Gynecomastia

[James]

I had surgery several years ago to remove the non AAS gynecomastia I developed as a teen. I've noticed a couple other guys report having the surgery as well. For guys like us who are naturally more prone to gynecomastia, even without exogenous testosterone converting to E2, would Tamoxifen be a better choice then Anastrozole since it works more directly on the chest? Would love for Dr. Saya to chime in on this.

 

[PAUL-E]

I thought if you hade the glands removed (surgery) you weren't able to get gyno again?

 

[James]

I thought if you hade the glands removed (surgery) you weren't able to get gyno again?

I had glandular excision and liposuction of the chest. I don't know the medical need or the science behind it but plastic surgeons generally leave some glandular tissue behind. The receptors in that tissue really enjoy E2, so I'm thinking Tamoxifen may be better if you're prone to gyne. But then you'd loose the other benefits of Adex, if you had high E2 symptoms and labs to back it up. Maybe a small 1/8th mg dose of each would be ideal. I take between 1/8 and 1/4 mg AI, with injection, depending on how I feel. Never used Tamoxifen. I understand it's not for everyone, I'm just thinking it may be for guys who have had gyno.

 

[Dr Justin Saya MD]

I had surgery several years ago to remove the non AAS gynecomastia I developed as a teen. I've noticed a couple other guys report having the surgery as well. For guys like us who are naturally more prone to gynecomastia, even without exogenous testosterone converting to E2, would Tamoxifen be a better choice then Anastrozole since it works more directly on the chest? Would love for Dr. Saya to chime in on this.

Appropriate balancing of E2/T levels would be the best approach. Manipulating dosage and frequency of T to minimize aromatization and, if needed, conservative use of an AI (anastrozole) would be best. Tamoxifen has a role if early or active gynecomastia is SUSPECTED, but is not a great option for LONGTERM PREVENTION as it only blocks the E receptors (i.e. doesn't actually control E2 levels per se...you miss a dose or two and "BAM" there are high E levels just waiting to get into those receptors and cause problems) and can have some negative impacts on IGF-1

 

[James]

Appropriate balancing of E2/T levels would be the best approach. Manipulating dosage and frequency of T to minimize aromatization and, if needed, conservative use of an AI (anastrozole) would be best. Tamoxifen has a role if early or active gynecomastia is SUSPECTED, but is not a great option for LONGTERM PREVENTION as it only blocks the E receptors (i.e. doesn't actually control E2 levels per se...you miss a dose or two and "BAM" there are high E levels just waiting to get into those receptors and cause problems) and can have some negative impacts on IGF-1

Makes sense. Since Tamoxifen blocks E2 receptors and doesn't actually control the levels of E2, if you miss a dose of tamoxifen, you have all that 'build up' of estradiol just waiting to converge on those receptors. That could be trouble!