SKINIPEDIA - Skin Obesity Problems: Gynecomastia Meds
Obesity and Skin Problems: Gynecomastia ("male breasts") - MEDICATIONS
work by Mark R Allee, MD, Associate Professor, Department of Medicine, University of Oklahoma Health Sciences Center Coauthor(s): Mary Zoe Baker, MD, Professor, Department of Medicine, Section of Endocrinology, Metabolism and Hypertension, University of Oklahoma; Medical Director, University of Oklahoma Physicians, Medicine Specialty Clinic, General Medicine Clinic and Medicine Residents' Clinic.
Medication
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Steroid hormones
These agents are used to inhibit the effects of estrogen.
Testosterone (Androderm, Andropository)
Predominant male sex hormone used for replacement therapy in male hypogonadism.
200-300 mg (testosterone enanthate) IM q2-4wk
4-6 mg (scrotal patch) transdermally qd
5 mg (nonscrotal skin patch) transdermally qd
Pediatric
10-25 mg testosterone propionate 2-3 times/wk
Documented hypersensitivity, breast cancer, prostate cancer, severe cardiac dysfunction, hepatic or renal disease
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Prostate hypertrophy or cancer; oligospermia (with prolonged use or excessive dosage); may accelerate bone maturation.
Clomiphene (Clomid, Milophene, Serophene)
Stimulates release of pituitary gonadotropins.
50-100 mg PO qd; not to exceed 6 mo
Pediatric
Not established
Documented hypersensitivity, liver disease, abnormal uterine bleeding, uncontrolled thyroid or adrenal dysfunction, pituitary tumor and risk of hemorrhage into tumor.
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Perform ophthalmic evaluation if patient develops visual symptoms
Tamoxifen (Nolvadex)
Competitively binds to estrogen receptor, producing a nuclear complex that decreases DNA synthesis and inhibits estrogen effects.
Adult
10-20 mg PO bid
Pediatric
Not established
May exacerbate hepatotoxic effects of allopurinol; may increase cyclosporine serum levels; increases anticoagulant effects of warfarin; aminoglutethimide reduces serum concentration; cyclophosphamide, methotrexate, and 5-FU increase thrombotic risk
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in leukopenia, thrombocytopenia, and hyperlipidemia; decreased visual acuity, corneal changes, and retinopathy may occur with >1 y of use; may induce ovulation.
Danazol (Danocrine)
Synthetic steroid analog with strong antigonadotropic activity (inhibits LH and FSH) and weak androgenic action.
Adult
200 mg PO bid for 3 mo
Pediatric
Not established
May increase risk of carbamazepine and cyclosporine toxicity; may increase PT in patients receiving oral anticoagulants; inhibits response to clomiphene
Documented hypersensitivity, seizure disorders, renal or hepatic insufficiency, lactation, conditions influenced by edema
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Increased risk of bleeding in hemophilic patients; risk of fluid retention, especially with overt CHF or renal failure; caution in seizure disorders
Testolactone (Teslac)
Synthetic peripheral aromatase inhibitor that blocks production of estradiol and estrone from testosterone and androstenedione.
150 mg PO tid for up to 6 mo
Pediatric
Not established
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