If you have found this article you are probably aware that gynecomastia is the condition of breast tissue overgrowth in males. Gynecomastia can develop in all stages of life, most commonly seen in early infancy, puberty, and then the later years in life, although it can occur at any age.  Before we get into how drugs or medications cause gynecomatia, lets dive a little deeper into the reason why gynecomastia develops in the first place.   

There are different reasons why males may develop breast tissue overgrowth or gynecomastia.  Some of the causes of gynecomastia are considered normal or physiologic such as in puberty with young boys, where we see a normal rise in testosterone as an adolescent male matures into an adult.  

In general, gynecomastia usually is not the sign of a serious problem, although it rarely can be.  No matter the specific cause of gynecomastia, what all of the conditions have in common is an imbalance between the testosterone and estrogen hormones.  Both testosterone and estrogen hormones are normally found in the male body. While we commonly think of estrogen as a female hormone, males naturally have estrogen in their system as well, only at much lower levels than in females. 

Testosterone and estrogen are closely related and interact or play off each other in our bodies.  A large rise in one hormone can have effects on the other. A perfect example which we mentioned earlier is puberty.  During puberty, we see a substantial rise the male hormone testosterone. This normal rise in testosterone indirectly leads to the rise of estrogen, which may lead to the development of male breast tissue or gynecomastia.  This male breast tissue overgrowth may occur in one or both of the breasts and can usually be felt under the nipple and tends to be tender to the touch.  Breast tissue overgrowth during adolescence is just one of many examples of how gynecomastia may present.

Now, on to the meat of this article: Drugs and Medications that cause gynecomastia.  One of the most common causes of gynecomastia or overgrowth of breast tissue in males are  drugs and medications.  There are several drugs and medications that can cause imbalances between estrogen and testosterone hormone levels as a side effect of their intended use.  

Other drugs, such as anabolic steroids, which are typically used for performance enhancement, mimic testosterone.  These drugs directly increase male hormone levels dramatically, which as we mentioned earlier, will have consequences on the body’s estrogen hormone levels, leading to an abnormal rise, and, you guessed it, gynecomastia.  That is why gynecomastia tends to be very common in the body building community.  

In general,  drugs and medications that cause gynecomastia can be broken down into several common categories:

Illicit drugs and alcohol

There are several illicit drugs or street drugs that have known links to gynecomastia.  Additionally, the abuse of alcohol can lead to the development of gynecomastia.  Lets dive into these topics for a little more detail:

How does alcohol cause gynecomastia?

Alcohol is considered, by all accounts, a recreational drug.  “ The last legal drug “ as Jack Nicholson so eloquently put it in “ As Good As It Gets “.  Alcohol is known to have many adverse side effects on the body.  Brain wasting, liver cirrhosis, and weight gain, to name a few.  

Chronic abusers of alcohol run the risk of developing alcoholic cirrhosis, and secondary gynecomastia.  The genesis of gynecomastia in alcoholic liver disease can be summarized as follows:  The liver has many functions, one of them being to process estrogen.  With a damaged or cirrhotic liver, the body processes estrogen less efficiently, leading to a rise in estrogen levels, which leads to the development of gynecomastia.  Additionally, chemicals known as a phytoestrogens are found in alcohol which cause a pseudo-physiologic spike in the body’s estrogen levels.  Furthermore, alcohol acts as an inhibitor of testosterone production. 

Lastly, calories: By now, we are all well aware that alcohol is considered an empty calorie source, meaning it has no nutritional value short of it being an energy source.  Drinking too much alcohol leads weight gain, and significant global body weight gain can lead to fatty breasts, yet another variant of gynecomastia.

Street Drugs That Cause Gynecomastia

There exist a handful of street drugs that may lead to the development of gynecomastia with chronic abuse.  The most common street drugs that have been linked to the development of gynecomastia include marijuana, methadone, heroin, and amphetamines.  

Medications That Cause Gynecomastia

There are several medications that, when taken on a regular basis for long periods of time, may lead to the development of gynecomastia. Below is a list of the most common category of medications that have been linked to gynecomastia.  

AIDS Medications – Some antiviral AIDS medications have been linked to the development of gynecomastia.  One of the drugs shown to have a stronger correlation to the development of gynecomastia is Sustiva ( Efavirenz ). 

Anabolic Steroids – As mentioned earlier in the article, there are several anabolic steroids linked to the development of gynecomastia.  To be clear, there are no steroids that directly cause gynecomatia.  Rather, certain anabolic steroids will lead to more aromatization of the hormone, which generates more estrogen.   The encouraging news is that a high remission rate can be achieved by stopping the anabolic steroid and placing the patient on a course of Tamoxifen.  If the gynecomastia does not resolve after a conservative treatment, then surgery may be recommended.  

Among more common anabolic steroids on the market include Anadrol, Dianabol, Deca-Durabolin, and of course, Testosterone cypionate. 

Anti-Androgen Medications 

Anti-Anxiety Medications

Antibiotics –  Several antibiotics have been linked to the development of gynecomastia.  Among those include isoniazid, ketoconazole, and metronidazole. 

Cancer Treatments

Heart Medications

Stomach Medications

Tricyclic Antidepressants

Ulcer Medications – Medications to treat and prevent the development of ulcers have been linked to gynecomastia.  These include Cimetidine, Ranitidine, and Omeprazole. 

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