Treatment of Pubertal Gynecomastia with the Specific Aromatase Inhibitor Anastrozole

Abstract

Gynecomastia can be detected in up to 70% of boys during puberty and in about one third of adult males. An imbalance of estrogen to androgen tissue levels is believed to be the major reason for the development of gynecomastia; as a result most medical treatments so far have tried to lower the estrogen level. Five boys with pubertal gynecomastia and breast tenderness were treated for 6 months with the selective aromatase inhibitor anastrozole. Initial plasma levels of estradiol (E₂), testosterone (T), androstenedione, dehydroepiandrosterone sulfate (DHEA-S) and gonadotropins were normal. DHEA-S showed a significant rise during treatment. T and androstenedione showed no significant change during treatment. E₂ decreased with therapy, although to no statistically significant extent. The E₂/T ratio decreased significantly during the treatment. Breast size decreased in 4 out of 5 patients, and in 1 of these 4 boys glandular breast tissue disappeared completely. The longer the duration of gynecomastia before anastrozole administration, the smaller was the reduction of breast size. Breast tenderness was resolved in all boys within 4 weeks. No adverse effects were recorded. Since the aim of medical treatment is the total disappearance of breast tissue, anastrozole, as previous aromatase inhibitors, is of limited effect. However, anastrozole seems to be of benefit for the treatment of tenderness in gynecomastia and for patients in whom surgery is particularly risky. However, as spontaneous disappearance of pubertal gynecomastia is common, further double-blinded, placebo-controlled trials are necessary before a definite conclusion can be drawn about the effectiveness and the side effects of this therapy.

Treatment of adolescent gynecomastia

“…Tamoxifen has been successfully used as prophylaxis against the development of gynecomastia in adult patients receiving chemotherapy for prostatic cancer [14]. Although the specific aromatase inhibitor anastrozole has been advocated by some [15], recent randomized studies indicated a response similar to that achieved with placebo [12]. One of our patients received tamoxifen without improvement, and 2 additional patients were being treated by an endocrinologist for years without improvement.…”

Treatment of familial male-limited precocious puberty with bicalutamide and anastrozole

“…Anastrozole has been used in children with pubertal gynecomastia, 23 McCune-Albright syndrome, 24 and growth hormone deficiency. 25 In adolescent boys, treatment with anastrozole resulted in no significant changes in blood counts, urinalysis, liver profiles, or HDL and LDL concentrations.…”

Effect of Operative Treatment on Psychosocial Problems of Men With Gynaecomastia

“…Gynaecomastia appearing in these age ranges is considered to be physiological and it is estimated to represent approximately half of all gynaecomastia cases (5)(6)(7)(8). The presence of physiological gynaecomastia is associated with hormonal changes in various periods of life -in neonates it is associated with the presence of maternal oestrogens and in the puberty period it results from increased secretion of gonadotrophins which, in addition to testosterone synthesis, stimulate also oestrogen production and in elderly men the cause is reduced production of testosterone (5,6,7).…”