? for Dr Bermant

[Doomed]

Hi Dr. Bermant, I was hoping you could answer a question for me with your expertise and knowledge.

I can understand how anti-androgen drugs can cause gyne and also hypertensives (raise prolactin) but how do antidepressants and/or anti-seizure medications cause gynecomastia?  Is it because they also raise prolactin?  I am wondering because surely they do not supress testosterone and increase estrogen directly...I am curious because I am taking an anti-depressant along with an additional mandatory medication for nerve pain.  I am wondering if these drugs raise prolactin, that perhaps I may discuss a medication such as Dostinex with my Doctor to help fight off the gynecomastia.  But if the medications do not cause gynecomastia through prolactin, then I would be curious to know what the mechanism may be and if there are any alternative medications to help combat this troubling side effect.

I have been on Gabapentin for a couple months for nerve pain and now and anti-depressant to help combat the anxiety I have associated with it but I have developed gynecomastia with a lump under one nipple that is tender (started about 8 weeks after Gabapentin and 3 weeks after the antidepressant).  If I squeeze that nipple I get a bit of lactation or discharge.  I also notice that the nipples are enlarged and more sore when I wake in the morning (they appear as if they are ready to be milked if that makes any sense  then they regress once I am up for a few hours and no longer appear puffy and pointed.

Just looking for some insight as to if these symptoms are any indication of prolactin induced gyne and what the mechanism is behind antidepressants and anti-convulsants causing gyne.

Thank you very much for your time.

[DrBermant]

Hi Dr. Bermant, I was hoping you could answer a question for me with your expertise and knowledge.

I can understand how anti-androgen drugs can cause gyne and also hypertensives (raise prolactin) but how do antidepressants and/or anti-seizure medications cause gynecomastia?  Is it because they also raise prolactin?  I am wondering because surely they do not supress testosterone and increase estrogen directly...I am curious because I am taking an anti-depressant along with an additional mandatory medication for nerve pain.  I am wondering if these drugs raise prolactin, that perhaps I may discuss a medication such as Dostinex with my Doctor to help fight off the gynecomastia.  But if the medications do not cause gynecomastia through prolactin, then I would be curious to know what the mechanism may be and if there are any alternative medications to help combat this troubling side effect.

I have been on Gabapentin for a couple months for nerve pain and now and anti-depressant to help combat the anxiety I have associated with it but I have developed gynecomastia with a lump under one nipple that is tender (started about 8 weeks after Gabapentin and 3 weeks after the antidepressant).  If I squeeze that nipple I get a bit of lactation or discharge.  I also notice that the nipples are enlarged and more sore when I wake in the morning (they appear as if they are ready to be milked if that makes any sense  then they regress once I am up for a few hours and no longer appear puffy and pointed.

Just looking for some insight as to if these symptoms are any indication of prolactin induced gyne and what the mechanism is behind antidepressants and anti-convulsants causing gyne.

Thank you very much for your time.

When patients have Red Flag Gynecomastia Symptoms such as tenderness and nipple discharge, I prefer an Endocrinologist's evaluation and advice as to issues involving issues affecting the endocrine system.  That is how I am able to help my patients keeping risk of recurrence so low.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction