Gynecomastia

Gynecomastia
Specialty	Endocrinology, plastic surgery

Gynecomastia or Gynaecomastia, /ˌɡaɪnkˈmæstiə/, is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyné (stem gynaik-) meaning "woman" and μαστός mastós meaning "breast." The condition can occur physiologically in neonates (due to female hormones from the mother), in adolescence, and in the elderly (Both in adolescence and elderly it is an abnormal condition associated with disease or metabolic disorders). In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubescent gynecomastia is not due to obesity, the breast development shrinks or disappears within a couple of years.

Pathophysiology

Micrograph showing gynecomastoid hyperplasia, the changes seen in gynecomastia. H&E stain.

The causes of common gynecomastia remain uncertain, although it has generally been attributed to high levels of sex hormone-binding globulin (SHBG) resulting in low levels of free testosterone or the tissue responsiveness to them; a root cause is rarely determined for individual cases. The condition may also be caused by an imbalance of estrogenic and androgenic effects on the breast, resulting in an increased or unopposed estrogen action on breast tissue. Approximately 4 to 10% cases of gynecomastia are due to drugs. Spironolactone (Aldactone) is a common cause, inducing gynecomastia in 10% of those receiving it as a treatment for heart failure. Both Digoxin and Furosemide are also reported to cause the same condition. Although, chances of gynecomastia could be more if these two drugs are coadministered. Breast prominence can result from hypertrophy of breast tissue, chest adipose tissue (fat) and skin, and is typically a combination. Breast prominence due solely to excessive adipose is often termed pseudogynecomastia or sometimes lipomastia.

Gynecomastia should be distinguished from muscle hypertrophy of the pectoralis muscles caused by exercise (e.g., swimming, bench press, running etc.).

Known Causes

Apparently, most people selling "treatments" and "cures" don't want you to know this, but somewhere from one in every five-hundred, to one in every one-thousand of men are born with Klinefelter's Syndrome. It is where a man is accidentally born with two X Chromosomes, instead of one. It causes their body to be slightly confused about which sex it is, but not entirely confused, as it does carry a Y Chromosome, which is what makes a person male. What is harmful of people selling treatments and cures not telling you about this true cause, is that it is not possible to cure it. While a breast reduction might treat the breasts, it does not treat infertility, or correct the patient's hormones. While testosterone treatments correct a patient's hormones, it probably does not improve fertility. This is yet another case of alleged medical professionals pushing a symptom as a cause in order to just treat a symptom, rather than the cause, so the problems persist, and you have to keep seeking treatments. If the cause of your gynecomastia is Klinefelter's Syndrome (considering how common it is, don't kid yourself, it's likely the cause), it is not curable, and you should not waste money on treatments you would have to find way to keep up for life (such as testosterone treatments) just to hide the way you were born.

Another magor known cause is to consume or touch things containing estrogens, or fake estrogens. This is probably the reason this article is saying some drugs can also be a cause, those drugs probably contain such ingredients. Men in western societies have very high exposure to chemicals the body mistakes as estrogen, because it is in most of the food and water in western societies, as well as in many non-consumable things you touch (it absorbs in through your skin). In fact, you're being exposed just by using your computer to view this web page. If you do not have Klinefelter's Syndrome, you should probably exercise plenty, and consume foods that increase testosterone to counter this possible cause of feminization of men.

Classification

"Puffy nipples" is among the most common forms of gynecomastia. This glandular tissue accumulation is concentrated under and typically confined to the areola, or can be slightly extended outside the areola forming a dome shaped appearance to the areola.

Pure glandular gynecomastia is common in bodybuilders and is thought to be a result of the use of anabolic steroids. In this case it is known as anabolic-androgenic steroid (AAS) induced gynecomastia. Due to excess testosterone levels from steroids, which is converted to estrogen, bodybuilders and other athletes are sometimes afflicted with gynecomastia in its purest form. Gynecomastia in lean men is usually only a breast tissue gland with little to no adipose tissue. Proper treatment of pure gynecomastia can be done only by excision of the breast tissue, which in the case of bodybuilders is by itself sufficient to achieve a flat nipple-areola complex. Liposuction is only rarely necessary.

Congenital or hereditary gynecomastia is typically evident by the ages of 12 to 18 in boys. Thirty percent to sixty percent of young boys suffer from large male breasts. As many as thirty percent may live with enlarged male breasts for the rest of their lives, but in other cases the gynecomastia will recede with age. However, severe forms of adolescent gynecomastia may require an intervention, in consultation with the patient, the parents, and child development professionals.

Related conditions

Pseudogynecomastia is typical of enlarged diameter and or excessive areola projection. However, it is not composed of glandular tissue, but of adipose tissue. It looks much like typical gynecomastia but requires different treatment. Exercise and diet may be effective in combating pseudogynecomastia. Only if this regimen is unsuccessful should surgery be considered. This is generally the only type of gynecomastia which can be improved with liposuction, but excision may be indicated in some cases.

Unilateral / asymmetrical gynecomastia occurs when only one breast is larger due to gynecomastia, the other breast is typically normal in both size and shape. Bilateral asymmetry occurs when gynecomastia is present in both breasts, each to a different degree.

Older persons suffering from gynecomastia tend to have less skin elasticity and thus will have a greater abundance of excess skin related to gynecomastia.

Health conditions

Several health conditions can cause gynecomastia by affecting hormone levels:

Hypogonadism

Any of the conditions that interfere with normal testosterone production, such as Klinefelter syndrome or pituitary insufficiency, can be associated with gynecomastia.

Aging

Hormone changes that occur with normal aging can cause gynecomastia, especially in men who are overweight.

Tumors

Some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance.

Hyperthyroidism

In this condition, the thyroid gland produces too much of the hormone thyroxine.

Kidney failure

About half the people being treated with regular hemodialysis experience gynecomastia due to hormonal changes.

Liver failure and cirrhosis

Hormonal fluctuations related to liver problems as well as medications taken for cirrhosis are associated with gynecomastia.

Malnutrition and starvation

When the human body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance. Gynecomastia can also occur once normal nutrition resumes.

Treatment

A large glandular mass of male breast tissue, surgically removed

Some medications (for example: risperidone) are found to cause gynecomastia in some patients. Sometimes an alternative medication can avoid gynecomastia side-effects. For example: instead of taking spironolactone, eplerenone can be taken.

Selective estrogen receptor modulator medications are treatment options, although they are not universally approved for gynecomastia treatment. Such treatments are: tamoxifen and clomifene, or androgens (typically testosterone) or aromatase inhibitors such as anastrozole.

Endocrinological attention may help during the first 2–3 years of gynecomastia development. However: after that timeframe the breast tissue tends to remain and harden. This leaves surgery as the only treatment option. Such surgical procedures are: liposuction, gland excision, skin sculpture, and reduction mammoplasty.

Radiation therapy is sometimes used to prevent gynecomastia in patients with prostate cancer before estrogen therapy.

Compression garments can camouflage chest deformity and stabilize bouncing tissue; this brings emotional relief to some.

Many American insurance companies deny coverage for surgery for gynecomastia treatment on the basis that it is a cosmetic procedure.

Prognosis

Gynecomastia is not physically harmful, but in some cases can be an indicator of other more serious underlying conditions, such as testicular cancer. Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful. Furthermore, it can frequently present social and psychological difficulties for the sufferer. Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging tissues about the chest, chest ptosis. The size and geometry of the fibro-glandular tissue present is unique to each patient. This results in a range of physically apparent aesthetic deformities, for which, classification systems have been devised.

Gallery

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  Glandular accumulation around the nipple
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  An example in a body builder
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  An example of gynecomastia in a teenager
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  Pseudogynecomastia
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  An example of asymmetric gynecomastia
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  An example of the combined procedures gynecomastia surgery and liposuction of the waists (flanks)

See also

• Male bra
• Male lactation

References

Notes

External links

• What is gynecomastia? Children's Hospital Boston
• Excessive alcohol consumption can lead to male breasts Fitho- Health & Fitness Resource