The abnormal enlargement of male breasts, in a way that resembles to female ones is called gynecomastia. It is a rather common condition that afflicts men of all ages; babies or young boys in puberty, adolescents and adults with some health problems. According to the experts the main cause of genuine gynecomastia is the imbalance in hormones, which can occur from liver or thyroid problems, numerous health conditions, but also from use of certain drugs that men can take in order to deal with other problems they might have. These drugs can be legal or not, prescribed by physicians or over the counter products.

Not all drugs and oral medication act the same way or produce the same results; as we know hardly two people can have the exact same problems when taking the same medication, as it all depends on the physiology and health condition of the individual. In any case, though, doctors know that there are particular types of drugs that can cause gynecomastia as a side effect, and usually prepare their patients for this possibility. Patients should not avoid or omit them, because not all drugs have the same side effects; it mainly depends on a vast array of factors.

Tricyclic antidepressants, valium and diazepam used by people with depression or psychotic behavior, anti-androgen such cyproterone, flutamide and finasteride and chemotherapy undergone by men with prostate cancer can affect the hormones in blood; estrogen and testosterone levels differentiate, causing gynecomastia. The vast majority of men suffering from gynecomastia from these drugs are over 40 years of age.

Among the known substances that cause gynecomastia are anabolic steroids and androgens. In fact this is the most common side effects of these substances, as it can occur to athletes, body builders and individuals who undergo one or more cycles of anabolic steroid use. Amphetamines and other similar pills can also affect the development of breasts in men of all ages. This is actually the most common cause of gynecomastia in younger men.

Medication and substances described above can upset the balance of hormones in blood. Men with certain health issues can show increased levels of estrogen and low levels of testosterone; these hormones are used to adjust the gender characteristics in any individual, thus, their imbalance can cause a series of side effects, among which is gynecomastia and development of female traits.

Drug reference books are an important resource in the library of a medical transcriptionist. In order to keep up to date on new drugs, a medical transcriptionist should purchase drug reference books every year or every other year.

The pharmaceutical companies use three different names to describe a drug, they are:

• The chemical name (which is a complicated formula describing the drug’s molecular structure).

• The generic name (a shorter name assigned to the drug chemical)

• The trade or brand name (the copyrighted name selected by the pharmaceutical company)

The trade or brand name is easy to pronounce, and may indicate what the drug is used for or how often it is taken, and is selected for its appeal to prescribing physicians. A generic drug may have several trade names copyrighted by different manufacturers.

Rules to remember when transcribing drug names include:

• Generic drugs are always written in lowercase letters. Trade name drugs always start with a capital letter. Some trade name drugs will also have internal capitalization (such as pHisoHex). It is also important to note that the PDR contains only prescription drugs. There is a separate publication for nonprescription drugs. In addition, only drugs that the manufacturer pays to have listed in the PDR are included.

• Be alert to drug names that sound alike but their uses are completely different, such as Xanax used to treat anxiety and Zantac used to treat stomach ulcers

• Words such as tablet, capsule, solution, elixir and cream are not part of the trade name of a drug and should not be capitalized for use

The standard drug reference is the Physicians’ Desk Reference (published annually) and well known as the PDR. It contains various sections of drugs and is found in most physicians’ offices. Sections of the PDR of most interest to the medical transcriptionist are:

• Yellow pages (list generic names of drugs)

• Pink pages (list brand names of drugs)

• Blue pages (list therapeutic category

• White pages (give a complete description of the listed drugs including indications and dosages)

The American Drug Index (ADI) is another standard drug reference book. This is a comprehensive reference that lists both generic and trade name drugs and prescription and nonprescription drugs in alphabetical order throughout the reference book. It lists every drug name in all capital letters. Generic drugs are preceded by a small black dot to denote their difference from trade and brand name drugs. Trade name drugs list the name of the manufacturer to alert the medical transcriptionist that the drug is to be capitalized.

The Saunders Pharmaceutical Word Book is a new drug reference book to be updated annually first published n 1992. It is an A to Z listing of medications with generic drugs in lowercase letters and trade names capitalized as the medical transcriptionist must type them. Each entry states briefly what the drug is for and the usual methods of administration. It has an appendix list of Sound Alikes, 879 pairs of drugs that sound enough alike to be confusing which serves as a special help to the medical transcriptionist.

Understanding Pharmacology is an easy-to-read textbook used in many pharmacology classes. Medical transcriptionists seeking a greater understanding of drugs and their uses may find it especially useful to include in their library as well.