Anyone familiar with Femara for gynecomastia?

[dbugmom]

My son is 15 and has had his gyno for 2 1/2 years.  He is 5'7", 130 lbs - not an ounce of fat on his body.  We are considering surgery for him as it is really starting to bother him.  My brother gyno surgery at 16 (10 years ago).  I know what this condition can do to a boy - I have seen my brother suffer, and I don't want my son to go through the same thing.  At this point, insurance is denying it, but I am filing an appeal.  We visited a pediatric surgeon about 4 months ago, and the surgeon said the condition would not go away on its own, that surgery was the only way to correct it.  Yesterday we visited an endocronologist, and he said the surgeon was wrong.  If all of his lab tests come back normal, he could take Femara for about 3-4 months, and the gyno would disappear.  I am getting conflicting information from 2 doctors, and I am not sure what to believe.  I was wondering if anyone on this board could give me their opinions and/or their stories.  Has anyone had success with Femara?

[DrBermant]

My son is 15 and has had his gyno for 2 1/2 years.  He is 5'7", 130 lbs - not an ounce of fat on his body.  We are considering surgery for him as it is really starting to bother him.  My brother gyno surgery at 16 (10 years ago).  I know what this condition can do to a boy - I have seen my brother suffer, and I don't want my son to go through the same thing.  At this point, insurance is denying it, but I am filing an appeal.  We visited a pediatric surgeon about 4 months ago, and the surgeon said the condition would not go away on its own, that surgery was the only way to correct it.  Yesterday we visited an endocronologist, and he said the surgeon was wrong.  If all of his lab tests come back normal, he could take Femara for about 3-4 months, and the gyno would disappear.  I am getting conflicting information from 2 doctors, and I am not sure what to believe.  I was wondering if anyone on this board could give me their opinions and/or their stories.  Has anyone had success with Femara?

Femara is the trade name for the generic chemotherapy drug Letrozole. Femara is a hormone therapy and is classified as an aromatase inhibitor.  It can help block the effects of breast growing hormones and glandular tissues currently so stimulated can shrink.  However once the effect of stimulation factor have reversed, what breast has already grown tends to remain. The studies I have sen have been poor in documenting just how much change takes place.  Someone who tells you it works should be able to show before / after pictures or other documentation.

How Old Before Considering Gynecomastia Surgery is a common question.  Be wary of a pediatric surgeon with little to no experience in this surgery.  I have posted How to pick a gynecomastia surgeon here:

http://www.gynecomastia.org/smf/index.php?topic=16474.0

Hope this helps,

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

[dbugmom]

Thank you for your reply Doctor.   ???I am really struggling with how you know when the time is right for surgery.  I mean, he's had it for 2 1/2 + years, we suspect there are no pathological causes (waiting for results to come back), and he wants to get rid of it.  His pediatrician said he has matured and is done going through puberty.  If there are no pathological causes, shouldn't it be gone? From what I have read, if someone has had it for approximately 3 years or more, chances are it isn't going to go away without surgery.  Can you comment on this?

[Dr. Elliot Jacobs]

According to the history you have presented, your son would most likely be a candidate for surgery.  Although it is doubtful that medication could improve him, you could relieve yourself of any doubts by giving it a 3-4 month trial.  But prepare yourself for it to be ineffective.  Surgery will then be your best option.

I have operated on many adolescent boys from age 12 - 18 and not one has had a recurrence or re-growth of his gyne.

One important suggestion:  choose a surgeon who is very experienced in gyne surgery.  The first operation provides the best opportunity for a good result.

Good luck!

Dr Jacobs

[DrBermant]

Thank you for your reply Doctor.   ???I am really struggling with how you know when the time is right for surgery.  I mean, he's had it for 2 1/2 + years, we suspect there are no pathological causes (waiting for results to come back), and he wants to get rid of it.  His pediatrician said he has matured and is done going through puberty.  If there are no pathological causes, shouldn't it be gone? From what I have read, if someone has had it for approximately 3 years or more, chances are it isn't going to go away without surgery.  Can you comment on this?

Male or female, breast tissue is breast tissue.  Breast tissue grows during stimulation. Remove that stimulation and there can be some decrease. With pregnancy, breast tissues grow under stimulation.  After removing that stimulation, they can shrink. However, many women have larger breasts after pregnancy.  Others return to the before pregnancy size. It is the same with Teenagers with Gynecomastia. Remove the stimulation and many return to a flat normal chest. Others shrink a little, but a significant contour deformity remains.

What has not resolved after 2 years, typically will not.

Options may include:

• Medical Treatment
• Weight Loss
• Waiting for Stabiliztion
• Temporizing with No Surgery Body Shaping Garments
• Surgery

Determining the right time for surgery is best explored during a consultation where the specifics can be better defined and the education of risks, benefits, and alternative methods of care discussed. We see many patients from around the world who prefer my techniques and the time we take in patient / parent education.  To minimize travel, many start with our Preliminary Remote Discussion. If interested in learning more, Jane is my office manager.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

Hope this helps,

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

[mrpower33]

I would try the Femara.  In fact, there are other drugs that could work also, you should talk to your endo about Exemestane (Aromasin).  I know these drugs are not well-documented in reversing gynecomastia in adolescents, but anecdotally, they have worked with body builders who have gyne from steroids.  These drugs are pretty safe, they're used for breast cancer patients after all, and Letrozole (Femara) has also been shown to slow the fusing of the growth plates in boys, which means your son could end up growing a little taller as well.  Since your endo is willing to prescribe it, you should go for it, I wish I had that benefit when I was younger.  If it doesn't work, he can always get the surgery later.