What medications cause gynecomastia?

The intake of drugs that influence the hormone balance can lead to the formation of gynecomastia.Active ingredients that inhibit male hormones, as used in the treatment of testicular cancer or prostate tumors, or a therapy with female hormones stimulate breast growth. However, other medications can also lead to the formation of gynecomastia as a side effect. These include spironolactone, a drug used for increased water excretion and as a blood pressure reducer, digitalis preparations (heart medication), H2 blockers (stomach protection), chemotherapeutic drugs, opiates, psychotropic drugs, antidepressants, anabolic steroids, steroids and various drugs such as heroin and amphetamines.

From a purely medical point of view, surgical therapy is generally not necessary in the presence of a real gynecomastia. However, in most patients, such an increase in breast tissue results in severe psychological impairment. In many cases, affected men lose a lot of self-confidence and their appearance is increasingly embarrassing.

The consequence is a constantly increasing social withdrawal. Living together with their partner also usually suffers from gynecomastia. In such cases, surgical removal of the excess breast tissue can enormously improve the patient’s quality of life.

The surgical correction is usually carried out via a small incision in the area of the areola, through which access to the glandular tissue is created. The increased tissue can then be easily removed by suction (in the same sense as with ordinary liposuction). In any surgical procedure, however, it should be remembered that gynecomastia is only a symptom.

For this reason, a search for the cause must be initiated. Only with appropriate treatment of the underlying problem can a renewed increase in breast gland tissue be prevented. For this reason, further decisive measures belong to the treatment of gynecomastia.

A change in lifestyle, especially in eating habits, is advisable for every affected patient. In addition, long-term weight reduction and the avoidance of alcohol should be aimed for. In the case of drug-dependent gynecomastia, an alternative medication must be used if possible.

If there is a deficiency of male sex hormones (androgens), hormone substitution may be necessary. Only a fake or pseudogynecomastia, in which too much fatty tissue has accumulated in the breast, can be treated itself. There are no real home remedies, but a lot of exercise, endurance sports and a healthy diet or change of diet can reduce the body fat percentage and thus lead to an improvement in gynecomastia.

In addition, anabolic steroids and growth hormones should not be used during weight training, as these promote breast growth. If there is no improvement despite these measures, it is probably a real gynecomastia. In this case a doctor should be consulted to clarify the hormone status and possible causes of breast enlargement.

Home remedies do not help here, as only surgery can remove the enlarged mammary gland permanently. The cause of a real gynecomastia can be a disrupted hormone balance. A doctor can determine the hormone status by means of a blood test and, if necessary, prescribe medication that can bring the hormone balance back into balance and thus prevent the progression of gynecomastia.

However, the administration of medication does not always lead to an improvement, in which case the only remaining step is the surgical removal of the excess breast gland tissue. Possible causes of gynecomastia are either too few male hormones (androgen deficiency) or too many female sex hormones. An androgen deficiency means that less male sex hormones are produced, especially testosterone.

This deficiency can be substituted by the administration of sex hormones as part of a hormone replacement therapy. Men also produce female sex hormones, which serve as a precursor for the production of testosterone. However, too high a production of female sex hormones can lead to an increase in mammary gland tissue and to gynecomastia.

In such cases, drugs to inhibit estrogen or testosterone can be administered directly. Similarly, an excess of the hormone prolactin has a stimulating effect on breast growth and can be treated with dopamine antagonists. The procedure of an andromastectomy (breast correction) to model a flat male breast depends on whether the patient is suffering from a real gynecomastia, i.e. a pathological proliferation of the mammary gland tissue, or from a fake pseudogynecomastia, in which only excess fatty tissue has accumulated in the breast.

A mixed form between both types of disease is also possible.In a preliminary consultation, the plastic surgeon discusses the procedure with the patient and explains exactly how he or she will proceed. In the case of a real gynecomastia, the doctor usually decides to remove the entire mammary gland in order to prevent further growth after the operation. The operation is performed under general anesthesia or, in the case of a smaller operation, under local anesthesia.

Depending on the patient’s condition, different methods are used: liposuction, removal of glandular tissue or a combination of glandular removal and liposuction. The doctor makes one or more incisions in the areola and cuts out excess breast gland tissue and possibly also fatty tissue. In some cases, ultrasound-assisted aspiration lipectomy (UAL) is also used, in which excess fatty tissue is liquefied by ultrasound and suctioned off.

Under general anesthesia, the patient is admitted as an inpatient and can usually be discharged the next day. After-effects of the operation are pain, bruising, swelling, numbness, which disappears after a few weeks. In addition, the patient must wear a bodice for several weeks after the operation to keep the now flat breast in shape and to support healing.

The cost of an operation for the surgical removal of a gynecomastia varies from one individual to another, as the price depends greatly on the condition of the patient, the extent of the enlarged breast and the effort involved. Normally, one can expect costs between 2,000 and 3,000 Euros. In most cases, the removal of an enlarged male breast is a purely aesthetic operation, the costs of which the patient has to bear alone.

The costs of liposuction are usually not covered by the health insurance. However, if the doctor certifies a medical necessity to perform the operation, the health insurance company will cover the entire costs or grant a subsidy. Especially men who suffer from a real gynecomastia with an increase in breast gland tissue have an increased risk of breast cancer.

In such cases, the health insurance company covers the costs of the operation. The scars resulting from the removal of a gynecomastia depend on the initial condition of the patient (real or fake gynecomastia) and the method used in the operation. In general, however, only very small scars appear, which heal well and are then hardly visible. When removing mammary gland tissue, a small incision is made at the areola, which is almost invisible once healed. In liposuction, only small incisions are made in the crease under the breast, which also leave hardly any scars.