Gynecomastia in men - Causes, symptoms and treatment. MF.

Gynecomastia is an increase in mammary gland tissue in men.

Causes of gynecomastia

Gynecomastia in men occurs as a result of hormonal disorders, in which the level of estrogen( female sex hormones) increases in comparison with the level of androgens( male sex hormones).
Gynecomastia can occur in healthy boys in the period of newborn, puberty, in old age. Such gynecomastia is called physiological. Physiological gynecomastia usually disappears on its own.

60-80% of newborns show swelling of the mammary glands, this is due to the action of the mother's estrogens, which were received by the baby during the intrauterine period. Usually disappears on its own within 2-4 weeks.

The pubertal gynecomastia occurs in 30-60% of boys 12-14 years old, in most cases bilateral, sometimes accompanied by secretions from the nipples, caused by temporary changes in the level of hormones. As a rule, such gynecomastia regresses within 12-24 months. Sometimes gynecomastia, developing during puberty, lasts more than two years, and it is called persistent pubertal gynecomastia.

Gynecomastia in the elderly is observed in men 50-80 years due to the age-related decline in testosterone levels and the predominance of female sex hormones.

However, in some cases gynecomastia in men may be a symptom of serious diseases. First of all, gynecomastia is caused by diseases of male genital organs( testes), accompanied by a decrease in the production of testosterone. They can be congenital: Klinefelter's syndrome, anarchy( absence of one or both testicles), defects in the synthesis of testosterone. To the acquired pathology of the male reproductive system include injuries, infections( mumps, orchitis), decreased blood flow, testicular cancer.

The cause of gynecomastia in men may be an increase in the production of estrogen in some testicular tumors, chorion carcinoma, bronchogenic lung cancer, true hermaphroditism, adrenal adenoma or carcinoma feminizing adrenal tumor.

Sometimes gynecomastia is a symptom of diseases of internal organs, endocrine glands. For example, gynecomastia may accompany chronic kidney failure, hyperthyroidism( increased thyroid function), hyperprolactinaemia( increased prolactin levels due to pituitary pathology), malnutrition, hunger, liver cirrhosis, obesity( there is an aromatase enzyme in adipose tissue that promotes the conversion of testosterone to estrogens).

Gynecomastia can also be a side effect of a number of medications:

- Spironolactone( Veroshpiron) - a diuretic with antiandrogenic activity;
- Calcium channel blockers - used to treat hypertension, ischemic heart disease( nifedipine, amlodipine, verapamil);
- Angiotensin converting enzyme inhibitors - drugs for the treatment of arterial hypertension and heart failure( captopril( Kapoten), enalapril( Enap, Ednit), lisinopril( Diroton),
- some antibiotics and antifungals( isoniazid, ketoconazole( Nizoral), metronidazole( Trichopolum), Metrid)
- antiulcer drugs( ranitidine( Zantac), cimetidine, omeprazole( OMez);
- hormonal drugs for the treatment of prostate cancer;
- methyldopa( Dopegit) - antihypertensive drug;
- en(
- digoxin - cardiac glycoside prescribed for heart failure;
- diazepam( Relanium, Seduxen) - tranquilizer;
- drugs( eg alcohol, marijuana, heroin);
- lavender oil and tea oiltree

Sometimes the cause of gynecomastia can not be identified, then the gynecomastia is called idiopathic

Symptoms of gynecomastia in men

The main symptom of gynecomastia is the increase in the male breast. At the heart of gynecomastia is an increase in glandular, rather than fatty tissue. Breast enlargement due to adipose tissue in men with obesity is called pseudo-gynecomastia.

As a rule, gynecomastia is bilateral, in about one third of cases it can be one-sided. Sometimes there are discharge from the nipples, similar to colostrum. The increase may be more on the one hand, even if both sides are involved. Soreness is usually absent, but there may be discomfort, hypersensitivity in the mammary gland.

One-sided gynecomastia in male

Two-sided gynecomastia in male( left) and glands normal( right)

Gynecomastia is usually associated with normal sexual potency, except for gynecomastia caused by excessive production of estrogens and a drop in testosterone. With an increase in estrogen levels, there may be a decrease and a lack of libido.

You should seek medical help without delay if you have signs characteristic of the malignant process: unilateral gynecomastia, a firm, dense consistency of formation, a change in the skin of the breast, an increase in axillary lymph nodes. Also, urgent medical examination with gynecomastia is necessary with the involvement of the testicles( changes in shape, swelling, swelling of the testicles), with signs of hyperestrogenia. Symptoms of hyperestrogenism include a change in voice( increased timbre), hair loss on the face( beards and mustaches), emotional disorders in the form of tearfulness, irritability and decreased libido.

Diagnosis of gynecomastia

A preliminary diagnosis is made based on palpation( probing) of breast tissue, axillary lymph nodes.

To clarify the diagnosis, identify a breast tumor using ultrasound examination of the mammary glands, axillary lymph nodes, less often mammography and breast biopsy.

Laboratory tests should include the determination of levels of testosterone, estradiol, luteinizing hormone( LH), thyroid-stimulating hormone( TSH), prolactin and human chorionic gonadotropin( hCG).With increasing levels of estradiol and hCG, studies to exclude malignant tumors should be carried out immediately!

If necessary, men are also prescribed ultrasound examination of the testicles, computed tomography of the adrenal glands to exclude tumors.

Consultations of the therapist, endocrinologist, urologist, oncologist, neurologist are often required.

Treatment of gynecomastia in men

The tactics of treating gynecomastia depend on the cause that caused it. Physiological gynecomastia of newborns in the overwhelming majority of cases does not require treatment, disappears on its own.
Gynecomastia, especially at pubertal age, is often independently retarded for approximately six months. Therefore, in the absence of signs of malignancy, in many cases, observation is preferable. If there is no positive dynamics within 6 months, medication is usually prescribed.

Drugs used to treat gynecomastia are prescribed only by your doctor!
Independent uncontrolled intake of these drugs without establishing the exact cause of gynecomastia can lead to aggravation of the gynecomastia, the progression of the disease or to serious side effects.

Testosterone - is given to patients with low testosterone levels, elderly men, for patients with normal testosterone levels, as a rule, ineffective.
Clomiphene is an antiestrogen, often used to treat gynecomastia.
Tamoxifen( Nolvadex) - a selective modulator of estrogen receptors - is most often used in severe and painful forms of gynecomastia.
Danazol is a synthetic derivative of testosterone, reduces the synthesis of estrogens in the testicles, is used to treat gynecomastia much less often than other drugs.

With gynecomastia caused by taking medications, the question of replacing the drug or reducing the dose is being decided.

Gynecomastia caused by internal or endocrine diseases requires treatment of the underlying disease.

If a malignant process is diagnosed, urgent surgery is necessary.

Surgical methods for the treatment of gynecomastia

Reduction mammoplasty( breast reduction surgery) is used in cases of severe gynecomastia, long-term( more than 1 year), undergone gynecomastia scarring, or in cases when drug treatment has proved ineffective.

Complications of gynecomastia

Gynecomastia, which exists for more than 12 months, may undergo scarring( fibrosis), which makes it extremely difficult to medicate.
Another complication of gynecomastia is psychological consequences, most often they occur in adolescents, if breast augmentation is the cause of inferiority complexes.

Prevention of gynecomastia

Prevention of gynecomastia is the prevention of diseases that can cause it, careful control over the intake of medications, taking into account their side effects. Prevention of physiological forms of gynecomastia does not exist.

Prognosis for gynecomastia

The physiological gynecomastia of newborns and adolescents usually has a favorable course, disappears without treatment.

The outcome for symptomatic gynecomastia depends on the elimination of the cause of the disease. In severe cases or cases of scarring of the breast due to the length of the process, the lack of adequate treatment, surgical methods in most cases can help restore the normal appearance of the breast.

Doctor endocrinologist Fayzulina N.M.