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Gynecomastia

gynecomastia
By Medicover Hospitals / 11 Mar 2021
Home | symptoms | gynecomastia
  • Gynecomastia is a benign enlargement of the male breast with firm tissue that extends concentrically beyond the nipple. Histologically, gynecomastia is a benign proliferation of the mammary ducts and hyperplasia of the duct epithelium accompanied by varying degrees of inflammation, edema, stroma, and fibrosis. Enlargement of the male breasts completely due to adipose tissue. The tissue is called pseudogynecomastia.
  • Article Context:

    1. What is Gynecomastia?
    2. Causes
    3. Diagnosis
    4. Treatment
    5. When to visit a Doctor?
    6. Prevention
    7. FAQ's

    What is Gynecomastia?

  • In men and boys, gynecomastia is a common disorder. The breasts swell and become abnormally large. All men and women have mammary glands, but they are not noticeable in men, because they are small and underdeveloped. Enlarged mammary glands in men can affect newborns, boys during puberty, and older men. In adulthood, 90 percent of cases resolve. Gynecomastia does not mean that being overweight. It is caused by extra breast tissue. Exercising or losing weight will not reduce the breast tissue in gynecomastia. Pseudogynecomastia is a separate condition, in which fat accumulates in the breasts, possibly due to being overweight or obese.
  • Causes:

  • Both malnutrition and refeeding have been shown to create a hormonal environment that can lead to gynecomastia. Similarly, cirrhosis of the liver disrupts normal hormonal metabolism and can lead to gynecomastia.
  • Disorders of the male sex organs (testicles) can cause decreased testosterone production and relatively high estrogen levels, leading to gynecomastia. These disorders can be genetic, such as Klinefelter syndrome, or gained due to trauma, infection, reduced blood flow, or aging. Testicular cancers can also secrete hormones that cause gynecomastia. Other conditions that are associated with an altered hormonal environment in the body and that may be associated with gynecomastia are chronic kidney failure and hyperthyroidism. In rare cases, cancers other than testicular tumors can produce hormones that can cause gynecomastia.
  • Medications that can make breasts enlarge in men include:
    • Anabolic steroids
    • Some antibiotics
    • Some medicines for ulcers
    • Chemotherapy
    • Tricyclic antidepressants
    • Diazepam (Valium) and some other medications to treat anxiety
    • Some HIV medicines, including efavirenz, also known as Sustiva
    • Antiandrogens, commonly prescribed for patients with cancer or an enlarged prostate
    • Some heart medications, including calcium channel blockers and digoxin
    • Tea tree oil and lavender products, used in creams and shampoos, can affect

    Risk factors:

    • Men who use anabolic steroids regularly
    • People with a gender identity disorder
    • Congenital disorders can increase the risk of gynecomastia, such as Klinefelter syndrome
    • Men with a family history of gynecomastia are at higher risk of developing the condition
    • Certain medications that reduce testosterone synthesis and alter the action of testosterone
    • Men with kidney failure may develop the risk of gynecomastia
    • Use of medications that increase estrogen levels or activate estrogen receptors
    • Men with hyperthyroidism have a higher risk of developing gynecomastia
    • Excessive alcohol consumption that leads to cirrhosis of the liver can increase the risk of contracting the condition

    Diagnosis:

  • To diagnose gynecomastia, the doctor will perform a physical exam, in which he will do a careful evaluation of the breasts. Also, the doctor will ask questions about personal medical history and any other health conditions that run in the family. The doctor would recommend the following tests to determine the underlying cause of the condition, including
    • A Blood test: A blood sample is taken to check the levels of testosterone and estrogen. Besides, thyroid-stimulating hormone (TSH) levels and free thyroxine levels are obtained to check if the patient has hyperthyroidism.
    • Mammography: In this procedure, low levels of X-rays are used to examine the breasts for signs of breast cancer.
    • Imaging tests: Your doctor would recommend imaging procedures such as computed tomography (CT) and magnetic resonance imaging (MRI) to obtain clear images of the mammary tissues and glands.
    • Testicular ultrasound: A testicular ultrasound is performed to produce images of the testicles and surrounding tissues. This helps rule out cancerous tumors and growths.
    • Biopsy: A sample of breast tissue is isolated and examined under a microscope to rule out certain conditions, such as cancer.

    Treatment:

  • Gynecomastia usually resolves without any treatment, but if there is an underlying condition, it may need treatment. If the condition is due to one drug, the patient may need to switch to another drug. If the patient is using the drug for a short time, the condition will be temporary.
  • Drugs for the Treatment of Gynecomastia:

  • Tamoxifen is a medication that blocks the action in the body of the female hormone estrogen. It is used to treat and prevent breast cancer, but it can also reduce symptoms of breast pain and enlargement in men. Aromatase inhibitors, which are used to treat breast and ovarian cancer in postmenopausal women, may be used unauthorized to prevent or treat gynecomastia in men.
  • Prevention:

  • Sometimes choosing a healthy lifestyle can prevent the risk of underlying conditions that lead to gynecomastia. Some of them include:
    • Avoid excessive alcohol consumption as it can increase the chances of liver cirrhosis.
    • Do not self-medicate, as some medications may contain high levels of estrogen, which can lead to gynecomastia.
    • Illegal substances such as methamphetamine, amphetamines, androgens, and marijuana should be avoided.

    Frequently Asked Questions:

  • An imbalance between the hormones estrogen and testosterone is the most common cause of gynecomastia. Estrogen, like breast development, regulates female characteristics. Testosterone is in control of male features including muscle mass and body hair.
  • For other cases, the concept of a low-estrogen diet can be useful, but merely consuming cruciferous vegetables and avoiding soy will not eliminate gynecomastia. With a deliberate dietary assault on insulin resistance, modifying the eating habits will only reduce the presence of man boobs.
  • Gynecomastia is generally not permanent. It usually progresses through several phases and then disappears. First, there is an inflammatory phase in which most men experience some breast tenderness. The inflammation subsides after about six to 12 months, leaving only scar tissue.
  • Citations:

  • Gynecomastia - https://www.nejm.org/doi/pdf/10.1056/NEJM198010023031405
  • Gynecomastia - https://jamanetwork.com/journals/jama/article-abstract/332010
  • Gynecomastia - https://www.nejm.org/doi/pdf/10.1056/NEJM198010023031405