Drug‐Induced Gynecomastia

Abstract

Drugs account for about 20% of gynecomastia cases in men. As a number of factors can alter the estrogen:androgen ratio, several pathophysiologic mechanisms are associated with drugs causing this disorder. Antiandrogens, protease inhibitors, and nucleoside reverse transcriptase inhibitors are the most common drug causes of gynecomastia, whereas first-generation antipsychotics, spironolactone, verapamil, and cimetidine are less common causes. Other drugs have been reported rarely as causes. Treatment may involve switching to an alternative agent or may require surgery or irradiation if the causative agent cannot be discontinued. We reviewed the literature on drug-induced gynecomastia and provided another perspective by reviewing data from the United States Food and Drug Administration's Adverse Event Reporting System. Epidemiologic studies are needed to provide a more accurate description of the frequency of drug-induced gynecomastia.

Gynaecomastia in two men on stable antiretroviral therapy who commenced treatment for tuberculosis

“…5 HIV and TB are both independent risk factors for hypogonadotrophic hypogonadism, with rates reported as high as 75% 6 and 73%, 7 respectively, but these may have been influenced by cachexia in an era when effective HIV treatment was not available. No evidence of hypogonadism or lipodystrophy was found on the physical examinations of these patients.…”

“…No evidence of hypogonadism or lipodystrophy was found on the physical examinations of these patients. Although refeeding syndrome 5 and immune reconstitution-induced gynaecomastia has been reported, 8 these were unlikely causes, given the stable ART regimens (two and seven years) prior to initiation of therapy for TB. Both histories favour potentiation of an otherwise stable ART regimen by the addition of HRZE.…”

Involvement of the Multidrug and Toxic Compound Extrusion Transporter in Testosterone Release from Cultured Pig Leydig Cells

“…Gynecomastia is known to be a possible side effect of cimetidine [31,32,33]. In humans, the class III MATE transporter has not been identified yet, but hMATE1 mRNA expression has been observed in the human testis.…”

Bilateral Mastectomy as Radical Treatment of Gynecomastia Secondary to Antiretroviral Therapy in a Low-Income Setting: A Case Report

“…Other drug classes seem to be protease inhibitors, and nucleoside reverse transcriptase inhibitors, although their association with gynecomastia is based on poor-quality evidence [6]. Finally, drugs probably associated with gynecomastia include risperidone, verapamil, nifedipine, omeprazole, alkylating agents, HIV therapies, anabolic steroids, alcohol, and opioids [7].…”