Long story short, 44 year old male,great shape and great health.Have had lipodystrohy and partially fixed with New-fill. This is a related problem in the lines of buffalo hump,and related wierdness cause of hiv meds. Long term on Sustiva and its caused Gynecomastia (confirmed by doc) All my hormones have checked out normal. The doc let me try a course of DHT gel rubbed on the pecs, but I am getting no results. The plan "B: is Tamoxifen but I am not hearing good things about it reversing minor gyno like mine. I have heard from the body building sites of something called Letrozole which they say is the best chance of reversing some of the gyno. It basically shuts down almost all of your production of Estrogen. Doc believes Sustiva is mimicing estrogen and thats why I have gyno. Any thoughts? Any idea where I can turn? I hate just throwing money at this, and I know if I wait to long the gyno can become permanent. The only effects I get from the dht is hair loss...

When confronted with a medication-related side effect, the first choice is usually to determine if there is an alternative agent to take the place of the offending drug. So in your case, could Viramune or Intelence or Isentress be substituted for Sustiva? Your doctor should have an opinion on this.

If prudence dictates that the medication causing a side effect must be continued, then a course of a drug to block estrogen might be useful. I posed your question to Nelson Vergel (website at this link), who is an expert on the use of anabolic steroids for HIV-related problems and he mentioned that Arimidex has been used for gynecomastia at a starting dose of 1mg daily for one week followed by 0.25mg daily for 3 weeks. You might discuss this option with your doctor if switching Sustiva is not a good choice for you.

I hope this information helps and best of luck!