***** Tits are a *****!



Most bodybuilders are familiar with the condition known as gynecomastia (gyno), commonly referred to as “***** Tits.” Gynecomastia often results from androgen use, but can also arise during puberty (as well as spontaneously) in some individuals. Treatment of gynecomastia is misunderstood by many bodybuilders. In this article I’ll discuss why non-surgical treatments often fail, and how to improve the effectiveness of non-surgical intervention.

Disclaimer: I am not a doctor, nor should this text be misconstrued as medical advice. If you have gynecomastia or any medical condition, seek the advice of a professional healthcare provider. The contents of this article are for discussion purposes only.

Breasts are Great – But not on Guys!

Gynecomastia is unwanted breast tissue growth in men. Most gynecomastia is estrogen related and such will be the focus of this article—why do as many as 40 percent of men get some form of gynecomastia?

There are three primary factors that contribute to gynecomastia:

1) Breast tissue sensitivity to estrogen

2) Increased estrogen levels

3) Decreased androgen levels

Why do some bodybuilders have no problem with gyno even when taking aromatizing androgens such as testosterone? The most likely answer is estrogen sensitivity, aromatase activity or a combination of both.

My Friends Call Me D-Cup – What do I Do?

Many doctors have limited knowledge about the treatment of gynecomastia. If they are even concerned, they will likely refer you to a surgeon, which in many cases is not covered by insurance. Most insurance companies consider gynecomastia correction a cosmetic issue. A more knowledgeable doctor may prescribe a S.E.R.M. (Selective Estrogen Receptor Modulator), which blocks the action of estrogen at the receptor site. Tamoxifen is a common S.E.R.M. that some doctors may prescribe off-label for gynecomastia.

Bodybuilders are also quite familiar with aromatase inhibitors. Drugs such as Arimidex™ (Anastrozole) effectively reduce the conversion of testosterone to estrogen via the aromatase enzyme.

Studies have shown varying degrees of success in treating gynecomastia with estrogen receptor blockers or aromatase inhibitors. When the treatment is not 100 percent successful, the patient often feels that surgery is the only viable alternative.

A More Complete Approach

Before I continue, it’s important to note that in many cases surgery is the only logical option for advanced gynecomastia. Either the tissue is too developed or the surrounding skin is too stretched—or both. However, with this said, there is a more effective approach that should be considered.

Have you ever noticed that some bodybuilders don’t develop gyno no matter what they do, and others can wind up winning a wet t-shirt contest after a little cycle of test? Sensitivity is the key. Your sensitivity to estrogen is likely determined at birth with your genetic makeup, but before you throw in the towel, let’s look at some chemical approaches to the problem.

I know I said it before, but any approach to resolve gynecomastia should be done legally under a physician’s care.

Estrogen Control
Any aromatase inhibitor or estrogen blocker will effectively work to control estrogen. It’s important to note that drugs such as tamoxifen are effective in blocking breast tissue estrogen receptors, but do not eliminate estrogen from the system. Often a combination of blocking estrogen with tamoxifen and controlling aromatization with an aromatase inhibitor (such as anastrozole or exemestane) is the most effective method of controlling the estrogenic contribution to gyno.

Sensitivity
Gynecomastia, particularly with painful tenderness, is a valid medical concern. If your doctor is not willing to work with you in resolving your condition, it may be time to find a new doctor.

Testolactone (Teslac™) is technically a testosterone derivative, although it has no anabolic (and negligible androgenic) properties. The drug was actually designed for second line breast cancer therapy in women. Interestingly, it is actually scheduled in the same IIIc status as testosterone. What makes testolactone of interest to us is two-fold. First, it is a powerful aromatase inhibitor. It dramatically reduces circulating estrogen levels in males. It has also been used in studies to reduce gynecomastia. Second, testolactone appears to cause a prolonged decrease in estrogen sensitivity for up to six months. Testolactone addresses both estrogen levels and estrogen sensitivity (at least for a period of time). An appropriate dose, 450 mg daily has been studied (off-label) for gynecomastia treatment. Note: Testolactone is not FDA approved for the treatment of gynecomastia.

Testolactone is very expensive. Many doctors will not prescribe testolactone simply because they are not familiar with off-label use of it for gynecomastia. If you ask your doctor about testolactone, it is advisable to print out one of the many studies available online as a reference.

Androgen Levels
Just as increased estrogen levels can aggravate gyno, decreased androgen levels can throw off the estrogen-androgen balance. Topical DHT has been shown effective in some cases for treatment of gynecomastia. Androstanes such as oxandrolone also seem to reduce gynecomastia, but good luck getting a prescription for this from your doctor. In theory, any non-aromatizing (and non-estrogenic/progesterogenic) androgen should exhibit some degree of anti-gyno behavior.

Just as increased estrogen levels can aggravate gyno, decreased androgen levels can throw off the estrogen-androgen balance. Topical DHT has been shown effective in some cases for treatment of gynecomastia. Androstanes such as oxandrolone also seem to reduce gynecomastia, but good luck getting a prescription for this from your doctor. In theory, any non-aromatizing (and non-estrogenic/progesterogenic) androgen should exhibit some degree of anti-gyno behavior.

A Combined Approach
Using any of these approaches alone can positively counteract gynecomastia. However, it’s no surprise that most treatment efforts that focus only on the reduction of estrogen are far from optimal. Ideally, all three of these issues should be addressed with non-surgical treatment.

Unfortunately, many will have difficulty getting treatment from a doctor that addresses all three of these primary contributing factors. So what else can you do? Here are a few very effective OTC alternatives.

Can’t get a Prescription?
There are a couple of unique compounds that have favorable effects on gynecomastia and are currently available as OTC products:

3,17-dioxo-etiochol-1,4,6-triene (ATD)
Last month I wrote about an exciting new supplement called ATD (3,17-dioxo-etiochol-1,4,6-triene). ATD is a powerful aromatase inhibitor that also blocks androgen activity site-specifically in the hypothalamus. The net result? A 50 percent reduction in estrogen and 400 percent increase in testosterone. Impressed yet?

Many have noted (anecdotally) a dramatic improvement in gynecomastia while using ATD. This makes sense as ATD alone addresses two of the three primary concerns contributing to male breast development.

Formestane
Formestane is another powerful and effective aromatase inhibitor. One of the unique properties to this compound is the reduction in progesterone and estrogen receptor concentration. Like other aromatase inhibitors, formestane up-regulates testosterone production.

You should see by now combining ATD with Formestane is a logical OTC approach to combating gynecomastia.

Avoiding D-Cup Status

Avoiding gynecomastia in the first place is the best option, so understanding the primary causes of male breast development allows for better choices.

1) Avoid aromatizing androgens or employ an aromatase inhibitor if you are sensitive.

2) Keep your liver healthy. The liver is responsible for clearing estrogens. Patients with cirrhosis have been shown to have problems with elevated estrogen levels. I should also note here that Agaricus Bisporus extract also aids with estrogen clearing.

3) For those who employ oral androgens: remember your liver health. Clearly androgens such as Methandrostenolone (Dianabol) and Methyltestosterone are poor choices for gyno-prone individuals. The combination of high aromatization and significant liver stress beg for a wet t-shirt contest.

4) Some have used Aminoglutethimide (Cytadren™) to prevent gyno. While Aminoglutethimide certainly blocks estrogen formation and could be used for this purpose, I do not recommend it as a general practice. Aminoglutethimide works by blocking the conversion of hormones in the body by inhibiting the enzymes aromatase and desmolase. While this may be effective during exogenous androgen use, it certainly is a sledgehammer approach to fixing the problem. Aminoglutethimide also blocks cortisol production and if misused can cause cortisol rebound.

5) Tamoxifen (Nolvadex™) has also been used to prevent and reduce gynecomastia. Unlike aromatase inhibitors, Tamoxifen works by competing at the estrogen receptor site blocking its activity. Tamoxifen will inhibit IGF-1 production to a degree and some claim that it inhibits gains, but keep in mind that it also inhibits water retention, which can effect bodyweight (but not muscle mass). Tamoxifen does not inhibit the formation of estrogen, however, and as such is best used short term while waiting for an aromatase inhibitor to take effect.

6) Tamoxifen does positively affect blood lipid profiles and therefore may be a good choice for some individuals. ATD is a logical choice during and after androgen administration as it will prevent estrogen accumulation, as well as maintain some degree of HPTA function.

Final Thoughts

Clearly avoiding gynecomastia is any bodybuilder’s best option. In many cases, the individual did not realize that they were susceptible or that they were one of those unlucky individuals who experiences spontaneous occurrence, unrelated to androgen use or hormonal manipulation. Of course, others are simply reckless.

Fortunately better information enables better choices.