Gynecomastia, zyprexa, prolactin

[Tripp]

I have been on Zyprexa (a mood stabilizer/antipsychotic) for about ten years now, and have developed moderate gynecomastia that hasn’t gone away despite my losing quite a bit of weight over the past year.  My primary care doctor has indicated that she believes my chest situation is due to the zyprexa, but my psych med prescriber had my prolactin levels tested, and they came back normal.  She told me this indicates that the zyprexa is not to blame.  Is it true that if the zyprexa were the cause, my prolactin levels would have to be elevated?  

My hope had been to find an alternate medication that might not have this side effect, but I’m uncertain if the zyprexa is at the root of this, though the condition has definitely worsened while I’ve been on it.  FYI, I am 40 years old, 5’10” and about 180 lbs.  I have  lost a lot of weight in my midsection, but my chest doesn’t seem much improved.  

I’m not prepared financially or emotionally for surgery, but if I were - would I expect the situation to recur after surgery due to the meds I’m on?

Thanks in advance for your help. 

I

[Dr. Elliot Jacobs]

I do not prescribe Zyprexa and am therefore not an expert on it.  But a brief internet search does not reveal gynecomastia as a known or common side effect.  

It is great that you do not have elevated prolactin levels -- certain psychotropic drugs (in the past) did indeed serve to elevate prolactin levels, particularly in young men.

However, there are other drugs, such as Propecia, which can produce gynecomastia as a side effect -- not due to prolactin but to induced testosterone abnormalities.  Although I believe the chances are remote, you might do well to have a complete endocrine workup with testosterone, estrogen and thyroid levels.  If some abnormalities are detected, then appropriate treatment can be initiated.

Finally, oftentimes the causes of gynecomastia are unknown, or idiopathic.  While you are young (40 years old is indeed young), the possibility of age-related gynecomastia does exist.

Good luck!

Dr Jacobs

[Dr. Schuster]

I agree with Dr. Jacobs. You might be able to contact the company that makes Zyprexa to find out more in depth explanation of how it works and if it could at all be related.