'Man boob' treatment included as approved MLB drug

There was one waiver given to a player that stood out when Major League Baseball released its annual drug program statistics this week.

It was for the treatment of gynecomastia, the swelling of male breast tissue often referred to as “man boobs.”

While the report didn’t list the player or the approved drug, gynecomastia is often treated with selective estrogen receptor modulators (SERM) drugs — the same class of drugs that now-retired slugger Manny Ramirez tested positive for in 2009 and other major leaguers have been linked to over the years. Dr. Jeffrey M. Anderson is the independent program administrator for MLB's Joint Drug and Treatment Program.

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“It raises a red flag,” Gary Wadler, a New York internist who is a former chairman of the World Anti-Doping Agency's (WADA) prohibited list and methods subcommittee, told USA TODAY Sports.

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According to the latest annual report released by the U.S. Anti-Doping Agency that polices Olympic athletes in this country, not one of the more than 400 applications for a TUE was for a SERM.

Gynecomastia affects about half of the male population, although it usually presents during adolescence or the elderly. It develops when there’s an imbalance estrogen and testosterone in the body and, although it’s often merely a cosmetic issue, it can take an emotional toll.

Before surgery, doctors often try a SERM, which blocks estrogen production. (The drugs are most often prescribed to women with fertility problems.) There hasn’t been a lot of research published on using such drugs to treat gynecomastia in adult males.

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But researchers at the University Hospital of Wales led a 2005 study published in The Breast Journal that showed a SERM was effective and “should be considered as an initial option before contemplating surgery.”

“The rules for a getting (a therapeutic use exemption) for a prohibited drug is to show that there are no alternatives and it’s medically necessary,” Wadler said. “That’s the only way you can make a case for a TUE.”

Steroid users have long used anti-estrogen drugs, including SERMs like Clomid and Nolvadex. Such drugs are used at the end of a steroid cycle to help the body regain its ability to produce testosterone naturally.