Medication Causes of Gynecomastia

Aka: Medication Causes of Gynecomastia, Drug-Induced Gynecomastia, Gynecomastia Secondary to Medication

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II. Causes: Recreational and Illicit Drug use

  1. Anti-androgen
    1. Marijuana
    2. Alcohol (also contains Phytoestrogens)
  2. Miscellaneous
    1. Amphetamines
    2. Heroin
    3. Methadone
    4. Anabolic Steroids (see below under hormonal agents)

III. Causes: Chemotherapy

  1. Anti-androgens
    1. Alkylating Agents
    2. Methotrexate
    3. Penicillamine (Cuprimine)
    4. Cisplatin
    5. Vinca Alkaloids

IV. Causes: Antimicrobial

  1. Anti-androgens
    1. Isoniazid
    2. Ketoconazole
    3. Metronidazole (Flagyl)
  2. Miscellaneous
    1. Antiretroviral agents
    2. Didanosine (Videx)
    3. Minocycline (Minocin)

V. Causes: Gastrointestinal

  1. Anti-androgens
    1. Cimetidine (Tagamet)
    2. Ranitidine (Zantac)
    3. Omeprazole (Prilosec)
  2. Hyperprolactinemia
    1. Metoclopramide (Reglan)
    2. Phenothiazines

VI. Causes: Hormonal agents

  1. Anti-androgens
    1. Bicalutamide (Casodex)
    2. Flutamide (Eulexin)
  2. Estrogenic agents
    1. Estrogens (including Topical Estrogen exposure from sexual partner)
    2. Gonadotropin-Releasing Hormone Agonists
    3. Human Chorionic Gonadotropins
    4. Phytoestrogens
    5. Tamoxifen
    6. Anabolic Steroids
      1. Suppress endogenous Testosterone production
      2. Allows for Estrogen predominance between Anabolic Steroid injections

VII. Causes: Cardiovascular agents

  1. Anti-androgens
    1. Spironolactone (Aldactone)
  2. Estrogenic agents
    1. Digoxin
  3. Miscellaneous
    1. Amiodarone
    2. Amlodipine (Norvasc)
    3. Angiotensin-converting enzyme inhibitors
    4. Atorvastatin (Lipitor)
    5. Diltiazem
    6. Fenofibrate (Tricor)
    7. Nifedipine (Procardia)
    8. Methyldopa
    9. Reserpine
    10. Rosuvastatin (Crestor)
    11. Verapamil
    12. Minoxidil

VIII. Causes: Neuropsychiatric agents

  1. Estrogenic agents
    1. Diazepam (Valium)
    2. Phenytoin (Dilantin)
  2. Hyperprolactinemia
    1. Haloperidol
  3. Miscellaneous
    1. Fluoxetine (Prozac)
    2. Mirtazapine (Remeron)
    3. Paroxetine (Paxil)
    4. Tricyclic Antidepressants
    5. Venlafaxine (Effexor)
    6. Risperidone (Risperdal)

IX. Causes: Herbals

  1. Lavender
  2. Tea tree oil
  3. Dong Quai
  4. Tribulus terrestris
  5. Soy Protein (>300 mg/day)

X. Causes: Miscellaneous agents

  1. Finasteride
  2. Theophylline
  3. Sulindac (Clinoril)
  4. Etomidate (Amidate)

XI. References

  1. Braunstein N Engl J Med 357(12): 1229-37 [PubMed]
  2. Dickson (2012) Am Fam Physician 85(7):716-22 [PubMed]
  3. Eckman (2008) Expert Opin Drug Saf 7(6):691-702 [PubMed]

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