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The efficacy of these treatments is limited once gynecomastia has occurred and are therefore most effective when used prophylactically. [66] In the United States, many insurance companies deny coverage for surgery for gynecomastia treatment or male breast reduction on the basis that it is a cosmetic procedure. [67] [68] [69] [70]
Aromatase inhibitors (AIs) are a class of drugs used in the treatment of breast cancer in postmenopausal women and in men, [1][2] and gynecomastia in men. They may also be used off-label to reduce estrogen conversion when supplementing testosterone exogenously. They may also be used for chemoprevention in women at high risk for breast cancer.
[53] [45] In one survey of over 9,000 patients taking cimetidine, gynecomastia was the most frequent endocrine-related complaint but was reported in only 0.2% of patients. [45] At high doses however, such as those used to treat Zollinger–Ellison syndrome, there may be a higher incidence of gynecomastia with cimetidine. [53]
Other medications are taken for similar purposes such as clomifene and aromatase inhibitor drugs; which are used in order to try to avoid the hormone-related adverse effects. Overall, tamoxifen appears to be a safe and effective treatment option for selected cases of gynecomastia.
Similarly, androstanolone enanthate via intramuscular injection has been found to be effective in the treatment persistent pubertal gynecomastia. [22] The medication has also been used as a topical gel to treat small penis in pre- and peripubertal boys with mild or partial androgen insensitivity syndrome. [23] [2] [24]
Letrozole, sold under the brand name Femara among others, is an aromatase inhibitor medication that is used in the treatment of breast cancer. [1] It was patented in 1986 and approved for medical use in 1996. [4] In 2021, it was the 222nd most commonly prescribed medication in the United States, with more than 1 million prescriptions.
Aromatase excess syndrome (AES or AEXS) is a rarely diagnosed genetic and endocrine syndrome which is characterized by an overexpression of aromatase, the enzyme responsible for the biosynthesis of the estrogen sex hormones from the androgens, in turn resulting in excessive levels of circulating estrogens and, accordingly, symptoms of hyperestrogenism.
Dutasteride. Dutasteride, sold under the brand name Avodart among others, is a medication primarily used to treat the symptoms of a benign prostatic hyperplasia (BPH), an enlarged prostate not associated with cancer. A few months may be required before benefits occur. [4]