Dr. Testosterone
By George Touliatos, MD

GYNECOMASTIA

By the term gynecomastia, we mean the accumulation of adipose tissue beneath the mammary gland, leading to breast tenderness and enlargement in the male.

This term is often used by bodybuilders, due to accumulated estrogens under the nipple (areola).

Estrogen levels that are in imbalance with testosterone levels (an increased ratio of estrogens/androgens) are responsible for the development of gynecomastia.

Moreover, elevated levels of IGF-1 may contribute, along with low levels of DHT, which is antiestrogenic.

Medications that can cause gynecomastia include:

-Androgenic-anabolic steroids (AAS) converted to estrogens (beta-estradiol) by the enzyme aromatase.

Estrogenic AAS are: oxymetholone, depending on aromatization environment; nandrolone; Equipoise; testosterone; methandienone; and methyltestosterone.

-Finasteride, an anti-androgen used in the treatment of benign prostate hyperplasia (BPH).

-Spironolactone, a diuretic with anti-androgenic property, can produce dose-dependent gynecomastia.

Given the fact that the adrenal cortex produces a fair amount of dehydroepiandrosterone (DHEA), it is understandable that abuse of spironolactone will lead to gynecomastia.

-Ranitidine/cimetidine: used in the treatment of duodenal ulcer.

-Opioids painkillers: codeine

-Marijuana (weed, pot)

-Ethanol (alcoholism)

-Barbiturates: Diazepam (Valium)

-DHT suppressors: ketoconazole, finasteride, dutasteride used in male pattern baldness: (alopecia areata, or AA)

Initially, the problem is addressed by reducing weight and lowering body fat percentage, accompanied by resistance training.

If there is no improvement, the athlete should undergo a hormonal blood panel (beta-estradiol, estriol, estrone and prolactin), which could reveal any supraphysiological serum levels of these hormones.

Accordingly, he should use an anti-estrogen (tamoxifen with mesterolone, or aromatase inhibitors, such as anastrozole, letrozole and exemestane).

Dopamine agonists such as cabergoline and bromocriptine will lower prolactinoma.

If the problem persists, then the gland should be removed surgically (mastectomy).

Liposuction is a surgical procedure, which removes breast fat, but not the breast gland tissue itself.

George Touliatos, MD is an author, lecturer, champion competitive bodybuilder and expert in medical prevention regarding PED use in sports. Dr. Touliatos specializes in medical biopathology and is the medical associate of Orthobiotiki.gr and Medihall.gr, Age Management and Preventive Clinics in Athens, Greece. Heis the author of four Greek books on bodybuilding, has extensively developed articles for www.anabolic.org and is the medical associate for the book Anabolics, 11th Edition (2017). Dr. Touliatos has been a columnist for the Greek editions of MuscleMag and Muscular Development magazines, and has participated in several seminars across Greece and Cyprus, making numerous TV and radio appearances, doing interviews in print and online. His personal website is https://gtoul.com/

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