include antiestrogens (clomiphene,tamoxifen), androgens (danazol), and aromatase inhibitors. Clomiphene has been tried mainly in uncontrolled studies, in which it had variable efficacy.19 Tamoxifen, in an uncontrolled study, resulted in complete regression of gynecomastia in 70% of cases.20 Danazol is a weak androgen that inhibits pituitary secretion of LH and FSH. In a randomized, double-blind study, danazol significantly reduced breast tenderness and size compared with placebo.21 In a head-to-head study,78% of patients receiving tamoxifen 20 mg daily showed complete regression of gynecomastia vs 40% in patients receiving danazol 400 mg daily.22 Testolactone, an aromatase inhibitor, was tried in a small uncontrolled study inpatients with pubertal gynecomastia, with good results.19 There have been no studies of the newer aromatase inhibitors letrozole or anastrozole in the treatment of gynecomastia."

I'm sure many of the folks here have already reviewed this article, along with many other articles referencing studies that are relevant. I hope I'm not bringing up a "dead horse" that's already been beaten to death, but.......does anyone know if the above excerpt was referring to studies done only with adolescents, or gynecomastia of recent onset? I don't get that from this excerpt. So, should the above referenced studies be considered a lot of rubbish or not? Even if someone achieved "some" relief thru drug therapy, isn't that something for others to put hope in, in that a drug therapy may work for some?

Thanks for any input.........

[folkers]

Complete regression in 70% of cases.......that's a pretty good response rate. It's too bad there aren't more documented studies that could support this. Based upon what I've read, it seems there's not a lot of support in favor of drug therapy as an option. There is no doubt that surgery can be considered the "ultimate" option because of the success rate, but for some who elect not to have surgery, it would be nice if drug therapy could be viewed as a viable alternative. I suspect that if one were to compare cases involving surgery against those involving drug therapy, surgery would win out right. But, if drug therapy produced partial or complete resolution, that's a good thing.

[moobius]

the thing is that alot of these drug therapies appear to work while they are being used b/c they diminish the prominence of the gland. they shift the hormonal balance to a more androgenic state by using androgens (danozol), aromatase inhibitors (arimidex, exemestane, formestane, etc) which decrease levels of estrogen in the body, or by antiestrogens (clomid, tamoxiphen) which compete with circulating estrogen for the estrogen receptors which in effect keeps estrogen from "doing it's thing".

in such a condition, the glandular tissue which is sensitive to this altered hormonal state will "deflate" (trying to create a mental image here). once drug therapy ceases, the orginal hormonal balance will return along with the "reinflated" gland.  it is not a permanent solution.

the same goes for all these snake oil "gyne-cure" supps that you find on the interent that usually are some mix of herbal supplements. yes, they may appear to work while taking them, but once off they havent' improved the situation -- but drained your wallet

[folkers]

Moobius,

Thanks for the input....if that's the reality of the situation, that's pretty sobering. Some the these "studies" have documented what you've described. If I have it right, one study indicated "no significant changes occurred 9 to 12 months after drug therapy was stopped", and another study indicated that the relapse rate was higher when Tamoxifen was used vs. Danazol (so the risk of relapse was acknowledged). So, let's say for arguments sake, if one had a 50% chance of some or total relapse after drug therapy, wouldn't it still be worth trying with a 50/50 shot? I guess I'm trying to make a case for trying drug therapy before surgery.

[folkers]

Some info:

I have had gyne for 30 yrs (since puberty). I was never considered obese. Tests with an Endocrinologist came back normal. Would it be reasonable to assume any of the following:

-During puberty, my hormones were tipped in favor of developing some glandular tissue that never resolved.

-Drug therapy "may" and I stress may help give that "tipped scale" a push in the correct direction with the hopes that things may remain stable with time.

-Drug therapy would be a waste of time, and surgery would be best.

-Do I have a pre-dispostion to gyne (based upon what happened during puberty), and that even if I had surgery, there's a good possibility of having a recurrence.

Any thoughts....

[moobius]

Some info:

I have had gyne for 30 yrs (since puberty). I was never considered obese. Tests with an Endocrinologist came back normal. Would it be reasonable to assume any of the following:

-During puberty, my hormones were tipped in favor of developing some glandular tissue that never resolved.

-Drug therapy "may" and I stress may help give that "tipped scale" a push in the correct direction with the hopes that things may remain stable with time.

-Drug therapy would be a waste of time, and surgery would be best.

-Do I have a pre-dispostion to gyne (based upon what happened during puberty), and that even if I had surgery, there's a good possibility of having a recurrence.

Any thoughts....

your first assumption may very well be true. if that was indeed the case, the assumption #2 would be have BEEN an option AT THE TIME that your hormones were "out of whack" (ie during puberty)... now that the tissue has developed, it will not simply "disolve" by bringing the current hormone levels back into proper alighnment(and at this point i highly doubt that any of your hormones are abnormal). IMHO, at this point assumption #3 is probably very true.

#4 may be true, but if the gynecomastia was caused by hormonal flux during puberty then i'd think it's a pretty safe bet you wont' have a recurrence barring anything that drastically throws your hormonal balance for a spin

[moobius]

Moobius,

Thanks for the input....if that's the reality of the situation, that's pretty sobering. Some the these "studies" have documented what you've described. If I have it right, one study indicated "no significant changes occurred 9 to 12 months after drug therapy was stopped", and another study indicated that the relapse rate was higher when Tamoxifen was used vs. Danazol (so the risk of relapse was acknowledged). So, let's say for arguments sake, if one had a 50% chance of some or total relapse after drug therapy, wouldn't it still be worth trying with a 50/50 shot? I guess I'm trying to make a case for trying drug therapy before surgery.

IMHO, i think you would be setting yourself up for a disappointment by trying to cure glandular gynecomastia with drug therapy.