Gynecomastia – Incidence, Causes And Treatment

Gynecomastia

Gynecomastia is a benign proliferation of glandular tissue in men, manifested by concentric growth of one or both breasts. The condition is common in the neonatal period, at adolescence and at old age. Asymptomatic gynecomastia among infants is estimated at 60-90%. According to studies, approximately 50-60% of boys aged between 10 and 16 years are prone to gynecomastia. Moreover, it is considered that gynecomastia is an event that occurs in the midst of puberty and is more common among boys with pubic hair. The last peak in the incidence of this disease is in men aged between 50 and 85 years, taken it is up to 70%. In such cases, the most common form is bilateral gynecomastia (both breasts).

Gynecomastia

Causes

Gynecomastia is a complex process resulting from several changes in body hormones. The pathology of this disease is given by the lack of balance between estrogen and androgen action on the breast tissue. Estrogens strongly stimulate the tissue, while androgens inhibit breast growth. Estrogens are known to bind less on the sex hormone-binding protein (SHBG) than androgens like testosterone. Several hypotheses try to explain the etiology of gynecomastia include increased levels of estrogen, too little free testosterone or the sensitivity of breast tissue, but for many patients, the etiology remains unclear.

The main causes of gynecomastia can be either idiopathic (adrenocortical tumors), age related, obesity, hyperthyroidism, liver disease, Klinefelter syndrome, testicular tumors, oral ingestion of testosterone, the use of estrogen creams, medication such as Spironolactone and Ketoconazole, cirrhosis, HIV, chronic diseases and lavender oil. Drugs that are involved in gynecomastia development are those containing hormones (anabolic steroids, growth hormones, etc.), anti-androgens (Flutamide, Duasteride), antibiotics (Isoniazid, Ketoconazole, Metronidazole), anti-ulcers (Cimetidine, Ranitidine), Metoclopramide , drugs prescribed for HIV, drug and alcohol abuse (marijuana, amphetamines, heroin).

Patient evolution

The first steps in the clinical evaluation of gynecomastia is the elimination of pseudogynecomastia and carcinoma. Laboratory and imaging tests will identify the cause of the disease. Tests for assessing liver function tests, kidney and thyroid function, blood testosterone, Luteinizing hormone (LH), Human chorionic gonadotropin (hCG) and estrogen levels respectively will be taken into account.
Puberty occurring gynecomastia disappears spontaneously for most teenagers in less than three years, but the patients should be kept under observation. Unfortunately, puberty occurring gynecomastia has a negative impact on personal image of adolescents and may lead to depression.
In adults with asymptomatic gynecomastia, no treatment is required. Men who experience pain or soreness need short-term treatment. If it turns out that gynecomastia is caused by the use of any drug, improvement in the situation can be seen in more than a month after the patient stops the use of that certain drug. Once diagnosed with gynecomastia, it is essential to maintain patient history and physical examinations in order to determine any changes that may occur.
For chronic gynecomastia, it is unlikely for the disease to be treated, either spontaneously cured or by the use of treatment. In these cases, subcutaneous mastectomy or liposuction can be considered. Liposuction alone may be sufficient in cases where breast enlargement pseudogynecomastia is caused by excess fatty tissue. In these cases of chronic gynecomastia, drug therapy is the most useful.
Anti-androgen therapies used for prostate cancer have an increased incidence for gynecomastia. One of the drugs used to treat gynecomastia is Tamoxifen – a dose of 20 mg per day (taken orally) for a period of up to 3 months. It has good results in normal cases, but can also be effective in painful gynecomastia cases.