drug-induced gynaecomastia
Last reviewed 01/2018
Drug-induced gynecomastia is common and may account for 20% to 25% of cases (1) .These may be categorised into:
- oestrogens and oestrogen like drugs, for example –
- diethylstiboestrol;
- exposure to partners using oestrogen containing vaginal creams;
- cosmetics containing oestrogens
- foods contaminated with oestrogens for example, from oestrogen or diethylstilboestrol injected cows
- phyotoestrogens
- digitalis administration, although the pathophysiology is poorly understood
- drugs which enhance oestrogen formation for example –
- gonadotrophins such as hCG
- following withdrawal of clomiphene which may result in increased secretion
of LH and consequently, of testicular oestradiol
- drugs which inhibit
- testosterone synthesis - ketoconazole, metronidazole, spironolactone, chemotherapy (cytotoxic drugs) (2)
- testosterone action
- androgen receptor blockers - bicalutamide
- 5 α reductase inhibitors - finasteride, dutasteride
- H2 blockers and proton pump inhibitors
- marijuana (2)
- drugs whose mechanism of action is unknown (it is thought that many may
act by altering liver function)
- tricyclic antidepressants-may increase the prolactin levels.(2)
- angiotensin converting enzyme inhibitors. (2)
- heroin
- amiodarone
- busulfan
- methyldopa
- captopril
- growth hormone
- highly active antiretroviral therapy
- calcium channel antagonists - long term use of verapimil
- isoniazid (2)
- others situations which can cause or lead to gynaecomastia :
- increasingly body builders taking anabolic steroids may present with gynaecomastia
- healing balms, scented soaps, skin lotions, shampoos and styling gels containing lavender oil and tea tree oil
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