Drug-induced gynecomastia: A systematic review and meta-analysis of randomized clinical trials

Abstract

Objective: To review the evidence concerning treatment-related gynecomastia in patients taking spironolactone, antiandrogens, 5 alpha-reductase inhibitors, lipid-lowering and psychotropic drugs. Material and methods: A search of Medline and EMBASE was performed up to 30 June 2021. We included randomized controlled trials comparing the effects of a drug belonging to these classes versus placebo or versus a drug of the same class. Results: A total of 32 randomized controlled trials were included in the final review. There was an increased odds of gynecomastia in men receiving antiandrogens (OR = 17.38, 95% CI: 11.26 to 26.82; 6 trials, 9599 participants) and 5 alpha-reductase inhibitors compared to controls (OR = 1.77, 95% CI: 1.53 to 2.06; 7 series out of 6 trials, 34860 participants). The use of spironolactone in mixed gender populations was characterized by significantly higher odds of having gynecomastia compared to controls (OR = 8.39, 95% CI: 5.03 to 13.99; 14 trials, 3745 participants). No placebo-controlled trials focusing on the risk of gynecomastia in patients taking antipsychotic drugs was available, although there was a significant difference in the odds of having gynecomastia in a comparison between risperidone and quetiapine (OR = 4.32, 95% CI: 1.31 to 14.27; 3 trials, 343 participants). Limited evidence about the effects of statins on mammary glands was found. Conclusions: Antiandrogens and to a lesser extent 5 alphareductase inhibitors and spironolactone are associated with an increased risk of developing gynecomastia. Such effect can be explained by a modification of the testosterone to estradiol ratio. Gynecomastia (and galactorrhea) associated to the use of conventional and certain atypical antipsychotics can be related to high prolactin levels.

Porous Se@SiO2 nanocomposites play a potential inhibition role in hyperoxaluria associated kidney stone by exerting antioxidant effects

“…The incidence of urolithiasis depends on several factors like geography, ethnicity, diet or genetics. The prevalence of urinary stone development varies from 4% to 20% ( 20 ). Several countries like the United States of America showed an increased prevalence of kidney stones, which is likely due to unhealthy lifestyle habits, such as high-protein/high-sugar/high-salt diets, smoking, drinking, and less physical activity/obesity ( 21 - 23 ).…”

Impact of body mass index on size and composition of urinary stones: a systematic review and meta-analysis

“…In Asia and North America subgroups, overweight and obese individuals had high risk of calcium oxalate, but in Europe subgroup, there was no significant difference. The trend of calcium oxalate stones in overweight and obese people among these regions varies considerably on account of environmental factors, especially dietary intake, and lifestyle ( 52 ). In general, high BMI was a risk factor of calcium oxalate stones formation, but different dietary intake and lifestyle might have impact on this type of urinary stones.…”

The Pharmacological Treatment of Chronic Pain: From Guidelines to Daily Clinical Practice

“…For example, nebivolol is the more indicated β-blocker in erectile dysfunction patients due to its action on nitric oxide [139]. The complaint of gynecomastia with drugs such as spironolactone, calcium antagonists, some antibiotics, efavirenz, or antipsychotics is a difficult issue [140]. Similar sexuality concerns are possible with women affected by menstrual cycle alterations [138].…”