Primary prevention

Avoidance of estrogenizing agents may be greatly facilitated by judicious prescribing. With respect to commonly prescribed medications, select those that are less likely to lead to male breast enlargement.

The following agents are listed in order of increasing risk for gynecomastia:[28][30][31][36][38]​​[52]​​​​[53]

  • H2 antagonists: cimetidine

  • Calcium-channel blockers: diltiazem < nifedipine

  • Aldosterone antagonists: eplerenone < spironolactone

  • Testosterone replacement in hypogonadal men: transdermal patch or gel < intramuscular

  • Prostate cancer therapies: bilateral orchiectomy < gonadotropin-releasing hormone agonist < nonsteroidal antiandrogen therapy < diethylstilbestrol < estrogen.

Consider the following when bicalutamide or flutamide are used in the management of prostate cancer:[54][55][56][57][58]​​[59][60]​

  • Prophylactic tamoxifen reduces development of gynecomastia

  • Low-dose breast irradiation (10-15 gray units) reduces development of gynecomastia, but is less effective than tamoxifen

  • The aromatase inhibitor anastrozole is no more effective than placebo in preventing gynecomastia.

Prevention of obesity, in theory, should also reduce the development of gynecomastia.

Secondary prevention

Preventive intent generally is limited to patients with prostate cancer, in which selective estrogen modulation may begin concurrently with antiandrogen. However, even in these patients, only a minority will develop gynecomastia.

In the vast majority of cases, gynecomastia is treated symptomatically. Only those troubled by the condition require treatment.

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