Recommendation A Guide to Managing Gynecomastia with Pharmaceutical Drugs


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Oct 8, 2023
A Guide to Managing Gynecomastia with Pharmaceutical Drugs

View attachment d9c687dfdff4aacaeda81c89bf9c2c2d.mp4
by @Amnesia

Table Of Contents:
  • Introduction
  • SERMs vs Aromatase Inhibitors
  • Risks of SERMs
  • Pharmaceutical Drugs
Gynecomastia is the unusual growth of breast tissue in a man. There are two kinds of tissue that grow: one is called glandular tissue, and the other is fat around the tissue. Some people have more fat, while some people have more glandular tissue. There's a ratio of both. The glandular tissue is somehow considered a little bit more permanent than the fat tissue. If somebody loses a lot of fat, for example, while they're losing fat and have low estrogen levels, they will redistribute their fat around their body. For example, if somebody took an aromatase inhibitor and then lost fat, a lot of that fat in the breast tissue would go away, but the glandular tissue doesn't really go away. However, it does do something, and I think this thing has been confusing a lot of people. So what it is, is this: if you block estrogen receptors in the glandular tissue very strongly and completely block them, the glandular tissue will retract in size. Any tissue that's growing in the body tends to have some kind of swelling in it, including extra water in the area as well as inflammation, whereas something that is atrophying tends to be small. You can think of a steroid user's testicles, for example, being small. They're losing cells there; the cells are dying slowly and so on. Will they ever lose their testicles completely by staying on steroids? No, the testicles will get smaller and smaller and smaller, but they won't disappear in the exact same way. Once you grow glandular tissue, it will not disappear. Now, somebody can avoid growing that tissue in their teenage years.

SERMs vs Aromatase Inhibitors
SERMs are much more potent at doing this than an aromatase inhibitor. AIs inhibit the conversion of testosterone to estrogen in men. An aromatase inhibitor can completely crush their estrogen levels if they want to, but only in that case when it's completely crushed, there is no signaling at the glandular tissue because remember those drugs don't modulate the glandular tissue or the estrogen receptor. On the other hand, SERMs, the selective estrogen receptor modulators, modulate the estrogen receptors differentially depending on the tissue in the body. But raloxifene and tamoxifen both almost completely inhibit estrogen signaling at the estrogen receptor in the breast tissue while not altering your systemic levels of estrogen.

So, for example, say you started to feel an itchy nipple, would your first choice be to use an aromatase inhibitor to lower your total estrogen levels? No, unless you were going to crash them. The first thing you would do is take tamoxifen or raloxifene for that day and a couple of other days while you use an aromatase inhibitor to slowly lower your estrogen levels to some level that you want without crashing it completely. You can lower it slowly because you have that SERM's inhibiting signaling at the breast tissue so you're not accumulating more damage anyway.

I hope this was a little bit explanatory, but the point is that the SERM nor the AI can completely get rid of. They can't cause complete attrition of the cells that grew in the breast tissue.

Risks of SERMs
SERMs are associated with ocular damage over time, and they do cause ocular damage. Some people have been on them for a year, a year and a half, and they begin to notice eye floaters in their eyes because there's modulation of all of the estrogen receptors in your body to some degree.

Pharmaceutical drugs
I currently have a mild case of gynecomastia, which is not visible but can be felt, causing discomfort. It doesn't pose any health risks, but it's irritating.

Raloxifene: This has been the safest and healthiest option. While the standard dosage is 20 milligrams, it's quite dosage-dependent. Many people have found 100 milligrams to be very effective initially, and then they decrease to a maintenance dosage.

Tamoxifen: Tamoxifen works through the same pathway. It's a SERM (selective estrogen receptor modulator), which basically blocks the estrogen receptor in the nipple. Only Raloxifene is just far more effective than tamoxifen, but tamoxifen is still the most widely used just because it's been around longer. However, Raloxifene has fewer side effects, is healthier, and safer, and more effective.

Aromatase Inhibitors: These include Exemestane, Letrozole, and Anastrozole. These inhibitors work by reducing estrogen levels in the bloodstream. Gynecomastia is often caused by excess estrogen or prolactin, and an imbalance in the androgen-to-estrogen-to-prolactin ratio. Aromatase inhibitors help rectify this balance, and Exemestane is the healthiest among them. However, Letrozole is more potent but may have more side effects. Anastrozole is also effective but slightly less healthy than Exemestane.

Prolactin-Lowering Medications: Bromocriptine, cabergoline, and pramipexole, with pramipexole being preferred for fewer long-term side effects. If You Want I'll Elaborate More in Reply's in A Few Hours Too Tired Rn.
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