gynecomastia (also spelled gynaecomastia) is an endocrine system disorder in which a noncancerous increase in the size of male breast tissue occurs. psychological distress or dysphoria may occur.
the development of
gynecomastia is usually associated with benign pubertal changes. however, 75% of pubertal
gynecomastia cases resolve within two years of onset without treatment.cases,
gynecomastia has been known to occur in association with certain disease states.
the pathologic causes of
gynecomastia are diverse and may include klinefelter syndrome, certain cancers, endocrine disorders, metabolic dysfunction, various medications, or may occur due to a natural decline in testosterone production.disturbances in the endocrine system that lead to an increase in the ratio of estrogens/androgens are thought to be responsible for the development of
gynecomastia.this may occur even if the levels of estrogens and androgens are both appropriate, but the ratio is altered.diagnosis is based on signs and symptoms.
causes:
testosterone in the male body usually prevents the breast tissue from expanding.
however, some males develop enlarged breasts due to hormonal changes or fluctuations.
● infants, due to their mother’s estrogen
● teenagers, due to changing hormone levels
● those over the age of 50
there are several potential causes of
gynecomastia, including:
● hormone changes
● taking certain antibiotics
● taking medications that block the action of testosterone
● excessive alcohol consumption
● taking certain psychiatric medications
● taking anti-ulcer medications
● taking herbal supplements that contain phytoestrogens
● using tea tree oil or lavender lotions
● using illicit drugs, such as anabolic steroids or androgens
● excessive body fat
● liver or kidney disease
● certain types of tumor
● overactive thyroid
● other conditions that cause lower testosterone levels
however, for many males, excess breast tissue is not the cause of “
man boobs.”
like the abdomen, the chest can accumulate fat. in these cases, exercise and dietary changes can reduce their appearance.
natural hormone changes:
the hormones testosterone and estrogen control sex characteristics in both men and women. testosterone controls male traits, such as muscle mass and body hair. estrogen controls female traits, including the growth of breasts.
most people think of estrogen as an exclusively female hormone, but men also produce it — though normally in small quantities. male estrogen levels that are too high or are out of balance with testosterone levels can cause
gynecomastia.
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gynecomastia in infants; more than half of male infants are born with enlarged breasts due to the effects of their mother's estrogen. generally, the swollen breast tissue goes away within two to three weeks after birth.
●
gynecomastia during puberty; gynecomastia caused by hormone changes during puberty is relatively common. in most cases, the swollen breast tissue will go away without treatment within six months to two years.
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gynecomastia in adults; the prevalence of
gynecomastia peaks again between the ages of 50 and 69. at least 1 in 4 men in this age group is affected.
a number of medications can cause
gynecomastia. these include:
● anti-androgens used to treat an enlarged prostate, prostate cancer and other conditions. examples include flutamide, finasteride (proscar, propecia) and spironolactone (aldactone, carospir).
● anabolic steroids and androgens, which are prescribed by doctors for certain conditions or are sometimes used illegally by athletes to build muscle and enhance performance.
●
aids medications.
gynecomastia can develop in men who are hiv-positive and receiving a treatment regimen called highly active antiretroviral therapy. efavirenz (sustiva) is more commonly associated with
gynecomastia than are other hiv medications.
● anti-anxiety medications, such as diazepam (valium).
● tricyclic antidepressants.
● antibiotics.
● ulcer medications, such as the over-the-counter drug cimetidine (tagamet hb).
● cancer treatment.
● heart medications, such as digoxin (lanoxin) and calcium channel blockers.
● stomach-emptying medications, such as metoclopramide (reglan).
risk factors:
● adolescence
● older age
● use of anabolic steroids or androgens to enhance athletic performance
● certain health conditions, including liver and kidney disease, thyroid disease, hormonally active tumors, and klinefelter syndrome
treatment:
usually you don't need to be treated. teenagers' breasts will go back to a more normal shape on their own, often within 2 to 3 years. during that time, ice packs and ibuprofen can lessen any pain.
if a health issue is causing your
gynecomastia, treating it will help. and if your breast size has changed because of a medicine you’re taking, you’ll see an improvement once you stop or switch to another drug. (but don’t do so without talking to your doctor first.) it’s also important to give up alcohol and any illegal drugs.
if your condition doesn't go away and you don't like the look of your chest, your doctor may prescribe a medicine that reduces the amount of estrogen your body makes.
surgery can also restore the shape of your chest and improve your self-image. after making a small cut, a plastic surgeon removes any extra breast tissue. because your breast will then become smaller and flatter, he may also need to reposition the nipple or areola (the dark area around it). some guys get
liposuction, too. that’s where the doctor suctions out extra fat under the skin.
while surgery is meant to give lasting results, you’ll need to stick to a healthy lifestyle to keep your new shape. gaining too much weight, using steroids, or taking drugs that affect your testosterone levels can all cause your
gynecomastia to come back.
gynecomastia, especially in pubertal males, often goes away on its own within about six months, so observation is preferred over specific treatment in many cases. stopping medications and treatment of existing medical problems or health conditions that cause enlarged breasts in men also are mainstays of treatment.
●
medical treatments are available to treat
gynecomastia, but data on their effectiveness are limited. no drugs have been approved by the fda for the treatment of
gynecomastia; however, medications that have been used to treat the condition include:
● testosterone replacement has been effective in older men with low levels of testosterone, but it is not effective for men who have normal levels of the male hormone.
●
clomiphene can be used to treat
gynecomastia. it can be taken for up to 6 months.
●
the selective estrogen receptor modulator (serm) tamoxifen (nolvadex) has been shown to reduce breast volume in
gynecomastia, but it was not able to entirely eliminate all of the breast tissue. this type of therapy often is most used for severe or painful
gynecomastia.
●
danazol is a synthetic derivative of testosterone that decreases estrogen synthesis by the testes. it works by inhibition of pituitary secretion of lh and follicle-stimulating hormone (fsh), substances that direct the sex organs to produce hormones. it is less commonly used to treat
gynecomastia than other medications.
medication:
medical treatment of
gynecomastia is most effective when done within the first two years after the start of male breast enlargement.selective estrogen receptor modulators (serms) such as tamoxifen, raloxifene, and clomifene may be beneficial in the treatment of
gynecomastia but are not approved by the food and drug administration for use in
gynecomastia. clomifene seems to be less effective than tamoxifen or raloxifene.tamoxifen may be used for painful
gynecomastia in adults.aromatase inhibitors (ais) such as anastrozole have been used off-label for cases of
gynecomastia occurring during puberty but are less effective than serms.
a few cases of
gynecomastia caused by the rare disorders aromatase excess syndrome and peutz–jeghers syndrome have responded to treatment with ais such as anastrozole.[8] androgens/anabolic steroids may be effective for
gynecomastia.testosterone itself may not be suitable to treat
gynecomastia as it can be aromatized into estradiol, but nonaromatizable androgens like topical androstanolone (dihydrotestosterone) can be useful.
if chronic
gynecomastia is untreated, surgical removal of glandular breast tissue is usually required. surgical approaches to the treatment of
gynecomastia include subcutaneous
mastectomy,
liposuction-assisted
mastectomy, laser-assisted
liposuction, and laser-lipolysis without
liposuction. complications of
mastectomy may include hematoma, surgical wound infection, breast asymmetry, changes in sensation in the breast, necrosis of the areola or nipple, seroma, noticeable or painful scars, and contour deformities.