# STEROIDS FORUM > ANABOLIC STEROIDS - QUESTIONS & ANSWERS >  Progesterone and prolactin induced gynecomastia

## D7M

More from Nandi....

PROGESTERONE AND PROLACTIN INDUCED GYNECOMASTIA 


Before delving into this subject, Id like to say first and foremost, that in users of anabolic /androgenic steroids (AAS) the first step in combating the development of gynecomastia, or male breast enlargement, is to eliminate the causative agent: the anabolic steroid . Drug-induced gynecomastia almost invariably resolves on its own when a person quits taking the drugs responsible for it, if caught before permanent fibrosis develops. Unfortunately, most AAS users dont want to employ this simple approach, for obvious reasons, so the foregoing will all be under the assumption that a person wants to prevent or treat gyno and still continue steroid use . 

In the belief that certain anabolic steroids increase prolactin levels as well as act as agonists at the progesterone receptor, some have advocated the use of antiprolactin agents, like bromocriptine, or progesterone receptor blockers like RU-486 to treat AAS related gynecomastia, in lieu of more traditional drugs like tamoxifen .

In truth, the etiology of gynecomastia is unknown and a number of agents including estrogens, progestins, GH, IGF-1, and prolactin may be involved. However, most authorities believe that a decreased (T+DHT)/E ratio is central to the development of gyno, and that blocking the effects of estrogen, or increasing T + DHT levels, is central to ameliorating the problem.

Regarding prolactin, androgens decrease prolactin levels whereas estrogens increase prolactin. Non-aromatizing androgens have never been shown to elevate prolactin levels in humans, but testosterone has, due to its aromatization to estradiol (19). Prolactin secreting tumors, or prolactinomas, are often associated with gyno. But in these cases the prolactin is believed to induce gyno by suppressing testosterone production: Prolactinomas that are sufficiently large to cause gynecomastia do so as a result of impairment of gonadotropin secretion and secondary hypogonadism. (20). However, this is a moot issue in AAS users whose gonadotropin secretion is already blunted.

According to research cited in (20), prolactin may have a direct stimulatory effect on mammary tissue development, but only in the presence of high estrogen levels:


The presence of mild hyperprolactinaemia is therefore not uncommon in patients with estrogen excess. Significant primary hyperprolactinaemia, on the other hand, may directly stimulate epithelial cell proliferation in an estrogen-primed breast, causing epithelial cell proliferation and gynaecomastia.

*So rather than focusing solely on lowering prolactin levels which may be elevated in users of aromatizing androgens, attacking estrogen should be the first line of action*.

GH and IGF-1 are considered critical to the proliferation of mammary tissue. An excellent review of the role played by these hormones, as well as a general overview of gynecomastia can be found here:




Since elevated GH and IGF-1 are considered important to the anabolic effect of AAS, it would be impractical and counterproductive to attempt to prevent gynecomastia by blocking GH/IGF.

Progesterone acts in concert with estrogen to promote breast development, and at least part of any role played by synthetic progestins may be to stimulate IGF-1 production in the breast. But again, blocking the action of progesterone or synthetic progestins is not practical. Specific progesterone receptor antagonists like RU-486 block not only the progesterone receptor, but the androgen receptor as well, and have actually been associated with the development of gynecomastia (21). *In any case, progesterone is thought to act on the breast to enhance the effects of estrogen (22) so once again, attacking estrogen is the easiest and most logical approach.*

DHT gel (Andractim) or a generic knockoff might help as well. DHT is thought to act as an aromatase inhibitor (23) and perhaps compete directly with estrogen for binding at the estrogen receptor (24). DHT has been used in several case reports and controlled trials to successfully treat gynecomastia. So perhaps a viable strategy would be to combine DHT gel with tamoxifen.* I would recommend tamoxifen rather than an aromatase inhibitor due to the simple fact that tamoxifen has been widely used in numerous controlled studies to succesfully treat gynecomastia,* whereas the evidence to support the efficacy of aromatase inhibitors is scanty at best.

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## D7M

References:

(1) Price TM, O'Brien SN, Welter BH, George R, Anandjiwala J, Kilgore M. Am J Obstet Gynecol 1998 Jan;178(1 Pt 1):101-7 

(2) Bjorntorp P. Hum Reprod 1997 Oct;12 Suppl 1:21-5 

(3) Ramirez ME, McMurry MP, Wiebke GA, Felten KJ, Ren K, Meikle AW, Iverius PH Metabolism 1997 Feb;46(2):179-85 

(4) Zmuda JM, Fahrenbach MC, Younkin BT, Bausserman LL, Terry RB, Catlin DH, Thompson PD. Metabolism 1993 Apr;42(4):446-50 

(5) Tomita T, Yonekura I, Okada T, Hayashi E
Horm Metab Res 1984 Oct;16(10):525-8 

(6) Mystkowski P, Seeley RJ, Hahn TM, Baskin DG, Havel PJ, Matsumoto AM, Wilkinson CW, Peacock-Kinzig K, Blake KA, Schwartz MW. J Neurosci 2000 Nov 15;20(22):8637-42 

(7) Greer,M. N Engl J Med 244:385, 1951

(8) Vagenakis AG, Braverman LE, Azizi F, Portinay GI, Ingbar SH. N Engl J Med 1975 Oct 2;293(14):681-4 

(9) Krugman LG, Hershman JM, Chopra IJ, Levine GA, Pekary E, Geffner DL, Chua Teco GN J Clin Endocrinol Metab 1975 Jul;41(1):70-80

(10) Liva SM, Voskuhl RR J Immunol 2001 Aug 15;167(4):2060-7 

(11) Ulloa-Aguirre A, Blizzard RM, Garcia-Rubi E, Rogol AD, Link K, Christie CM, Johnson ML, Veldhuis J Clin Endocrinol Metab 1990 Oct;71(4):846-54

(12) Hochman IH, Laron Z Horm Metab Res 1970 Sep;2(5):260-4 
.
(13) Steinetz BG, Giannina T, Butler M, Popick F
Endocrinology 1972 May;90(5):1396-8 

(14) Ferrando AA, Sheffield-Moore M, Yeckel CW, Gilkison C, Jiang J, Achacosa A, Lieberman SA, Tipton K, Wolfe RR, Urban RJ.
Am J Physiol Endocrinol Metab 2002 Mar;282(3):E601-7 

(15) Sheffield-Moore M, Urban RJ, Wolf SE, Jiang J, Catlin DH, Herndon DN, Wolfe RR, 
Ferrando AA
J Clin Endocrinol Metab 1999 Aug;84(8):2705-11 

(16) Doumit ME, Cook DR, Merkel RA..Endocrinology 1996 Apr;137(4):1385-94 

(17) Bricout VA, Germain PS, Serrurier BD, Guezennec CY.Cell Mol Biol (Noisy-le-grand) 1994 May;40(3):291-4 

(18) Ferrando AA, Sheffield-Moore M, Yeckel CW, Gilkison C, Jiang J, Achacosa A, Lieberman SA, Tipton K, Wolfe RR, Urban RJ.
Am J Physiol Endocrinol Metab 2002 Mar;282(3):E601-7 

(19) Nicoletti I, Filipponi P, Fedeli L, Ambrosi F, Gregorini G, Santeusanio F
Acta Endocrinol (Copenh) 1984 Feb;105(2):167-72 

(20) Ismail AA, Barth JH.Ann Clin Biochem 2001 Nov;38(Pt 6):596-607 

(21) Grunberg SM, Weiss MH, Spitz IM, Ahmadi J, Sadun A, Russell CA, Lucci L, Stevenson LL J Neurosurg 1991 Jun;74(6):861-6

(22) Nomura K, Suzuki H, Saji M, Horiba N, Ujihara M, Tsushima T, Demura H, Shizume K
J Clin Endocrinol Metab 1988 Jan;66(1):230-2

(23) Perel E, Stolee KH, Kharlip L, Blackstein ME, Killinger DW
J Clin Endocrinol Metab 1984 Mar;58(3):467-72

(24) Casey RW, Wilson JD.
J Clin Invest 1984 Dec;74(6):2272-8

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## D7M

I've highlighted some parts in bold for those of you who have trouble reading several paragraphs  :Wink/Grin:

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## D7M

^^^^^^

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## marcus300

Excellent read D7M, many dont know the first port of call should be to attack estrogen and see if that reduces the complaint of Prg,

Thanks D7M keep them coming




Keep bumped

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## FuzzyPeaches o.O

Good post! Hopefully this will cut down on the "can I use nolva while using a 19nor?" threads.

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## HawaiianPride.



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## D7M

Up for the morning crowd....

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## Swifto

I've been saying this for ages.

Estrogen is the regulator of prolactin. If you want more information, research the 'Long Feedback Mechanism'.

Only compounds that aromotase and interect with the ER can increase PRL.

AI's will help control PRL.

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## tballz

Great read....

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## Charlie6

can we put this in the educational section as well?

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## jojomcgo

> 



Talk about package delivery. :0ae86hump:

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## Bonaparte

> I've been saying this for ages.
> 
> Estrogen is the regulator of prolactin. If you want more information, research the 'Long Feedback Mechanism'.
> 
> Only compounds that aromotase and interect with the ER can increase PRL.
> 
> AI's will help control PRL.


?
I thought estrogen directly regulated progesterone, not prolactin. Oh Christ...

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## Matt

Great thread....

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## Aizen Sosuke

D7M thanks for digging this up. We should sticky this. HP that is the pic of the day.

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## HawaiianPride.

It fits this thread perfectly.

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## Bertuzzi

Bump....

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## SomeLiveForTheBill

Is the original post suggesting use of tamoxifen over anastrozole during cycle to combat estrogen sides?

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## D7M

> Is the original post suggesting use of tamoxifen over anastrozole during cycle to combat estrogen sides?


Yes, but only secondarily. 

Of primary note is that one should seek to control elevated PrL levels by first controlling Estrogen levels. 

And the author recommends Tamox for this, yes.

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## SomeLiveForTheBill

> Yes, but only secondarily. 
> 
> Of primary note is that one should seek to control elevated PrL levels by first controlling Estrogen levels. 
> 
> And the author recommends Tamox for this, yes.


So, use A-dex from day 1? If you see estrogen sides, switch to Tamox?

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## D7M

If you're using Adex from day one you shouldn't be having and Estrogen sides. 

Both Adex (AI) and Tamox (SERM) are effective for controlling Estrogen. 

The author was suggesting the use of Tamox.

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## Hazard

I recently had a bad bout of 19-nor induced gyno..... I immediately used Exemestane and nolva with a bit of caber and now no more problems. Only a maintenance dosage once or twice a week now.....

~Haz~

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## 40plusnewbie

I'm on cyp and tren and have a higher than recommended bf so am at greater risk of estro issues. i have adex and letro both on hand. i've been taking a little letro as a precaution every 3-4 days. Is this a reasonable approach (assuming i don't want to just wait to see if I have symptoms or stop my cycle)? or switch to the adex? I felt like the letro was more of an estro killer than adex or nolva (I have nolva and torem on hand too). My plan OK or sugggsted changes with the pct drugs I have on hand. I'm also taking HCG 250iu 2x/week.

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## songdog

great thread

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## HawaiianPride.

Bump.

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## sms

> If you're using Adex from day one you shouldn't be having and Estrogen sides. 
> 
> Both Adex (AI) and Tamox (SERM) are effective for controlling Estrogen. 
> 
> The author was suggesting the use of Tamox.


D7M,

please correct me as Im newbie but wouldnt an AI be better to use to combat Estrogen as first port of call as it stops the Aromatization to Estrogen rather than a SERM as its a blocks the recptor sites not the conversion to estrogen?? good damn I'm confused now??  :Hmmmm:

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## blizzard

Bump

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## baseline_9

Nice read

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## Matt

> D7M,
> 
> please correct me as Im newbie but wouldnt an AI be better to use to combat Estrogen as first port of call as it stops the Aromatization to Estrogen rather than a SERM as its a blocks the recptor sites not the conversion to estrogen?? good damn I'm confused now??


Yes it would be better to use and ai like adex or stane to control estrogen in the first place...

Sometimes though people will use nolva, i like using nolva because i don't mind the slightly elevated estrogen levels. Just don't like gyno, and yes we use nolva to stop estrogen from binding to breast receptors...

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## 2jz_calgary

great thread. Ive read swiftos advice on all this earlier. I used to think prolactin could cause gyno as well as nolva will make it worse...both myths.

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## jimmyinkedup

Shame this man is no longer with us...
You know the only things I ever read that were written by that POS A. Roberts that were true - were the things he down right plagerized /stole from this man. Everytime i see anything Nandi wrote ..it makes me hate roberts more and more....
Anyway Im real familair with this post, its great info..as was always the case coming from this guy.

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## 2jz_calgary

bump

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## Swifto

> ?
> I thought estrogen directly regulated progesterone, not prolactin. Oh Christ...


Bonaparte,

Nandi is spot on.

http://forums.steroid.com/showthread...s-sex-problems

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## Nebuchadnezzar

thank u so much
i had so many questions regarding prolactin and u answered everything beautifully 
thanx man

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## yungone501

> I recently had a bad bout of 19-nor induced gyno..... I immediately used Exemestane and nolva with a bit of caber and now no more problems. Only a maintenance dosage once or twice a week now.....
> 
> ~Haz~


Wow, if you had some man-boobs, you'd look very close to a competitive female bodybuilder! :-)

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## denzel

why is there 100 posts throughout different forums/internet saying serms/ai will not help progesterone induced gyno...i thought it was not estrogen related so serms/ai could not help?!

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## Lemonada8

Cuz there is no such thing as progesterone induced gyno... :-P

and its all about estrogen control... the main hormonal difference between men and women is the levels of estrogen, yet we can change sexes through hormonal therapy... so other horomones begin to react with elevating estrogen when estrogen gets high enough

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## sizzlechest

Tren E gave me Gyno.

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## Swifto

> Cuz there is no such thing as progesterone induced gyno... :-P
> 
> and its all about estrogen control... the main hormonal difference between men and women is the levels of estrogen, yet we can change sexes through hormonal therapy... so other horomones begin to react with elevating estrogen when estrogen gets high enough


Progesterone shows to speed breast cell proliferation in primates. But this is in the presence of estrogen. Never seen anything alone.

Tamox is the key here, as in most cases. Whether is estrogen alone or a combination of estorgen+progesterone, doesnt matter.

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## Cwired

So what should you take or do if you already have gyno?

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## EpyoN

Im failing to understand how prolactin or progesterone come to be. Do certain hormones convert into prolactin or progesterone when there is an excess?

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## songdog

Good job bro.

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## DanB

I been looking for this thread, couldnt remember who wrote it

Admin where are you? Sticky!

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## kelkel

Saved it to my favorites. Another excellent thread! Damn.

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## bob87

oops replied to old post

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## bob87

oops replied to old post

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## Lemonada8

> Im failing to understand how prolactin or progesterone come to be. Do certain hormones convert into prolactin or progesterone when there is an excess?


they are natural hormones in the human body, that play a key part in sexual differences. Estrogen is a major stimulator when it comes to them doing certain actions. 

aka, prolactin by it self doesnt do much, but when there are high estrogen levels, it increses the breast tissue to begin to grow and lactate (similar to a preggo woman breast feeding) but in males, since we dont have that much of dominance of estrogen in our bodys (testosterone is our main one) that function doesnt occur. 
Think of the word "gynecomastia ' which literally means "women breast" when broken down to the original greek term definations. normally this doesnt happen in males, and if it does its due to a hormonal imbalance ( mens breasts dont get NEARLY the size of a preggo womans) so its more of a cosmetic thing than anything else. 

Prolactin is released from the pituitary gland, and is usually controlled by Dopamine. (thats why its suggested to take dopamine agonists *caber, bromo* to couteract those effects) however the down side is that they are pretty potent drugs and not to be taken lightly. Personally, i would go with tamox, vit b6, and the supplement L-Dopa before taking one of those dopamine agonists. but thats a side issue, and im not wanting to start a debate on that type of stuff, just trying to answer ur question as thorough as i can (b/c im procrastinating from studying :P) but the main effects of prolactin that would cause gyno are minimal without the presence of elevated estrogen. The estrogen makes the prolactin 'more effecient' at its biological function for breast growth. (probably due to the genome changes that estrogen induces to the DNA which slows certain proteins from being made to others being made more... hence estrogen being carcinogenic in males b/c we dont need nearly the same amount of changes as women do)

Progesterone is considered the 'mother of all hormones' (behind pregnenolone *for those scholars out there :P ) that it is the first step in the hormone transformation in the body and can become any part of the 4 major hormones in the body (Progestins, mineralocorticoids, androgens, estrogens) check out this graph which explains the process a lil better of how they all interact . There really isnt a true 'progesterone induced' gyno, because thats way to early in the hormonal process to determine that is the cause. 

Basically the end line is that if you control your estrogen levels while on a cycle, then prolactin issues shouldnt be a problem. And the best thing for *gyno only* is tamox (nolvadex )... (yet rolaxifene is showing some good progress, its a newer drug with a different structure but still looks good for the future)

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## DanB

I shall bump this thread

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## bob87

It's a great thread.

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## DanB

> I shall bump this thread


getting deja vu

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## blacksmoke

Bump

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## Scabtree

Gotta love information with references. It's so rare; thanks D7M.

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## DanB

Its about time for me to bump this again

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## AnabolicDoc

I recently read an article abstract that compared raloxifene vs tamoxifen in treating gynecomastia in prepubescent males and the results favored raloxifene, which is also known as Evista. The dosage is 60mg per day.

I tried to include the article in my post but when I do so my post keeps getting denied. So if u want to see the article, go to PubMed and search for it.

FYI, this is my first post and I'm new to the site.

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## kelkel

Here you go AD. http://www.ncbi.nlm.nih.gov/pubmed/15238910

You have to be here a bit before your allowed to post links or PM other members. Safety method to avoid scammers, etc.

Welcome to the forum AD!

kel

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## AnabolicDoc

Thank you.

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## AnabolicDoc

It is commonly believed that an elevated prolactin level is most often due to stress, physical and/or mental, and should always be rechecked before starting medication.

I posted this just as a reminder for those who privately check their own blood work and obtain medication, without a doctor (or if you're seeing a doctor who's not entirely competent). Double checking prolactin levels could spare you a wrong diagnosis, unnecessary grief, cost, side effects, and imaging tests (looking for a prolactinoma).

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## DanB

new years bump ! ! ! ! ! ! ! ! ! ! ! ! ! ! !

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