Does this site have non-surgical information for gynecomastia

[Keep_It_Moving]

I'm not saying this is a remedy, but I've been doing tons and tons of research on this and here are a few interesting things to look at....

1: J Pediatr. 2004 Jul;145(1):71-6. Related Articles, Links

Comment in:

* J Pediatr. 2005 Apr;146(4):576; author reply 576-7.
* J Pediatr. 2005 Apr;146(4):576; author reply 576-7.

Beneficial effects of raloxifene and tamoxifen in the treatment of pubertal gynecomastia.
Lawrence SE, Faught KA, Vethamuthu J, Lawson ML.
Department of Pediatrics, University of Ottawa, Ontario, Canada.

slawrence@cheo.on.ca

OBJECTIVES: To assess the efficacy of the anti-estrogens tamoxifen and raloxifene in the medical management of persistent pubertal gynecomastia.

STUDY DESIGN: Retrospective chart review of 38 consecutive patients with persistent pubertal gynecomastia who presented to a pediatric endocrinology clinic. Patients received reassurance alone or a 3- to 9-month course of an estrogen receptor modifier (tamoxifen or raloxifene).

RESULTS: Mean (SD) age of treated subjects was 14.6 (1.5) years with gynecomastia duration of 28.3 (16.4) months. Mean reduction in breast nodule diameter was 2.1 cm (95% CI 1.7, 2.7, P <.0001) after treatment with tamoxifen and 2.5 cm (95% CI 1.7, 3.3, P <.0001) with raloxifene. Some improvement was seen in 86% of patients receiving tamoxifen and in 91% receiving raloxifene, but a greater proportion had a significant decrease (>50%) with raloxifene (86%) than tamoxifen (41%). No side effects were seen in any patients.

CONCLUSION: Inhibition of estrogen receptor action in the breast appears to be safe and effective in reducing persistent pubertal gynecomastia, with a better response to raloxifene than to tamoxifen. Further study is required to determine that this is truly a treatment effect.

PMID: 15238910 [PubMed - indexed for MEDLINE]



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1) ............We decided to evaluate the effect of raloxifene in a series of patients with gynaecomastia. Twelve patients aged 18-84 years were treated. Breast enlargement was unilateral in 5 cases; its duration ranged from a few weeks (7 cases) to several years (5 cases). Four patients were hypogonadal by clinical criteria, and had low serum testosterone. In two patients there was a possible drug effect (prasterone in one, ranitidine in the other). The size of breast tissue ranged between 1.5 and 6.0 cm. All patients had normal testes by palpation, and normal serum levels of estradiol, lh - leutenizing hormone - , FSH - follicle stimulating hormone - , prolactin, and alpha-HCG - human chorionic gonadotropin - . Liver function tests and serum creatinine also were normal. The dose of raloxifene was 60 mg every other day in 4 elderly patients (age 70 years or more), and 60 mg daily in the remaining; the medication was given for 2-12 months. Hypogonadal patients received, in addition, i.m. injections of testosterone enanthate, 100 mg twice a month.

Raloxifene was well tolerated; only one young patient reported a slight decrease in sexual potency. No subject complained of hot flushes; there were no episodes of thrombophlebitis during follow-up. The analgesic effect of treatment was fast (2-4 weeks) and sustained among 9 patients with pain and tenderness. The size of the gynaecomastia was evaluated monthly by means of a caliper (all patients), and ultrasonography (7 patients). All patients responded: there was an average reduction in size of 61% (range: 34-100%); in 2 patients gynaecomastia disappeared. Six of 8 eugonadal patients (75%) had a reduction in the size of breast tissue of at least 50% (average, 73%). Among hypogonadal patients (all of them followed with ultrasonography) gynaecomastia disappeared in one, and size reduction in the remaining subjects ranged between 46 and 67% (this is particularly noteworthy, since testosterone replacement not infrequently causes or aggravates gynaecomastia due to local aromatization to oestrogens by mammary tissue). Maximal effect was observed during the first 2 months of treatment.

This open, observational study suggests that raloxifene may be a safe, well tolerated and effective therapeutic alternative for drug-induced or idiopathic gynaecomastia in men of all ages.

[Paa_Paw]

Very interesting. and very suggestive that there may be something. The next step would be a double blind test using a larger sample group.

This information that you might think the drug companies would be interested. A reliable drug that would reduce Gynecomastia would be a gold mine for a pharmaceutical company.

The next questions might be: Why is there no follow up to this item from 8 years ago? Was a double blind test done? You get the idea, The article is provocative, but not conclusive.

I really admire your sense of hope. If you live long enough you may actually see what you want.

[Keep_It_Moving]

Paa_Paw-


Thank you for the kind words. I have over a dozen articles and I would like to share some with this community. Is there someone I can contact so I can send them for their approval?

Here is another one that light up my face...

My raloxifene research (EVISTA®)
 

Raloxifene - 2nd Generation SERM (Specific Estrogen Receptor Modulator)
Brand Name - Evista (Raloxifene HCL)
Halflife - 27.7 hours

A few studies:

Effects of raloxifene on gonadotrophins, sex hormones, bone turnover and lipids in healthy elderly men
EJ Duschek, LJ Gooren, and C Netelenbos

Department of Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands. e.duschek@vumc.nl

OBJECTIVE: To explore effects on serum lipids, pituitary-gonadal axis, prostate and bone turnover of the administration of the mixed oestrogen agonist/antagonist raloxifene in healthy elderly men. PARTICIPANTS: Thirty healthy men aged 60-70 years randomly received raloxifene 120 mg/day (n=15) or placebo (n=15) for 3 months. MEASUREMENTS: In this double-blind, placebo-controlled study, serum gonadotrophins, sex hormones, prostate specific antigen (PSA), a marker of bone turnover, urinary hydroxyproline (OHPro) and cholesterol were measured at baseline and after 3 months. RESULTS: Raloxifene significantly increased serum concentrations of LH and FSH (by 29% and 21%), total testosterone (20%), free testosterone (16%) and bioavailable testosterone (not bound to sex hormone-binding globulin (SHBG; 20%). In parallel with testosterone, 17 beta-oestradiol also increased by 21%. SHBG increased by 7%. Total cholesterol (TChol) decreased significantly, from 5.7 to 5.5 mmol/l (P=0.03). Low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) showed a trend to decrease. Overall, there was no change in urinary OHPro/creatinine ratio as a marker for bone resorption. However, the raloxifene-induced increases in both serum testosterone and 17 beta-oestradiol were significantly related to a lower OHPro/creatinine ratio. Total PSA increased by 17% without significant changes in free PSA or free/total PSA ratio. Participants reported no side effects and raloxifene was well tolerated. CONCLUSION: In healthy elderly man, raloxifene 120 mg/day for 3 months increased LH, FSH and sex steroid hormones. Potentially beneficial effects were the small but significant decrease in TChol and the trend towards a decrease in LDL-c. Negative effects were the trend towards a decrease in HDL-c and the significant increase in serum PSA. A decrease in markers of bone resorption during raloxifene treatment was found only in men with relatively high increases in serum testosterone and 17 beta-oestradiol. Overall, there were no clear beneficial effects of administration of raloxifene to ageing men in this preliminary investigation.

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A study showing raloxifenes use in treating pre-existing gynocomastia

from Superior muscle

Selective estrogen receptor modulators (SERMs) are a relatively new family of drugs designed to act as estrogens on some, but not all, tissues.2 Tamoxifen is a first-generation SERM. Raloxifene, a second-generation SERM, has been extensively studied on postmenopausal women, and is indicated for the treatment of postmenopausal osteoporosis.3 It is an alternative to estrogen replacement therapy in women with a history of breast cancer.4, 5 Its anti-proliferative effect on mammary tissue is such that prolonged use reduces the risk of breast cancer among osteoporotic women.6

In a recent placebo-controlled short-term trial, the drug was administered to 34 healthy males (mean age, 48 years) at the dose of 60 mg/day for one month; no subject developed gynocomastia. Besides, serum testosterone increased 20%, and serum estradiol decreased slightly.7

We decided to evaluate the effect of raloxifene in a series of patients with gynocomastia. Twelve patients aged 18-84 years were treated. Breast enlargement was unilateral in 5 cases; its duration ranged from a few weeks (7 cases) to several years (5 cases). Four patients were hypogonadal by clinical criteria, and had low serum testosterone. In two patients there was a possible drug effect (prasterone in one, ranitidine in the other). The size of breast tissue ranged between 1.5 and 6.0 cm. All patients had normal testes by palpation, and normal serum levels of estradiol, LH, FSH, prolactin, and alpha-hCG. Liver function tests and serum creatinine also were normal. The dose of raloxifene was 60 mg every other day in 4 elderly patients (age 70 years or more), and 60 mg daily in the remaining; the medication was given for 2-12 months. Hypogonadal patients received, in addition, i.m. injections of testosterone enanthate, 100 mg twice a month.

Raloxifene was well tolerated; only one young patient reported a slight decrease in sexual potency. No subject complained of hot flushes; there were no episodes of thrombophlebitis during follow-up. The analgesic effect of treatment was fast (2-4 weeks) and sustained among 9 patients with pain and tenderness. The size of the gynocomastia was evaluated monthly by means of a caliper (all patients), and ultrasonography (7 patients). All patients responded: there was an average reduction in size of 61% (range: 34-100%); in 2 patients gynocomastia disappeared. Six of 8 eugonadal patients (75%) had a reduction in the size of breast tissue of at least 50% (average, 73%). Among hypogonadal patients (all of them followed with ultrasonography) gynocomastia disappeared in one, and size reduction in the remaining subjects ranged between 46 and 67% (this is particularly noteworthy, since testosterone replacement not infrequently causes or aggravates gynocomastia due to local aromatization to estrogens by mammary tissue). Maximal effect was observed during the first 2 months of treatment.

This open, observational study suggests that raloxifene may be a safe, well tolerated and effective therapeutic alternative for drug-induced or idiopathic gynocomastia in men of all ages.

Zulema Man, MD.
TIEMPO, Buenos Aires, Argentina

Ariel S??nchez, MD, PhD;
Hugo Carretto, MD;
Ricardo Parma, MD.
Centro de Endocrinolog??a, Rosario, Argentina

References

1. Khan HN, Blamey RW. Endocrine treatment of physiological gynaecomastia. Br Med J 2003;327:301-2.

2. Compston JE. Selective oestrogen receptor modulators: potential therapeutic implications. Clin Endocrinol 1998;48:389-91.

3. Agnusdei D, Iori N. Raloxifene: results from the MORE study. J Musculoskel Neuron Interact 2000;1:127-32.

4. Cummings SR, Eckert S, Krueger KA, Grady D, Powles TJ, Cauley JA, Norton L, Nickelsen T, Bjarnasson NH, Morrow M, Lippman ME, Black D, Glusman JE, Costa A, Jordan VC. The effect of raloxifene on risk of breast cancer in postmenopausal women. J Am Med Ass 1999;281:2189-97.

5. Mincey BA, Morahan TJ, Perez EA. Prevention and treatment of osteoporosis in women with breast cancer. Mayo Clin Proc 2000;75:821-9.

6. Cauley JA, Norton L, Lippman ME, Eckert S, Krueger KA, Purdie DW, Farrerons J, Karasik A, Mellstrom D, Ng KW, Stepan JJ, Powles TJ, Morrow M, Costa A, Silfen SL, Walls EL, Schmitt H, Muchmore DM, Jordan VC. Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Breast Cancer Res Treatment 2001;65:125-34.

7. Uebelhart B, Bonjour JP, Draper MW, Pavo I, Basson R, Rizzoli R. Effects of selective estrogen receptor modulator raloxifene on the pituitary gonadal axis in healthy males (Abstract). J Bone Miner Res 2000;15(Suppl 1):S453.


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A study documenting the long term use of Raloxifen

Effects of Long-Term Use of Raloxifene, a Selective Estrogen Receptor Modulator, on Thyroid Function Test Profiles


Sandy H.-J. Hsu, Wern-Cherng Cheng, Men-Wang Jang and Keh-Sung Tsai

Estrogen (1)(2)(3)(4)(5) may increase hepatic production of thyroxine-binding globulin (TBG) and decrease TBG clearance (6), thus increasing serum total thyroxine (tT4) (3)(4) and, to a lesser extent, total triiodothyronine (tT3) (3)(4). As a result, increased tT4 and tT3 are seen in states of excessive estrogen and/or progestin, such as pregnancy, estrogen replacement therapy (HRT) (5), and oral contraceptive usage (1). This phenomenon may cause problems in clinical diagnoses when tT4 or tT3 is used for these patients. On the other hand, estrogen has been shown to increase thyroid-stimulating hormone (TSH) and to decrease free thyroxine (fT4) through a mild inhibitory effect on the thyroid gland (4). Compound that are analogs of estrogens, such as tamoxifen, have been shown to increase TSH without decreasing fT4 (7)(. Recently, a new category of therapeutic agents, collectively termed selective estrogen receptor modulators (SERMs), has been developed to treat patients with postmenopausal osteoporosis (9). Raloxifene is one SERM. It decreases bone resorption (9)(10) and serum LDL-cholesterol (9)(11)(12), but it does not stimulate breast (13) or endometrium (14) at the recommended dosage of 60 mg daily. This agent is becoming one of the first-line pharmaceutical agents for postmenopausal osteoporosis and is currently administered to a large number of patients. However, the effect of long-term raloxifene usage on TBG, T3 uptake, tT3, tT4, fT4, and TSH has not been well documented. To investigate whether raloxifene causes changes in serum concentrations of these markers, we compared the effects of 1 year of treatment with either raloxifene or combined continuous estrogen and progesterone (CCEP) on the thyroid function test profiles, estradiol 2 (E2), and follicle-stimulating hormone (FSH).

We studied 60 euthyroid postmenopausal women (age range, 40–75 years) with relatively low bone mineral density. The t-score, using the mean and SD of healthy premenopausal Taiwanese women as reference (15), ranged from +1 to -2.49. These 60 women were divided into two groups in a double-blind, randomized fashion. Fifty women received raloxifene (60 mg daily) before breakfast, and 10 women received combined conjugated equine estrogen (premarin®; 0.625 mg) and medroxyprogesterone acetate (provera®; 5 mg) daily. Fasting serum samples were collected for all participants at baseline and after 1 year of treatment. All of the serum samples were stored at -70 °C, thawed simultaneously, and measured on the same day. All participants completed the treatment program. The compliance was good for both groups. Pill counting showed that each patient consumed 85–100% of the tablets/capsules.

Serum tT3, tT4, fT4, TBG, third-generation TSH, T3 uptake, E2, and FSH were all measured using commercial chemiluminescent immunoassays and instruments (Immulite; DPC). The within-day imprecision (CVs) of these assays was 3–7%.

We used two-way ANOVA for repeated measures to compare the concentrations of E2 and FSH and the thyroid function profiles between the two therapeutic groups, before and after treatment. The data were analyzed by the general linear model procedure (PROG GLM) included in the SAS package (SAS, Ver. 6.12; SAS Institute).

The anthropometric data and the mean value (± SE) for each thyroid function test item before and after treatment in the CCEP and raloxifene groups are shown in Table 1 . At baseline, there was no significant difference in height, weight, age, years since menopause, or thyroid function test items between these two groups. CCEP significantly increased serum TBG (17%), tT3 (5.7%), and tT4 (19%) and decreased T3 uptake (9%), whereas it did not change TSH. The mean fT4 concentration decreased by 3%, but the change was not statistically significant. Raloxifene also increased serum TBG (7.8%), tT3 (4.4%), and tT4 (5.7%) and decreased T3 uptake (3.7%). The mean fT4 concentration decreased by 3%, but this change was not statistically significant (Table 1 ). The changes in these five markers were apparently smaller than those caused by CCEP but did not reach statistical significance.

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[Paa_Paw]

Same thing. A small number of selected patients and no control group.

A really valid test would have many times more subjects and a control group.

It has been known for some time, that for some selected patients, Some drugsmay be beneficial. The trouble is that they do not work across the spectrum of men and they need to be carefully monitored, usually by an Endocrinologist.

There was a time when I personally thought every man should have a complete work-up by an Endocrinologist prior to seeing a surgeon. The truth is that the number of men who were helped by that was so small that the concept proved impractical.

The magic pill you are looking for may actually come along some day, but I certainly do not expect to live long enough to see it.

[Keep_It_Moving]

Paa Paw-

I hope that one day a pill is available to reverse or at least reduce the size of gyno. I have to give this method a shot before deciding to go through with surgery. I will be attempting the Raloxifene medication and log it in a thread. Best!

[Alchemist]

HI Keep_it_moving,

Good luck in your search.  At 65 I worry about the side effects of drugs that affect my health.  However, effects on male breast size are not a concern.  Having lost 40 pounds I have gone done from DD to D cup, which is to say no practical difference.  I was told as teen to loose weight.  I got down to 170 at 5'11" with a muscular build.  Nope, they didn't go away.  "Do pushups" the doctors said.  Right.  That made them more outstanding than ever.

I had no illusions that anything would change even if my breasts would disappear.  So I became a nudist, got rid of body shame and fear, and had a good time instead.  Make the most out of your life.  It's a shame to waste so much time, energy and concern on something that just don't make any difference when it comes right down to it.  One I got out of school and away from all the juvenile  minded nobody but bullies and as others have expressed the best way to deal with a bully is make them look like a fool in front of everybody.  When younger I also beat the crap out of some.  Bullies made me angry and I responded to them in ways so as to discourage them.  As I grew older I developed the skills to do it verbally.  Never let a bully win.

[hammer]

Alchemists and I (and some others) can also have fun in wet t-shirt contest putting the girls to shame as we win! LOL,  Double Ds can take home the prize many times when there on guys!

We have not only have learn to accept, live with, but have a little fun besides!

[Keep_It_Moving]

Alchemist-

Thank you for sharing your story with me. Having the dedication and determination to change your body by working out is inspiring. I've definitely let myself go for the past 4-5 weeks, but it's time to man up and enjoy my workouts.

Hammer-

Reading about you guys enjoying your lives despite the given circumstances is very encouraging. Inspirational. Thank you.

[Keep_It_Moving]

An interesting find....

[Testosterone and estradiol levels in male gynecomastia. Clinical and endocrine findings during treatment with tamoxifen].
[Article in German]
Eversmann T, Moito J, von Werder K.
Abstract
Oestradiol-(E2) levels in serum were significantly higher in a group of 91 males with gynaecomastia than in a control group. The levels were highest in patients with testicular tumour, hyperprolactinaemia and idiopathic gynaecomastia. In gynaecomastia of puberty and primary or secondary hypogonadism, the E2 level was within normal limits, but the testosterone/oestradiol ratio was significantly reduced. Tamoxifen, at a daily dose of 20 mg, was administered over 2-4 months to 16 patients with gynaecomastia. Of twelve patients with painful gynaecomastia ten became painfree. Gynaecomastia regressed partially or completely in 14 patients, in only 2 was it unchanged. There was no recurrence of gynaecomastia after discontinuing tamoxifen. Side-effects did not occur. It is concluded that tamoxifen is a promising alternative to the surgical treatment of gynaecomastia.
PMID:
6489180
[PubMed - indexed for MEDLINE]

[robirobi]

The poster did not mention alternative remedies actually. He said that in some cases Gyne is caused by a hormone imbalance and he was asking why this type of info isn't present on the site. No I don't know if hormones as someone said are "manageable" but it seems to me a fair question to ask? Most of you are mentioning the alternative medicine route which the poster isn't mentioning!

[Sven]

I will be attempting the Raloxifene medication and log it in a thread. Best!

Have you given this a shot?  I have similarly done a great deal of research on Raloxifene and I recently ordered it from an online pharmacy.  I am curious to know whether you ended up giving it a go, and if so what dosage you took and for how long.  Any results?  Thanks and good luck!

[Paa_Paw]

People will believe what they want to believe and a person will find a way to prove what they want to prove.

The study cited by Keep it Moving is an example. Actually he did a good piece of research but the study itself is flawed.

For starters, E2 levels were higher in the group of 91 men with Gynecomastia than in the control group. How many men were in the control group?

Next I would ask how the participants were selected. We know that the group of 91 included men with teaticular tumors and others with hyperprolactinemia but what is the actual incidence of those conditions? Obviously this was a select group even from the start.

Selecting 12 out of the 91 that had painful breasts, 10 were pain free as a result of the treatment. Breasts are painful only when they are actively growing, either in puberty or prior to lactation. I dare say that for most of us the growth happened long ago raather than now.

The 12 mentioned above were part of a group of 16 who were treated. Suddenly over 80% of the group were eliminated! I think screening probably showed that they would not benefit from the treatment. Anyway, 14 of the 16 had partial or complete regression. If the size of your vreasts is carefully measured, How much regression would you be happy with? 5% or maybe 10% No!you want it all gone.

What this study proves is what we have said here for at least 10 years. If a person has a glandular problem or their vreasts are actively growing, An Endocrinologist will be able to benefit a small number of selected patients. Most of us are not in that tiny group. I think the pre-operative screening by most surgeons would send most men to an Endocrinologist if there was a chance that it was the right thing to do.

[Keep_It_Moving]

I will be attempting the Raloxifene medication and log it in a thread. Best!

Have you given this a shot?  I have similarly done a great deal of research on Raloxifene and I recently ordered it from an online pharmacy.  I am curious to know whether you ended up giving it a go, and if so what dosage you took and for how long.  Any results?  Thanks and good luck!

I did give Tamoxifen/ Raloxifene a shot (prescribed by my doctor).

It really didn't help me out, had some side effects.
I hated taking the medication and really wish I hadn't but oh well. What can one do?

I'll be getting the surgery done here within the next 9 months....A few of the surgeons on this site look very promising.

Going to get in the best shape humanly possible and pray my hair will regrow once my body begins to run itself again.

Hope this helps someone...
All the best,
K.I.M.

[Paa_Paw]

As we used to say, that sounds like an E ticket ride for sure.

Thank you so much for your very candid account. Every once in a while someone has to give it a try just to prove that it is not a good idea. I'm truly sorry for what you went through and hope that you have a positive surgical experience.

[Alchemist]

Hi Keep_it_moving,

My T levels fell to below 200 with b12/folate deficiencies when I was 39.  My whole body crashed.  Upon re-understanding the sequence for me it went something like this. 

I had folate problems from birth.  The B12 deficiencies followed when my mother cut back meat and increased veggies, increasing my paradoxical folate deficiency symptoms and making the b12 deficiency worse.  One year after she cut back my meat by 75% I grew breasts starting at 11.  There is no doubt that B12/folate deficiencies tremendously affect hormones.  The methylation chemistry is needed, the ATP and enzymes are needed.  At 39 I had an ATP crash and methyl-trap occur together and my hormones fell like a rock. 

I have been on testosterone, 140mg/week injections for the last 11 years, Androgel for 2 years before that.  It has helped my health tremendously.  It did not affect my hair thinning which had been frozen in time for 20 years.  However, when I started methylb12 3 years later and started healing generally that is when my hair picked up thinning just a little.   In the past 30 years I have taken probably 50 drugs that can "cause" gynecomastia.  Not one one of them changed anything.  I also take 100mg of pregnenolone and 50mg DHEA.  My hormones are measured each 6 months and have been quite stable and my internist is satisfied.  A drop of 10-20% of testosterone dose and I stop being able to get erections, so if functionality is looked at the dose is about the lowest dose that works.

Through the years I have been D or DD depending upon subcutaneous fat.  I'm 6', 190 pounds with a 48 inch chest (naturally large, 37" arms) and currently 35 inch waist.  My hips are gone and I can't keep 36" pants up without a belt.  I sink now with 2/3 of a lung of air.  Before I couldn't sink.  My pecs, when not flexed, just look like part of the breasts.  What I have found is that taking the last 20 pounds off, from 210, has increased the flirting and hugs from the ladies at the nudist club a good 400%.

Another 15 pounds and those brushed denim green hip-hugger bells I could wear in the 70s could be this years fashion disaster.