Help the development of the site, sharing the article with friends!
Gynecomastia is the enlargement of one or both male mammary glands (breasts). The prevalence of this ailment is common, yet this topic is rarely discussed, as it is a shame for people affected by gynecomastia. It is worth knowing who may have gynecomastia, what are its causes and treatment methods.
Gynecomastiais the growth of the glandular tissue of the nipples leading to their enlargement, it can occur in men of any age. It is estimated that even every second man will have this kind of problem at some point in his life.
The most common causes of gynecomastia are hormonal: puberty in boys, drug-induced in adults, idiopathic (of unknown cause), rarely due to cancer, and in the elderly due to age-related hormonal changes.
Gynecomastia rarely results from serious diseases, but in any case it is necessary to see a doctor, first of all to rule out cancer.
Treatment is aimed at the cause of gynecomastia, psychological support is necessary if necessary, and in rare cases surgery is performed to remove excess tissue.
The underlying problem is the excessive growth of tissues: glandular, and sometimes also fat and fibrous, all of them are normal components of the mammary gland.
Under certain conditions, most often under the influence of hormonal stimuli, they begin to grow, causing enlargement of the glands. If this growth is rapid and severe, the enlarged glands may become swollen and painful.
It should be remembered that a certain amount of adipose and glandular tissue in the nipple area is the norm and there is no strict definition of what is normal and what is an increased amount that requires diagnostics, this issue will be best assessed by a doctor, and if necessary he will take it up necessary diagnostics.
Gynecomastia itself, although it is an excessive growth of tissues, is not cancerous.
Unfortunately, for people suffering from it, it is a big problem and often a cause of embarrassment, especially when it occurs in adolescence. It is then the cause of lack of acceptance by peers and complexesrelated to their appearance, and often also the cause of depression.
Gynecomastia: causes
Gynecomastia is a symptom, not a disease in itself. There are many causes, most of them are hormonal disorders - their secretion, structure or receptors.
It is the female sex hormone estradiol that causes the mammary glands to grow, and testosterone (male sex hormone) inhibits its action by preventing the growth of the glands. If the balance between them is disturbed, estradiol begins to dominate and gynecomastia develops.
It happens that enlargement of the glands is the result of taking medications or obesity, which also affects the hormonal balance. The most common causes of gynecomastia are:
- Excess of active female hormones (estrogens) compared to male hormones (testosterone)
Under normal conditions, men have small amounts of female hormones, but the appropriate amount of testosterone reduces their effect, there are states in which this balance is disturbed by:
- increased estrogen synthesis
In adolescence - strong hormonal changes, this is a completely normal phenomenon, usually disappearing within a few months, although sometimes this condition may become permanent due to tissue overgrowth.
In mature people, gynecomastia caused by excess estrogens should be a cause for concern, because it may result from testicular cancer, which is often hormonally active producing androgens or estrogens.
Another cause of gynecomastia is adrenal hyperplasia or tumors originating in this organ.
The adrenal glands are the endocrine glands that are responsible for the production of cortisol, aldosterone and small amounts of sex hormones. If the overgrowth or neoplastic process involves estrogen-producing cells, this can trigger gynecomastia.
Reduced androgen synthesis, for example in older men or in so-called hypogonadism, or testicular dysfunction. This impairment occurs as a result of damage to the testes (mechanical or radiation) or due to hormonal reasons - a lack of gonadotropic hormones, especially luteinizing hormones, produced by the pituitary gland.
The described hormone deficiency is hypopituitarism, and the most common causes are injuries, cancer or inflammation.
- reducing the amount of free testosterone in the plasma
Under normal conditions, two fractions of this hormone circulate in the blood - associated with a protein called SHGB, this form is hormonally inactive, and the free fraction, which has a normal biological effect. Sometimesit happens, for example in hyperthyroidism, that the amount of SHGB produced increases, this causes the binding of free testosterone molecules and their inactivation, which disturbs the balance of active sex hormone concentrations.
- hormone metabolism disorders
Cirrhosis of the liver (its failure) and kidney failure slow down the metabolism of hormones - their breakdown and excretion. If, as a result of this process, estrogen breakdown is more impaired than testosterone, there will be an excess of female hormones compared to male hormones, leading to gynecomastia.
- increasing the amount of aromatase
It is a hormone that converts testosterone into estradiol, which is found, for example, in adipose tissue. In obese people, with its excessive accumulation, it causes a local increase in the concentration of female hormones, as a result of which the glandular tissue of the nipples is stimulated to grow.
- mammary gland hypersensitivity to estrogens
For unknown reasons, there is an increase in the number of estrogen receptors in the glandular tissue of the breast, leading to hyperplasia and gynecomastia, even though the blood estrogen concentration is normal.
- congenital defects of the androgen receptor
In this case, the amount of sex hormones is normal, but due to the damage to the receptor in the glandular tissue, it becomes less sensitive to the effects of testosterone. This defect most often occurs only in the nipple, the effect of testosterone in other regions of the body is unaffected.
The androgen receptor can also be blocked by drugs, e.g. some drugs used in high blood pressure (spironolactone), in the treatment of mycosis (ketoconazole) or gastric ailments (ranitidine, omeprazole), the effects are the same as in birth defects. In some diseases, e.g. prostate cancer, hormonal treatment is used, which may result in gynecomastia.
Some nutrients have an estrogenic effect (e.g. beer), hypersensitivity to these substances may cause gynecomastia, in which case they should be excluded from the diet.
It also happens that excess body fat contributes to the occurrence of gynecomastia. This happens in several mechanisms: the aforementioned excess of aromatase and the secretion of estrogens.
The production of female hormones in adipose tissue is normal, and when this tissue is in excess, the total amount of estrogen produced is large, both locally and systemically. This, in turn, is the direct cause of gynecomastia. It is worth remembering that the growth of only adipose tissue in the nipple area is associated with obesityit is lipomastia itself.
In some people with this ailment, it is not possible to find its cause and it remains the only symptom, then we talk about idiopathic gynecomastia.
Gynecomastia: diagnostics
The diagnosis is made on the basis of a medical examination, further proceedings are aimed at clarifying the cause of glandular tissue growth.
During the visit to the doctor, it is very important to inform about the medications you are taking, as well as other disturbing symptoms, as they can significantly facilitate the diagnosis.
In the field of laboratory tests, the levels of hormones - mainly estradiol and testosterone, but also pituitary hormones (prolactin, luteinizing hormone, follicle-stimulating hormone) are assessed in order to detect possible disorders.
The determination of kidney, liver and thyroid function as well as tumor markers is often helpful in the differential diagnosis.
The decision regarding the ordered laboratory tests is made by the doctor on the basis of an interview and examination, which allows for a hypothesis as to the most probable cause of gynecomastia.
The enlargement of the mammary glands should be first of all differentiated from the neoplastic growth of the nipple, which, although rarely, occurs in men. For this purpose, imaging tests are used: ultrasound and possibly a nipple biopsy, and if there is a suspicion of testicular cancer - ultrasound of the testicles.
In order to exclude pathologies of other organs, abdominal ultrasound, computed tomography (when suspected adrenal gland disease is suspected) and magnetic resonance imaging, if a complete pituitary diagnosis is necessary.
Gynecomastia: treatment
The basis of the procedure is to identify the cause, because the therapy should be directed at it. If the cause is a tumor (of the breast or endocrine organs), oncological treatment should be undertaken, if gynecomastia is caused by drugs - change them to other drugs with a similar effect and not showing such side effects.
In the case of diseases of the liver, kidneys or thyroid gland, you should focus on improving the function of these organs, if possible.
In the case of gynecomastia occurring during puberty, it usually resolves spontaneously and does not require treatment.
If the gynecomastia is very severe, its cause has been removed or is unknown (idiopathic gynecomastia), surgical treatment may be undertaken to excise the excess glandular tissue.
Hormone therapy is used very rarely in the treatment of gynecomastia - drugs that inhibit the action or synthesis of estrogens or androgens.
If the main causeglandular tissue growth there are changes related to obesity, you should reduce body weight by limiting the amount of food consumed and increasing physical exertion.
In the treatment of gynecomastia, the psychological aspect must not be forgotten, if this ailment is the cause of depression, complexes and lowered self-esteem, the help of a psychologist and possibly a psychiatrist is necessary.