Dihydrotestosterone for HAART-associated breast enlargement in men

Highly active antiretroviral therapy (HAART) has greatly reduced death rates from complications of AIDS in North America, Western Europe and Australia. But HAART regimens can be complex and have side effects.

One of the more rare side effects is breast enlargement (gynaecomastia). Until recently doctors were at a loss for how to relieve this distressing problem. Now researchers in Paris, France, have reported their success in treating breast enlargement with the use of a form of testosterone called DTH (dihydrotestosterone).

The doctors reported on four HIV positive male patients who had been taking various combinations of HAART for several years before they experienced breast enlargement. Technicians analysed blood samples from the four patients and found normal levels of the following hormones:

The doctors prescribed DTH gel, 5 grams daily, applied to the enlarged breasts. In three of the four cases, the breasts returned to their normal size after 10 to 30 days. In the remaining case, although his breast size did decrease, it did not shrink to its normal size.

Why did breast enlargement occur?

The researchers aren’t certain why breast enlargement occurred but they have a theory. They noted that in HIV negative people a similar problem can happen when certain drugs – digitalis, tricyclic antidepressants – are used. In such cases, gynaecomastia likely occurs because these drugs somehow mimic the hormone oestrogen and/or progesterone or increase the body’s production of the hormone prolactin. Since all four men had normal levels of prolactin, the dramatic reduction in breast size associated with the use of DTH reinforces their theory that HAART drugs may somehow mimic the effect of oestrogen on breasts.

Further investigation on the reasons for HAART-associated breast enlargement needs to be conducted as the findings from France are preliminary.

A note on DTH

The use of testosterone may be dangerous in men who have prostate cancer or who are at high risk of prostate cancer. The French team noted that what makes DTH different from other forms of testosterone is that it cannot be converted into oestrogen by breast tissue. Although DTH is not licensed in Canada, it is available in France and other countries of the European Union. In France, DTH gel is sold under the brand name Andractim and is made by Laboratoires Besins-Iscovesco. Canadian physicians who wish to order non-approved drugs can discuss their request with Health Canada’s Special Access Program at 613.941.2108 between the hours of 8:30 am and 4:30 pm Eastern time.

Benveniste O et al. Successful percutaneous dihydrotestosterone treatment of gynaecomastia occurring during highly active antiretroviral therapy: four cases and a review of the literature. Clinical Infectious Diseases 2001;33:891-893.
http://www.ncbi.nlm.nih.gov/pubmed/11512095?dopt=Abstract

CATIE News. CATIE-News is written by Sean Hosein, with the collaboration of other members of the Canadian AIDS Treatment Information Exchange, in Toronto. From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE’s Information Network at
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