gynecomastia

Gynecomastia: description

Female breast growth in men is called gynecomastia. The glandular tissue grows, which goes through stages similar to those in puberty in girls. Doctors distinguish different forms of gynecomastia based on their causes. Depending on whether it is a natural (physiological) or a pathological process, the doctor knows whether and how gynecomastia has to be treated.

Gynecomastia: symptoms

Gynecomastia (men with breast growth) may be either unilateral or bilateral in the chest area. Gynecomastia is actually a symptom, not an independent disease. The trigger must be found in order to develop a suitable therapy.

Depending on the cause of gynecomastia, other symptoms may occur. Gynecomastia can lead to subjective complaints, such as a feeling of tightness in the breasts, a restriction of movement, or a special contact sensitivity of the nipples.

But it can also appear exclusively by the increase in size of one or both mammary glands, without causing other discomfort. Adolescents can significantly burden the so-called puberty gynaecomastia and cause swimming pools, changing rooms or sports to be avoided for fear of ridicule.

Gynecomastia: causes and risk factors

In most cases, the underlying condition, a normal (physiological) body process, drugs or drugs affects the hormone ratio of testosterone and estrogen: The normal testosterone level in adult young men is about six nanograms per milliliter of blood (ng / ml), the normal estrogen levels 20 to 40 picograms (pg / ml). This results in a testosterone / estrogen quotient of about 200-300.

The mammary gland tissue is very sensitive to fluctuations in the male hormonal balance, so it can lead to breast growth in disorders of balance. All things that intervene in this balance therefore play a role as risk factors for the development of gynecomastia.

The distinction between gynecomastia and so-called pseudogynaecomastia (lipomastia) is important, because in this disorder only fat is stored in the breast. A pseudogynaecomastia usually arises in the context of obesity.

The most important gynecomastia forms and causes at a glance:

Physiological gynecomastia

Physiological gynecomastia results from an altered balance between female sex hormones (estrogens) and the male sex hormone (testosterone). The proportion of the female messenger, which also circulates in small quantities in the man always in the body, it increases. The mammary gland tissue is very sensitive to such changes. However, these are not always caused by pathological processes, but can also occur naturally in certain phases of life:

• Neugeborenengynäkomastie: About 60 percent of all male newborns have a small breast in the first few weeks. However, this occurs only temporarily and disappears after a few weeks to months again. Male babies come into contact with female mother’s hormones during pregnancy and the first few weeks of their life. Estrogen is passed through the placenta and breast milk to the child. The child’s liver can not break down this hormone so efficiently in the first few weeks of life that estrogen initially has a greater impact on the child’s development and may result in a slight breast formation.

• pubertal gynecomastia: During puberty, some boys develop breast growth, a so-called puberty gynecomastia. Again, a changed balance of sex hormones is responsible. In the course of the serious changes in the hormone balance, it is possible that more and more female sex hormones are formed. The puberty gynecomastia is usually back to the age of 20 back. If it persists, the glandular tissue can be surgically removed. Many adolescents find puberty gynecomastia embarrassing and their self-esteem suffers. Since adipose tissue plays a role in the conversion of the male sex hormone testosterone to female estrogen, pubertal gynaecomastia is more common in overweight adolescents.

• Altersgynäkomastie: As you age, body fat increases and testosterone production decreases. The enzyme aromatase, which is particularly abundant in adipose tissue, converts testosterone to estrogen. Both effects together can cause the mammary tissue to begin to grow. This form of breast growth is often favored by obesity.

Pathological gynecomastia

Breast growth in males can also be indicative of a pathological process in the body that interferes with hormone balance, or that occurs directly in the breast itself.

• Hereditary Gynecomastia: Some men have a problem with the production or processing of hormones. For example, enzymes can not produce certain precursors of the male hormone, or both testes – the main producers of testosterone – are missing. The doctor gets first evidence of this form of gynecomastia in the patient interview, because “men with breasts” are then often already known in the family.
  Sometimes sections of the genetic material DNA are missing, or the (female) X-chromosome X is duplicated (Klinefelter syndrome). So it may happen, in spite of actually male sexual characteristics, that female breast, pelvis and buttocks develop female. Such defects in the genetic material usually arise in the production of the sperm or egg or in their fusion (fertilization).

• Chronic diseases: The finely balanced hormone balance of the body can be disturbed by diseases.
  • A particularly important role is played by the liver, because it is responsible for the breakdown of hormones, in particular estrogens. In liver diseases such as cirrhosis of the liver, there may be an excess of female hormones, and thus gynecomastia. The kidney can also cause gynecomastia. In the case of a functional disorder (renal insufficiency), the altered filter function also influences the hormone balance.
  • Severe malnutrition, such as those caused by anorexia, dramatically reduces testosterone levels and prevents the liver from working at full strength. If you switch to a normal diet after such a hunger phase, the hormone levels will still be disturbed for a while and gynecomastia may develop. However, this usually returns within a year or two.
  • Losing one or both testes can also alter the ratio of testosterone / estrogen to the clinical picture of a “man with breasts”.

• Cancers and gynecomastia: Tumors are cell aggregates that have lost their normal task. Your growth metabolism is no longer subject to natural limits and regulatory mechanisms. Some tumors themselves produce effective amounts of hormones, so that an excess of these messengers circulates in the body. Sometimes these are sex hormones or substances that actually occur only in the pregnancy of the woman in the body. As a result, breast growth can be stimulated and gynecomastia develops. In this case, one speaks of “paraneoplastic symptoms” (neoplasia = tissue regeneration).
  However, excessive hormone production with gynecomastia does not always indicate a tumor. There are also many other, less serious diseases that alter the hormonal balance, such as the relatively frequent hyperthyroidism (hyperthyroidism).
  Breast cancer can also occur in men. This is much rarer than the woman and is therefore often recognized late. Typical of a tumor-related gynecomastia (breast cancer) are their acute, one-sided occurrence, pain and a feeling of tightness.

• Gynecomastia due to drugs, drugs or care products: A very common cause of gynecomastia is the external supply of hormones or substances that affect hormone balance. Some heart medicines, antibiotics or antidepressants change the hormone metabolism. If a doctor examines a man with a “female” breast attachment, he must also inquire in detail about possible drug use (marijuana, heroin), because both substances lead to prolonged abuse including gynecomastia. Even heavy, long-term alcohol consumption can be the cause of a hormonal disorder with gynecomastia.
  Some skin and hair care products contain small amounts of artificial female hormones that enter the bloodstream through the skin or scalp. The doctor may therefore also ask for the hair gel or shampoo.

Pseudogynecomastia (lipomastia)

It is important to distinguish gynecomastia from lipomastia. In pseudogynacomastia, the glandular tissue does not multiply, but fat is stored in the breast. The pseudo-gynecomastia occurs especially in severe overweight and obesity (obesity). On the basis of the BMI (Body Mass Index) one can estimate the overweight itself.

Gynecomastia: examinations and diagnosis

The most important tool of the gynecomastia doctor is the patient interview (anamnesis). Often it comes because of drug or drug use for gynecomastia, or it is a natural growth process during puberty, the so-called puberty gynecomastia. For this reason, in boys under 15 years usually no further diagnostics necessary.

Based on the shape and size of the nipple you can divide the growth of the breast into stages and observe and compare for a long time.

In gynecomastia, the doctor must distinguish between pseudogynaecomastia (lipomastia) and true gynecomastia. Therefore, palpation is a very important step in the diagnosis. In this way, the physician can quickly distinguish glandular tissue from simple adipose tissue and assess whether there is abnormal growth of the mammary gland tissue. Some doctors prefer to detect this difference with the ultrasound machine.

In addition, the doctor in the blood determines in particular the liver and kidney values ​​and the hormone levels of estrogen and testosterone and their degradation products.

Ultrasound examination of the testicles and abdomen is important to assess the production sites of the hormones. In this process, the testicles are also scanned, in this way, for example, structural changes or nodes can be felt. In adolescents, the development of the penis and the body is assessed at the same time – they allow conclusions about the physical development and the stage of puberty. An X-ray or computed tomography scan of the chest may also be important in certain types of gynecomastia or suspected tumors.

A one-sided gynaecomastia with hard tissue parts (nodules) can lead to a suspected breast cancer. In this case, a mammogram for the exclusion of breast cancer is also made in the man.

If no cause for gynecomastia can be found or exists since birth or puberty, a chromosomal analysis may provide evidence of a possible genetic disorder. For cost reasons, this study is only made on further evidence of a genetic disease.

Gynecomastia: treatment

At gynecomastia treatment is determined according to the cause of the disease. Often it is only a temporary problem, such as puberty gynecomastia, and no treatment is needed. If the cause is known and treatable, the treatment approaches aim to correct the hormone balance again. If this is not achieved by simple means such as a change in diet or the absence of hidden external sources of estrogen, one can intervene with drugs in the hormone balance. Either by direct administration of testosterone, or by blocking the conversion, production and action of the female hormone estrogen. However, such drug therapy is controversial and it is estimated that this will only be effective in the first few months after the onset of breast growth.

Gynecomastia: OP

If medication does not help, surgical removal of the breast may be considered. Read everything in the article Gynecomastia Surgery.

Gynecomastia: disease course and prognosis

In the case of physiological gynecomasites, treatment is only necessary if the changes put a strain on the patient. In addition, it is often only a temporary appearance, which regresses after some time by itself. If, on the other hand, it is pathological gynecomastia, various examinations help to detect possible underlying diseases and hormonal disorders.

In men with breasts who visit a doctor, the doctor must always try to distinguish a true gynecomastia from a pseudogynaecomastia. A pseudogynecomastia may be cosmetically stressful for the patients, but has no disease value. Often it is also mixed forms, because fatty tissue plays an important role in the hormone balance of the man and therefore also in the Gynecomastia.