Gynecomastia in men: symptoms and treatment
Gynecomastia is a disease characterized by an increase in mammary glands in men.Can occur in healthy newborn boys, in adolescence and in older men.Such gynecomastia is called physiological, does not require any specific treatment and passes independently.But there is also a pathological type of the condition in question.Table of contents: Causes of gynecomastia Symptoms of gynecomastia in men Diagnostic measures Treatment of gynecomastia in men
Causes of gynecomastia
Gynecomastia occurs against a background of hormonal disorders when the level of female sex hormones( estrogens) is significantly increased in comparison with the level of male sex hormonesAndrogens).In most cases, gynecomastia occurs in newborns - in 80% of cases.The swelling of the mammary glands in this case is associated with the action of the mother's estrogens, which entered the baby's body in its prenatal development.As a rule, gynecomastia in newborn boys disappeared independently by the age of one month.
Pubertal gynecomastia( adolescent) may appear in boys aged 12-14 years, which is explained by temporary changes in the level of hormones.As a rule, in this case, both mammary glands will increase, sometimes there are discharge from the nipples.Usually within a maximum of 2 years, the hormonal background in the adolescent is stabilized, and the gynecomastia disappears on its own.There are cases when pubertal gynecomastia persists for more than 2 years - doctors will classify it as persistent.
In the elderly( 50-80 years), gynecomastia also has a physiological character, and its appearance is due to the fact that due to age-related changes in men, the level of estrogen( female sex hormones) rises.
But if we consider gynecomastia as a symptom of a serious pathology, it can appear in men with the development of the following diseases:
- testicular pathology, which is accompanied by a decrease in testosterone production - for example, an anarchy( absence of one or two testicles), Klinefelter's syndrome, testosterone synthesis defects, decreased blood flow in the testes, benign / malignant neoplasm, orchitis, parotitis and trauma;
- bronchogenic lung cancer;
- true hermaphroditism;
- adrenal tumor of a feminizing nature( adenoma or carcinoma);
- chronic renal failure;
- hyperthyroidism - increased thyroid function;
- Hyperprolactinemia - a consequence of pathology of the pituitary gland;
- malnutrition and hunger;
- cirrhosis of the liver;
In addition, this pathological condition may be a side effect of a number of medications:
- Ranitidine, Omeprazole - antiulcer drugs;
- Dopegit is an antihypertensive drug;
- Nizoral, Metrid - antifungal agents;
- Veroshpiron is a diuretic and antiandrogenic agent;
- Amlodipine, verapamil - calcium channel blockers, which are used to treat hypertension;
- Kapoten, Diroton are angiotensin converting enzyme inhibitors that are used to treat hypotension and heart failure;
- hormonal drugs for the treatment of malignant formation in the prostate;
- preparations for antiretroviral therapy in the human immunodeficiency virus;
- tranquilizers - for example, Realnium or Seduxen;
- tea tree oil.
In some cases, doctors are unable to determine the cause of gynecomastia and then it is called idiopathic.
Symptoms of gynecomastia in men
The main symptom of this condition is an increase in the mammary gland.Moreover, the basis of this process is an increase in non-adipose tissue( usually the similarity of gynecomastia is observed with obesity), but glandular.Most often, bilateral gynecomastia is diagnosed and only one-third of patients have a one-sided character.Sometimes with gynecomastia there are discharge from the nipples, which resemble colostrum.The soreness of enlarged mammary glands is absent, but a man may experience localized discomfort.
Note: gynecomastia is never accompanied by impotence or other intimate problems.Violation of erectile function can occur only if a man has a lowered level of testosterone.
There are a number of signs that are characteristic for the development of the tumor process, which is of a malignant nature:
- gynecomastia unilateral;
- at the point of enlargement to the touch defines a dense consistency;
- changes appear on the skin of the breast;
- axillary lymph nodes increase.
In such a case, you need to urgently seek qualified medical help - the earlier the diagnosis is made, the more likely the man will have a favorable outcome.Urgent medical examination is also required if there is swelling / swelling or changes in the shape of the testicles against the background of gynecomastia, hair from the beard and mustache is falling out, the tone of the voice is raised, emotional disorders( irritation, tearfulness) occur.
At the initial examination the doctor can diagnose only after palpation of breast tissue and axillary lymph nodes.But to clarify the diagnosis and identify tumors specialists use ultrasound examination of the mammary glands, axillary lymph nodes.Very rarely, in the diagnosis of gynecomastia, mammography and a biopsy of the mammary gland are performed.
A man who is diagnosed with "gynecomastia" must also undergo laboratory tests - determination of the level of estradiol, prolactin, testosterone, thyroid stimulating hormone, human chorionic gonadotropin and luteinizing hormone.
Note: , if an increase in the level of human chorionic gonadotropin and estradiol has been detected in laboratory studies, the patient is immediately placed in an oncology clinic for a complete examination to exclude / confirm the presence of malignant tumors.
If the doctor deems it necessary, as part of the diagnosis with gynecomastia, ultrasound examination of the testicles and computed tomography of the adrenal glands can be prescribed-these procedures will also exclude tumor processes.
Treatment of gynecomastia in men
The treatment regimen of the condition in question is always selected individually, because it all depends on the causes that triggered the increase in mammary glands in men.If a malignant tumor was not detected during the examination, the doctors prefer to simply observe the patient( this tactic is often chosen when gynecomastia is at pubertal age).If there is no positive dynamics, then specialists resort to medical therapy.
Drug therapy for gynecomastia in men
As part of the treatment of the condition under consideration, physicians are assigned sufficiently aggressive, powerful medications - taking such alone will lead to serious consequences.That's why doctors insist on visiting a medical institution and conducting treatment under the supervision of specialists. The following drugs are most often used in the treatment of gynecomastia:
- Tamoxifen( Nolvadex) is a selective modulator of estrogen receptors, often used in severe forms of the disease under consideration, the course of which is accompanied by pain.
- Testosterone - is given to those patients who have a low level of testosterone, as well as elderly men.If a man has gynecomastia, but the level of testosterone at the examination is detected within the limits of the norm, then this drug is absolutely ineffective.
- Danazol is a synthetic derivative of testosterone.The drug reduces the synthesis of estrogens( female sex hormones) in the testes, but is used to treat the condition in question extremely rarely.
Please note : if gynaecomastia was diagnosed with certain medications, doctors should consider changes in the tactics of treating the underlying disease, cancel / replace the already prescribed drug.
Gynecomastia is never treated if it is caused by some internal disease.In this case, the specialists conduct a full course of therapy for the underlying disease, and when the man recovers, the gynecomastia disappears on his own.
Operation with gynecomastia
If there is a severe course of gynecomastia, or this condition remains unchanged( without positive dynamics) throughout the year, doctors use surgical treatment.We are talking about reduction mammoplasty - breast reduction surgery.The same operation is carried out also in the event that the therapeutic treatment has not yielded positive results.
Gynecomastia is a complicated disease, because at any time fibrosis of the tissues( scarring) can develop, which further complicates( or makes impossible) medical treatment.Another problem related to gynecomastia is the psychological factor.Especially bright it is manifested in adolescent boys, can lead to a sharp change in the psychological background, the appearance of an inferiority complex.
Tsygankova Yana Aleksandrovna, medical reviewer, therapist of the highest qualification category