Gynecomastia

Development of breast tissue is one of the most classic signs of secondary sexual development in females at the time of puberty. Besides serving as a key differentiating factor, breast tissue also serves a number of other functions in women. But what happen if breast tissue begins to grow in males?

What Is Gynecomastia?

Gynecomastia refers to non- cancerous growth of breast tissue in males, resulting in enlarged or prominent breast tissue in men. The pathophysiology of this disease mainly revolves around an imbalance of sexual hormones (primarily estrogen and testosterone). It is imperative to mention that although estrogen is a female hormone, all men also produce this hormone in small quantities. When estrogen level increases in men (or testosterone levels decline due to a disease or disorder), the affected men develop gynecomastia.

Who Develops Physiological Gynecomastia?

Usually newborn boys who are exposed to their mother’s estrogen are more common victims of gynecomastia. It may also occur in boys going through adolescence. However, in both infants and adolescents, the condition is temporary and goes away on its own after some time. In adults, some degree of this problem is seen in men over the age of 50 years.

What Are Some Pathological Causes In Adult Men?

Excessive or abnormal enlargement of breast tissue in males may occur secondary to a systemic dysfunction; some pathological causes of gynecomastia are:

• Liver impairment
• Kidney disease
• Kidney failure
• Hyperthyroidism
• Tumors in testicles, adrenal glands, pituitary gland
• Use of certain medication or drugs over an extended period of time

It may also happen due to certain health conditions that may lower the testosterone levels, such as:

• Klinefelter syndrome
• pituitary gland problems

being overweight or obese also leads to an imbalance of sex hormones by increasing the peripheral conversion of testosterone to estrogen; thereby leading to gynecomastia. Sometimes it is age related i.e. with age, testosterone declines gradually.

How To Diagnose?

The diagnosis of Gynecomastia involves a complete and comprehensive medical history including the medications being used, both OTC and prescription drugs. A detailed physical examination is also needed to find out whether the tissue growth is due to gynecomastia or some other medical condition. Sometimes, breasts get enlarged due to fat deposition, benign tumors or development of cysts filled with fluid. If required, doctor may also examine testicles for presence of possible tumor. Besides this, your doctor may ask for some laboratorial tests, including:

• Blood tests to examine hormonal levels
• Tests for liver, kidney and thyroid functions
• CT scans or ultrasounds are needed to rule out tumors
• Breast cancer is a very rare condition in men and mammogram are performed to rule out these cancers in men

Treatment Of Gynecomastia

Treatment of this disease depends mainly on the causative factor. In some cases, no treatment is needed at all. If gynecomastia is secondary to another disease, treatment of that condition is required to resolve gynecomastia. If a specific medicine is causing breast enlargement, your doctor would advise an alternate drug or may suggest a dose adjustment to control the adverse effects.

Surgical removal of breast tissue is suggested when there is excessive tissue mass or the condition is causing physical or psychosocial issues. However, it is highly recommended to address the inciting cause first. Drugs that block the peripheral activity of estrogen can also be advised to treat this condition.

What To Do If You Are Worried About Gynecomastia?

The best solution is to discuss your condition with your doctor. A proper diagnosis is helpful in finding out the real cause. If it requires any treatment, your doctor will discuss the options with you and select the most suitable one.

References

• Deepinder, F., & Braunstein, G. D. (2014). Gynecomastia: incidence, causes and treatment. Expert Review of Endocrinology & Metabolism.
• Ladizinski, B., Lee, K. C., Nutan, F. N., Higgins 2nd, H. W., & Federman, D. G. (2014). Gynecomastia: etiologies, clinical presentations, diagnosis, and management. Southern medical journal, 107(1), 44-49.
• Lee, S. W., Kwak, D. S., Jung, I. S., Kwak, J. H., Park, J. H., Hong, S. M., ... & Ahn, Y. H. (2015). Partial androgen insensitivity syndrome presenting with gynecomastia. Endocrinology and Metabolism, 30(2), 226-230.