Endocrinology Book

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Medication Causes of Gynecomastia

Aka: Medication Causes of Gynecomastia, Drug-Induced Gynecomastia, Gynecomastia Secondary to Medication
  1. See Also
    1. Gynecomastia
  2. 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)
  3. Causes: Chemotherapy
    1. Anti-androgens
      1. Alkylating Agents
      2. Methotrexate
      3. Penicillamine (Cuprimine)
      4. Cisplatin
      5. Vinca alkaloids
  4. Causes: Antimicrobial
    1. Anti-androgens
      1. Isoniazid
      2. Ketoconazole
      3. Metronidazole (Flagyl)
    2. Miscellaneous
      1. Antiretroviral agents
      2. Didanosine (Videx)
      3. Minocycline (Minocin)
  5. Causes: Gastrointestinal
    1. Anti-androgens
      1. Cimetidine (Tagamet)
      2. Ranitidine (Zantac)
      3. Omeprazole (Prilosec)
    2. Hyperprolactinemia
      1. Metoclopramide (Reglan)
      2. Phenothiazines
  6. 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
  7. 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
  8. 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)
  9. Causes: Herbals
    1. Lavender
    2. Tea tree oil
    3. Dong Quai
    4. Tribulus terrestris
    5. Soy Protein (>300 mg/day)
  10. Causes: Miscellaneous agents
    1. Finasteride
    2. Theophylline
    3. Sulindac (Clinoril)
    4. Etomidate (Amidate)
  11. 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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