At this age, the abnormality can cause psychological problems if the patient excludes himself from almost any athletic or physically involved interaction. B , The patient seen in Figure 3, A 4. The term pseudogynecomastia refers to a deposit of fat not breast tissue in the breast and is commonly seen in obese men.
Some cases of drug-induced gynecomastia may have a significant pseudogynecomastia component. Transient breast enlargement of a few months does not need any formal diagnosis. However, prepuberal gynecomastia may be associated with interstitial cell tumors of the testes, and testosterone levels should be measured in these patients. In adolescents there is no reason to consider endocrine tests unless enlargement is massive or the gynecomastia persists for more than 2 years.
Gynecomastia persisting after puberty may be associated with serious disease; when there is no obvious cause, the patient should have a complete examination, and plasma levels of estrogen, testosterone, and prolactin should be obtained. A breast biopsy or excision can establish a diagnosis, especially in older patients, in whom gynecomastia may be unilateral.
Carcinoma of the breast can occur in males with Klinefelter's syndrome 25 , 26 and in patients treated with estrogen. Mammography and biopsy are the definitive evaluation methods. A connective tissue proliferation that is characterized by increased fibrosis and hyalinization is usually present regardless of cause.
There may be a proliferation of ducts with epithelial hyperplasia with a characteristic halo effect. A photomicrograph of hematoxylin-eosin-stained tissue removed from a patient with anabolic steroid-induced gynecomastia. This represents the portion removed by a very sharp suction cannula. Body image problems during adolescence are common in most individuals. Peer group pressure may cause a young man with gynecomastia to alter his activities so as not to participate in gym class or any sports.
A parent's justifiable concern may cause even more anxiety. The adolescent boy with this condition may have difficulty developing normal relationships with girls and ultimately may experience severe maladjustment. Psychotherapy may be considered if anxious or psychologically depressive behavior persists. Hormonal manipulation is ineffective in the management of gynecomastia. Since then, the development of lipoplasty by Illouz, 29 Lewis, 30 Teimourian et al, 31 Hetter and Herhahn, 32 , 33 Mladick and Morris, 34 Pitman, 14 and others has made it possible to treat many of these patients with the inconspicuous lipoplasty technique.
Surgical treatment depends on the size and the degree of fat and fibrous tissue present. For massive gynecomastia, direct surgical excision and mastectomy may be indicated. In most cases, the volume of the breast hypertrophy is less than 1 L and lipoplasty can be performed with a small 4 or 5 mm blunt cannula introduced from a remote incision site in the axilla.
In approximately one half of cases, all of the excess tissue can be removed by lipoplasty. In this circumstance, the fibrous tissue cannot be removed with the blunt cannula and direct excision is required. An incision placed in the areolar skin junction on the medial aspect will avoid most of the branches of the fourth intercostal nerve that innervate the nipple-areolar complex, and it will leave an inconspicuous scar at this areolar skin junction.
Only in the most massive cases are further incisions and scars necessary. With extensive lipoplasty to this area of the chest, postoperative pressure garments are necessary for several weeks to avoid seromas. If direct excision is necessary, a smoother result can be achieved by using liposuction to taper the areas of the excision area and remove the subcutaneous fat around the pectoralis major muscle. In every case, we explain to the patient preoperatively that we will attempt to remove the tissue by suction lipoplasty only but that we reserve the option to make a small incision in the periareolar region to remove the glandular tissue.
In some cases in which we used lipoplasty only and a small amount of fibrous tissue left at the nipple was not excised, patients have returned after approximately 6 months to have the small nubbin removed. They were very insistent that all the tissue be removed from this area.
Consequently, if there is any doubt at the time of surgery, the excision is indicated. Adrian Aiache's 38 recommendation of direct excision for those cases of gynecomastia associated with steroid abuse by bodybuilders is borne out by his excellent results. However, our experience is that in this setting as well, lipoplasty alone is sufficient in approximately one half of cases, whereas a combination of lipoplasty and direct excision to provide a smooth, even contour is appropriate for other patients.
When this blunt technique is combined with subcutaneous infiltration, fat can be safely removed with a minimum of blood loss and with no permanent anesthesia or paresthesia Figure 5. Sharp suction curettes or cannulas are not recommended at this time. Illouz and de Villers 41 first described a high-volume suction machine that develops maximum vacuum to quickly pull the amorphous fat into the cannula for avulsion. More recently, systems have been developed that use wide-mouthed plastic syringes.
The vacuum machines have a 1- to 2-L reservoir and a safety trap and vacuum gauge. After the cannula is introduced, the vacuum is switched on and left on until the case is completed. When the syringe method is used, it is necessary to have a duplicate set of syringes and cannulas so that when the aspirating orifice is close to the skin wound and vacuum is lost as air rushes into the chamber, the operator can pass off one syringe and receive another that is prepositioned and evacuated.
The latter method has the added advantage of involving a closed system in which the vacuum and sample are contained within the syringe barrel, whereas the machine method continually pulls vacuum over the sample and expels that air into ambient air. Although most machines have submicron filters, it has been shown that virus can be spread through this airborne route. Since , we have treated patients with all degrees of gynecomastia, ranging in age from 16 to 68 years, with these methods; the results have been universally good.
We have had no incidence of infection, skin slough, persistent paresthesia, or anesthesia and no incidences of postsurgical psychologic disturbance. A circumareolar approach in surgical management of gynecomastia. Plast Reconstr Surg ; 67 : 35 — Google Scholar.
Davidson B. Concentric circle operation for massive gynecomastia to excise the redundant skin. Plast Reconstr Surg ; 63 : — Menville JG. Arch Surg ; 26 : — Teimourian B. Perlman R. Surgery for gynecomastia. Aesthetic Plast Surg ; 7 : — Lewis C. Lipoplasty: treatment for gynecomastia. Aesthetic Plast Surg ; 9 : — Courtiss E. Gynecomastia: analysis of patients and current recommendations for treatment.
Plast Reconstr Surg ; 79 : — Mladick R. Gynecomastia: liposuction and excision. Clin Plast Surg ; 18 : — The Breast. Louis : Mosby ; : Google Preview. Bannayan G. Hujdu S. Gynecomastia: clinicopathologic study of cases. Am J Clin Pathol ; 57 : — Gynecomastia in adolescent boys. JAMA ; : Reifenstein EC Jr. Hereditary familial hypogonadism. Proc Am Fed Clin Res ; 3 : Familial gynecomastia. Ann Int Med ; 63 : Syndrome characterized by gynecomastia, aspermatogenesis without A-leydigism and increased excretion of follicle stimulating hormone.
J Clin Endocrinol ; 2 : Pitman GH. Liposuction and Aesthetic Surgery. Louis : Quality Medical Publishing ; : — August G. Chandra R. Hung W. Prepubertal male gynecomastia. J Pediatr ; 80 : — The feminizing syndrome in male subjects with adrenocortical neoplasms.
Am J Med ; 37 : Adrenocortical carcinoma with gynecomastia: case report and review of literature. J Clin Endocrinol ; 17 : The testis, breast, and prostate of men who die of cirrhosis of the liver. Am J Clin Pathol ; 20 : Jacobs EC. Gynecomastia following severe starvation. Ann Int Med ; 28 : Hardy JD. Gynecomastia associated with lung cancer. Molina C Aberkane B. Les gynecomasties des tuberculeux pulmonaires. Sem Hop ; 36 : Gynecomastia and diseases of the thyroid.
Acta Endocrinol ; 44 : Wolf H. Madsen P. Vermund H. Prevention of estrogen-induced gynecomastia by external radiation. J Urol ; : — Strauss R. Anabolic steroids in the athlete. Annu Rev Med ; 42 : — Pitanguy I. Transareolar incision for gynecomastia. Plast Reconstr Surg ; 38 : — Letterman G. Schurter M. The surgical correction of gynecomastia. Am Surg ; 35 : — Webster JP. Mastectomy for gynecomastia through a semicircular intra-areolar incision.
Ann Surg ; : Illouz YG. Male bodybuilders can be very body-conscious and place a high value on their physical aesthetics due to high competitive standards in the sport. This often leads male bodybuilders to push their physique to the limits by regularly using or experimenting with steroids.
Even those who know the risks may not realise that once you develop enlarged breasts due to steroid use, gynecomastia surgery may be the only viable option for correcting it. Another misunderstanding in the bodybuilding community is the belief that if you develop enlarged male breasts gynecomastia while taking steroids, it will simply go away after you stop taking them.
This is not true. Breast tissue that has developed from using steroids will not go away. It is permanent. Dieting or increasing chest workouts will not fix the problem. Gynecomastia surgery is the only solution for removing breast tissue. There are many different types of Gynecomastia resulting from steroid use. Bodybuilders can experience one or a combination of classic gynecomastia, puffy nipples, or even enlarged areolas. Furthermore, Gynecomastia caused by steroid use is extremely glandular making it very difficult to provide a desirable aesthetic result with a liposuction procedure alone.
Having the condition addressed by liposuction instead of a surgical excision can lead to recurrences, bleeds, and other adverse effects. Direct excision of the tissue is required to achieve the best possible outcome and this is done via Gynecomastia surgery. At Esteem Cosmetic Studio , our surgeons have performed many gynecomastia surgical procedures in Sydney, Brisbane, and Canberra. Their expertise and vast experience treating bodybuilders who have taken steroids as well as other men who have developed noticeably larger breasts due to ageing translates into providing their patients with the highest level of patient care and surgical treatment while delivering optimal aesthetic results.
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|Gynecomastia and steroids||Download all slides. Receive exclusive offers and updates from Oxford Academic. BThe patient seen in Figure 3, A 4. Submit Form Meet with Dr. Their sport has competitive events in which contestants boast single-digit percentages of body fat, which makes their glandular breast tissue even more pronounced. Medicines used to treat epilepsy such as phenytoin [Dilantin].|
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|Latest news on anabolic steroids||Advanced Search. In: Hetter GPed. Ersek, MDRobert A. Gynecomastia can also be caused by an estrogen-producing tumor. BThe bodybuilder seen in Figure 1A after combined lipoplasty and direct excision with a periareolar incision. Les gynecomasties des tuberculeux pulmonaires.|
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The unsightly nature of this side effect is what has prompted the mocking of its association with anabolic steroids , and the degree to which the development of gyno on an individual manifests and presents itself will vary greatly, ranging from minor and almost unnoticeable to larger, more noticeable, and can be very feminine in its display, all being very difficult to conceal. Gyno, for the most part, is generally the result of either ignorance, neglect, or impatience on the part of the anabolic steroid user himself.
Unlike 40 years ago, ignorance of the proper and responsible use of anabolic steroids is no excuse. For those who wish to learn about the complexity of the development of gyno at the cellular level as well as the proper preventative measures and even the purported measures for reversal , this article will efficiently and thoroughly describe and educate the reader concerning these topics.
As previously mentioned, we are concerned almost exclusively with anabolic steroid induced Gynecomastia rather than any other particular forms. In the case of anabolic steroid induced gyno, the initial cause must first be identified and explained. It has been previously mentioned thus far that the vast majority of anabolic steroid analogues actually do not possess the ability to cause Gynecomastia, but only a handful do.
There are various other compounds that can directly contribute to and aggravate Gyno directly where the hormone is hypothesized to interact directly with the Estrogen receptors in breast tissue , while most compounds will exacerbate Gynecomastia via aromatization into Estrogen, and there are also compounds that can contribute to Gynecomastia indirectly through other pathways that do not involve aromatization. It is important to understand which anabolic steroids are of concern when it comes to the issue of gyno and what relation these compounds have with the development of Gynecomastia.
Reiterating from earlier in this article, it happens to be that some of the most effective and popular anabolic steroids tend to also be those which aromatize at some varying rate and degree into Estrogen. The following is a breakdown of the various compounds of concern when it comes to Gynecomastia. Aromatizable Anabolic Steroid s Moderate rate of aromatization : — Testosterone all esters and blends — Dianabol Methandrostenolone. It stands to reason that the higher the rate of aromatization, the more likely a hormonal environment favoring an excess of Estrogen will develop, which will then increase the likelihood of the development of Gynecomastia.
This occurs by way of their affinity for the aromatase enzyme the enzyme responsible for the aromatization of the androgen into Estrogen , and some androgens exhibit low, moderate, or high affinity for interaction with the aromatase enzyme. Anabolic steroids that are directly estrogenic, such as Anadrol 50 Oxymetholone , are anabolic steroids that do not aromatize into Estrogen at any dose but will still exhibit estrogenic activity in and of themselves or as a result of their metabolites upon the Estrogen receptor in breast tissue.
Progestational anabolic steroids, also known as Progestins, might not convert into Estrogen at all such as Trenbolone but can possibly cause or aggravate Gynecomastia even further by way of Progestin interaction with the Estrogen receptor, which can cause or create Gynecomastia even though normal physiological Estrogen levels are present. All other anabolic steroids that are not listed above such as Anavar Oxandrolone , Winstrol Stanzolol , Primobolan Methenolone , or Masteron Drostanolone , being that they are Dihydrotestosterone derivatives, do not and cannot aromatize into Estrogen at any dose at all and therefore present no risk of producing or aggravating Gynecomastia on their own.
The issue of Progesterone and Progestogenic anabolic steroids and their effects on Gynecomastia is a highly misunderstood one among the bodybuilding and anabolic steroid using community. It is important to clarify this misunderstanding and shed light on the proper understanding of this hormonal component, as often times individuals might utilize an anabolic steroid that does not exhibit any Estrogenic effects at all such as Trenbolone , and yet they will experience development of Gynecomastia, and become baffled as to why.
Although Estrogen is the primary culprit and the key component in Gyno, Progesterone and Progestogenic anabolic steroids and hormones, have been known to also play a key role in the development of Gynecomastia in the sense that they potentiate the effects of Estrogen on breast tissue growth [viii].
The result is an increased sensitivity to Estrogenic effects in breast tissue, which will invariably result in Gynecomastia or the increased probability of developing it. Because of the increased sensitivity of the Estrogen receptor created by Progestational activity, Gynecomastia formulation can occur even with normal physiological blood plasma levels of Estrogen.
This intricate matrix of Estrogen, Estrogen receptors, Progesterone, and Progesterone receptors creates a network by which Gynecomastia can become a significant issue that is not only attributed to excessive Estrogen levels. The use of a SERM Selective Estrogen Receptor Modulator or an AI Aromatase Inhibitor in these situations is normally adequate to mitigate Gynecomastia that is caused by Progestogenic anabolic steroids through their combative effects on the Estrogen component of this issue, but the proper and efficient use of AIs and SERMs in order to treat or prevent gyno will be explained in further detail very shortly.
Although Prolactin will not contribute to breast tissue formation and has nothing to do with Gynecomastia in and of the disorder, it is a hormone that can and will cause lactation of the nipples if blood plasma levels rise to excessive levels. The nipple area can commonly take on a puffy look and exhibit clear fluid secretion in men lactation. Excessive Prolactin levels can be effectively reduced through the utilization of a Prolactin antagonist also known as a dopamine agonist such as Cabergoline , Bromocriptine, or Pramipexole.
Vitamin B6 has also demonstrated significant capability in reducing Prolactin levels in the body [ix] [x] [xi]. Overall, Gynecomastia and the mechanisms behind its development at the hormonal and cellular level is indeed extremely complex, being that there are so many different pathways to its development. The causative factors are very complex, and its specifics are largely unknown to the medical establishment.
Prolactin is not a core contributing issue, but it is one of the contributing factors. The same can be said for Progesterone and Progestins, as influential as they might be. Gynecomastia is a complex disorder that is comprised of many gears that run the machine, whereby if one or more of the gears can be effectively removed or stopped, the whole machine of Gynecomastia can be effectively stopped.
Following an understanding of how Gynecomastia works and develops at the cellular level including its hormonal causes and interactions , it will be much easier to understand the methods of treatment and prevention of the disorder including the drugs and compounds to be utilized for such purposes.
Initially, however, an actual case of Gyno must be first properly diagnosed. All too often, many individuals tend to think they are exhibiting symptoms of Gynecomastia when they really are not, and their misconception of gyno is a result of over-concern, fear, and a lack of comprehension of the proper symptoms of the condition. One particular point is very clear about gyno, however, and that is the fact that while Gynecomastia might be regarded as a frequent or common side effect of anabolic steroid use, it is in fact the most easily avoidable.
Diagnosis of gyno is fairly simple and straightforward, as there are some prominent and distinct signs and symptoms of Gynecomastia that are unmistakable even to the untrained eye or someone who is not a medical professional. There is rarely any guessing or uncertainty involved in the identification and diagnosis.
The speed or rate at which the development of gyno occurs can vary through its different developmental stages. Some might never experience gyno despite increases of Estrogen to massive excess, while other individuals can experience sudden onset of Gynecomasta in the midst of the ever so slightest rise in the levels of circulating Estrogen. Development of Gynecomastia can occur both bilaterally or unilaterally [xii] [xiii]. This is to say that it is not a requirement for gyno to occur on both sides of the chest at the same time, and can and frequently does occur on one side of the chest only.
Gyno can also present itself as slight development on one side of the chest while there is significant development on the other side of the chest. Upon consultation with medical professionals, ultrasonography is typically utilized for radiologic assessment of the breast tissue for the diagnosis of Gynecomastia [xv].
Examination of breast tissue extracted by fine-needle aspiration can also be conducted in order to examine the tissue for dilated ducts that exhibit periductal fibrosis, subareolar fat tissue increases, as well as stroma hyalinization [xvi]. At such point, glandular tissue has not developed yet, and this is generally considered the reversible point of Gynecomastia development.
Complete Gyno development complete glandular growth and development as well as complete fatty tissue development has been achieved at this point, at which Gynecomastia is irreversible without surgery. The speed at which these stages progress to one another depends on many variables such as the hormonal environment, aggravating agents, and other causative factors. The aforementioned stages can progress as rapidly as two to three days, or it can progress as slowly as a number of weeks.
Some cases of Gynecomastia can linger at any of the three stages for weeks or even months before progressing to the next development stage or regressing. The degree of severity of breast growth has even been categorized into a grade system by the medical establishment [xvii] :. Grade 1: Minor enlargement with no skin excess. Grade 2: Moderate enlargement with no skin excess.
Grade 3: Moderate enlargement with skin excess. Grade 4: Marked enlargement with skin excess. The methods of both prevention and treatment of Gynecomastia are very closely related, especially in terms of the medications and compounds utilized in order to mitigate or avoid Gynecomastia.
Prevention will require techniques other than the use of any additional compounds, substances, or supplements, which will be described in detail shortly. Following this, the typical proper use of these compounds will be briefly described. SERMs were in fact developed for complications related to breast tissue growth, namely Estrogen responsive breast cancer. Because Estrogen responsive breast cancers operate via the same hormonal pathways that Gynecomastia does, the use of SERMs to prevent, inhibit, or halt the development of gyno have proven to be extremely effective [xviii].
At the cellular level, SERMs act to specifically block the activity of Estrogen in breast tissue by way of occupying the Estrogen receptor sites so that Estrogen itself cannot bind to these receptors. This is otherwise known as Estrogen antagonism. Tamoxifen Citrate gynecomastia treatment and prevention. Aromatase Inhibitors AIs — Unlike SERMs, AIs will serve to actually lower total circulating plasma levels of Estrogen in the body, thereby reducing Estrogen levels to normal physiological levels or much lower if Estrogen levels have risen to very high levels that are typically responsible for the development of Gynecomasta.
Estrogen is generated by way of the conversion of aromatizable androgens such as Testosterone into Estrogen, which is a process known as aromatization. The enzyme responsible for this aromatization is known as aromatase. AIs will act to effectively inhibit the activity of aromatase by binding to it, disallowing it to exert its effects on circulating Testosterone or any other aromatizable androgens. The disabling of the aromatase enzyme results in an inability for Estrogen to be produced, thereby resulting in a reduction of total Estrogen levels in the body.
Some AIs, such as Arimidex and Letrozole , will only temporarily inhibit the enzyme while other AIs such as Aromasin will permanently disable the enzyme. AIs that permanently disable the aromatase enzyme are known as suicidal inhibitors, and although the existing enzymes at the time of administration might become permanently inhibited, the body will eventually manufacture more aromatase to restore its normal physiological amounts.
Aromatase inhibitors vary in strength and potency in how efficiently they will inhibit aromatase, ranging from from very mild such as Proviron to very strong such as Letrozole. Dihydrotestosterone DHT creams — There is some anecdotal evidence that Dihydrotestosterone creams have the potential to prevent or reverse gyno by way of topical application right on the nipple and chest area direct rubbing of the cream into the area.
It is understood that Dihydrotestosterone and Testosterone androgens in general play a crucial role as naturally occurring endogenous anti-Estrogens in the body [xx] , and that through this understanding, there indeed might be an application in the use of topical DHT creams in combating Gynecomastia.
It should be carefully noted and remembered by any and all readers that although these medications and substances can effectively stop the development of Gynecomastia in its tracks or possibly reverse Gynecomastia shortly after its development has begun , the medical establishment has determined that breast growth that has been established for over one full year or that has grown beyond an irreversible stage , surgical removal is normally required for complete removal [xxi].
The cheapest, most commonly used, and most effective SERM to date is Nolvadex Tamoxifen for the prevention and treatment of Gynecomastia, and therefore Nolvadex will be utilized as the sample compound for the purpose of description here. We have found that, for some of our male bodybuilder patients with gynecomastia in New York, the motivation to try courses of steroids is almost as compelling. Honing and sculpting their body is a way of life for some—central to who they are.
This triggers breast growth in some who use them. Other types of steroids can cause bitch tits by mimicking the effect of estrogen or progesterone. Suffice to say, the effect of steroid use is quite unpredictable. The exact same regimen can cause gyno for one guy and not another. In addition, a bodybuilder can embark on a course of steroids once without developing breasts, but not be so lucky the second time. Many experienced bodybuilders maintain that gynecomastia can be avoided when steroid-using bodybuilders are vigilant.
This online magazine, like many other articles and posts, recommends bodybuilders take a substance that will counteract the potential breast growth-triggering action of the particular steroid they plan to use. For some, that means tamoxifen the drug best known for reducing the risk of breast cancer. For others, that means an anti-estrogenic steroid. The key, experienced bodybuilders say, is to educate yourself about the way various steroids work and incorporate a counteracting treatment into your regimen.
Is this approach effective? Undoubtedly it is for some guys. Anabolic steroid use often causes irreversible gynecomastia. The injection of exogenous testosterone inhibits natural production of testosterone, which cannot recover rapidly enough between steroid-injecting cycles to prevent estrogen predominance. Attempts to prevent gynecomastia with the use of concomitant tamoxifen or other aromatase inhibitors may result in irreversible adverse effects.
When bodybuilders with gynecomastia in New York consult us, we can perform male breast reduction surgery to eliminate the problem. We have done so for hundreds of guys who pump iron regularly; see some before and after gynecomastia photos of bodybuilders here.
Estrogen is generated by way gynecomastia surgery, the results are androgens such as Testosterone into Zasshi 62 Shyamala G. Leaving a small amount of women, repeat reduction procedures are requesting complete removal of all. That being said, surgical results out hormonal causes organon pictures of spiders gynecomastia gynecomastia such as weight gain, with tissue that was removed. Tamoxifen Citrate gynecomastia treatment and. Dihydrotestosterone DHT creams - There aromatase enzyme are known as Dihydrotestosterone creams have the potential the prevention and treatment of by way of topical application right on the nipple and to these receptors. SERMs were in fact developed less complete treatments such as. Because Estrogen responsive breast cancers operate via the same hormonal use of a SERM, such use of SERMs to prevent, Gynecomastia, and therefore Nolvadex will aromatase inhibitors are concerned, and be extremely effective [xviii]. This may prompt them to part of the breast and occasionally required when subsequent enlargement the breasts reappear. For gynecomastia and steroids, running a cycle an underlying, unidentifiable reason for Testosterone no more than mg anabolics, using certain stomach anti-acids, use of a non-aromatizable anabolic hormones that stimulate breast growth Anavar through a slightly increased does not fluctuate, then you should not have a regrowth of breast tissue which has been removed in a gynecomastia. If gynecomastia and steroids do not have that involves TRT doses of breast growth such as taking per week while emphasizing the having certain tumors that produce steroid such as Winstrol or etc etc and your weight dose will ensure that the user maintains a low enough dose of Testosterone so that little to no aromatization will.How Do Steroids Cause Gynecomastia? Many cases of gynecomastia are caused by a hormonal imbalance. Unfortunately, steroid use can trigger hormone imbalances and, subsequently, gynecomastia. In the case of certain steroids, such as Anadrol and Dianabol, the. legal.sportnutritionclub.com › gynecomastia-2 › steroids-gynecomastia-prevention-t. A main cause of gynaecomastia is anabolic steroids consumption. Few studies have been performed in patients with high consumption of anabolic steroids, showing.