Does Paxil cause gynecomastia? (+2 evidences)
In this article, we will discuss if Paxil can cause gynecomastia in men. We will also discuss the research study and the interventions to reverse gynecomastia.
Does Paxil cause gynecomastia?
Yes, Paxil may cause gynecomastia. However, there are very rare chances of developing gynecomastia with the use of Paxil. While some teenagers experience gynecomastia as a normal event, it is crucial to examine Paxil-induced breast growth in adults.
The mechanism by which Paxil causes gynecomastia is still not fully known. The treatment of Paxil-induced gynecomastia includes stopping the drug. Surgical and medical interventions are only used in very rare cases.
Gynecomastia is usually asymptomatic and goes unnoticed by the patient. The occurrence of gynecomastia in men rises with age and is often thought to be caused by an increasing estradiol/testosterone ratio. This makes interpreting Paxil-related gynecomastia more difficult
How may Paxil cause gynecomastia?
Because of adaptive alteration in dopaminergic neurons, Paxil causes changes in dopaminergic neurotransmission and hyperlactatemia. Two pathways have been hypothesised for Paxil causing gynecomastia:
- Presynaptic suppression of dopamine release due to serotonin release by serotonergic neurons, and
- Prolactin release due to stimulation of postsynaptic serotonergic receptors present in the hypothalamus (1, 2).
What does the research suggest?
In a case report, a 30-year-old man reported an enlarged left breast during the use of Paxil for panic disorder. The breast examination confirmed that there was no malignancy and the level of prolactin was 14 ng/ml. The discontinuation of Paxil and surgical interventions were done to fix gynecomastia (3).
The Netherland Pharmacovigilance Center Lareb database obtained 12 cases of gynecomastia-related reports due to the use of Paxil. Other side effects might also include increased hyperlactatemia, breast tenderness and increased tiredness.
Does Paxil-induced gynecomastia affect breastfeeding?
Gynecomastia in females can happen due to the increased level of estrogen and drugs. Paxil-induced gynecomastia can affect one or both of the breasts. It may begin as a painful lump or fatty tissue beneath the nipple. Breats often grow unevenly in such cases.
The symptoms can include pain, swelling, tenderness and nipple discharge. This can be more problematic for women who are breastfeeding. It will cause more pain to the mother while feeding. Additionally, the nipple discharge can cause more discomfort.
Increased levels of prolactin can cause galactorrhea. It is a pale yellow milky discharge that is not related to pregnancy or breastfeeding. This can cause an increase in the baby’s breast tissues. If the discharge is persistent, the mother and child should be evaluated by the healthcare professional.
Is Paxil-induced gynecomastia reversible?
Gynecomastia often resolves on its own over time. However, if gynecomastia is the result of a medical condition then it might require therapy. If Paxil is causing gynecomastia then the patient should always refer to the doctor for better options.
Clinical and non-clinical interventions can be adapted to reduce the occurrence of gynecomastia. In case of severity, the doctor might instruct the patient to discontinue the medication or to try a new antidepressant.
What are the non-surgical interventions to reduce Paxil-induced gynecomastia?
The following lifestyle modification can be adopted by men facing the challenge of Paxil-induced gynecomastia:
- Loss weight,
- Dieting to avoid excessive weight gain,
- Avoiding the use of steroids or drug abuse,
- Reducing alcohol consumption,
- Hormonal replacement therapy.
What are the surgical interventions to reduce Paxil-induced gynecomastia?
If the appearance or personal issues upset the patient, surgery could be an option. There are two gynecomastia surgery options:
- Liposuction: this procedure removes breast fat but not breast gland tissues.
- Mastectomy: the breast gland tissue is removed during this procedure.
What are the pharmacological interventions to reduce Paxil-induced gynecomastia?
Some pharmacological therapy may be tried if the gynecomastia is severe, does not resolve on its own, and does not have a curable underlying cause. Medical treatment falls into three categories (4):
- Androgen therapy with testosterone or danazol,
- Anti-estrogens like tamoxifen, and
- Aromatase inhibitors like letrozole.
Which other conditions can cause similar symptoms?
It is important to understand that other disease conditions can mimic the symptoms of gynecomastia. These conditions might include:
- Fatty breast tissue: it is also known as pseudo gynecomastia. It occurs occasionally in obese patients.
- Breast cancer: it is less common in men but the presence of a firm lump increases the possibility of male breast cancer.
- Lipoma: this fatty, slow-growing mass is not gynecomastia.
- Mastitis: inflammatory breast tissue that may or may not be infected.
In this article, we discussed the possibility of getting gynecomastia with Paxil use. We also discussed the non-surgical, surgical, and pharmacological interventions that can be used to reduce Paxil-induced gynecomastia. I recommend that you always consult your doctor if you feel breast tenderness or enlargement during Paxil use without feeling shy.
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