Gyno. Bitch tits. Man boobs. The fear of developing gynecomastia is one that has plagued bodybuilders and athletes who use anabolic steroids since the very beginning of the steroid era in sports. Various strategies have historically been employed to prevent and treat gyno. Recent pharmacological advances have given bodybuilders many more options in addressing this problem.
When it comes to treatment, there is no shortage of steroid users who think they know the answer as to the best and most effective way of treating gynecomastia. They will tell that all you need is an anti-aromatase inhibitor (AI) such as Arimidex (anastrozole) or letrozole. And they will be absolutely wrong!
The best treatment for gyno involves the use of selective estrogen receptor modulators (SERMs) such as Nolvadex (tamoxifen), toremifine and Clomid (clomiphene). The claim that an AI is superior to SERMs for treating gyno is a myth that has become entrenched within the bodybuilding community. Many so-called steroid “experts” will endlessly argue that an AI is the best choice to treat gyno and some will even argue it is the only choice needed.
They are wrong. This does not mean that AIs are not useful in the treatment of gyno. They are. After all, AIs help manage estradiol (E2) levels when bodybuilders are using highly aromatizable steroids (i.e. steroids that readily convert to estradiol during normal metabolism). But AIs should never be the first or only choice for gyno treatment.
SERMs should be considered the first choice for treatment and this is why. I must thank the esteemed Michael Scally, M.D. for providing the following “castle analogy” to dispel the myth of AIs superiority over SERMs.
“Imagine there is a castle with 100 gates to enter. And, you have the job of protecting the castle against marauders,” Dr. Scally explained. “The marauders in this case is E2! There are two options: (1) Protect ALL of the gates (SERM); or (2) Protect NONE of the gates, but kill 50+% (even say 90%) of the marauders (AI). Which of these options will best protect the castle?”
The castle analogy makes the choice obvious. The best way to treat gyno would be to find a way to block all receptors. The only way to do this is with SERMs. AIs will only block 50-90% of conversion to estradiol (and none of the receptors). This means there will always be some E2 circulating in the blood stream and there will be plenty of receptors for it to latch on to. This could make matters worse for the individual afflicted with gynecomastia.
AIs are the best way to manage E2 during steroid cycles and may minimize the development of gyno. SERMs are the best way to prevent/treat gyno during steroid cycles but will do nothing to manage E2 levels.
The important thing to realize is the question of E2 management is a different question than the question of preventing/treating gyno.
Take home lesson: E2 management is very important. Use AIs to manage E2 on cycle. This can not be guaranteed to prevent gyno especially on high dosages of aromatizable steroids. You should ALWAYS have SERMs like Nolvadex on hand to prevent/treat gyno should the need arise. SERMs are the only drugs guaranteed to prevent/stop gyno development.