Description

Gynecomastia is the benign enlargement of breast tissue in males caused by an imbalance between estrogen and testosterone levels. It can occur at any age and is often reversible, depending on the underlying cause. Causes of Gynecomastia Physiological Causes: Neonatal: Transient due to maternal estrogen, resolves within weeks. Puberty: Common in adolescent males (peak age 13–14 years); typically resolves within 6–12 months. Aging: Occurs in older men due to declining testosterone and increased fat tissue, which converts testosterone to estrogen. Pathological Causes: Hormonal Imbalance: Increased estrogen or decreased testosterone production. Hypogonadism (e.g., Klinefelter syndrome, testicular injury). Systemic Diseases: Liver disease (e.g., cirrhosis). Kidney failure (e.g., chronic kidney disease). Thyroid disorders (e.g., hyperthyroidism). Tumors: Testicular tumors (e.g., Leydig or Sertoli cell tumors). Adrenal tumors. hCG-secreting tumors. Medication-Induced: Drugs that disrupt the hormonal balance or act on breast tissue: Anti-androgens (e.g., finasteride, bicalutamide). Anabolic steroids. Antipsychotics (e.g., risperidone). Certain antibiotics and antifungals (e.g., ketoconazole). Cardiovascular drugs (e.g., spironolactone, calcium channel blockers). Proton pump inhibitors and anti-ulcer drugs (e.g., cimetidine). Substance Use: Alcohol abuse. Recreational drugs (e.g., marijuana, heroin, amphetamines). Idiopathic: No identifiable cause in some cases. Symptoms of Gynecomastia Physical Symptoms: Enlargement of breast tissue (unilateral or bilateral). Tenderness or sensitivity in the breast area. Palpable rubbery or firm glandular tissue beneath the nipple. Psychological Impact: Emotional distress or embarrassment. Decreased self-esteem. Diagnosis of Gynecomastia History and Physical Examination: Duration and progression of symptoms. Medication and substance use history. Signs of underlying conditions (e.g., liver disease, hypogonadism). Laboratory Tests: Hormonal Evaluation: Testosterone, free testosterone. Estradiol. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Prolactin. Thyroid-stimulating hormone (TSH) and free T4. Beta-hCG (to rule out malignancy). Liver, kidney, and adrenal function tests. Imaging: Breast ultrasound or mammography to distinguish gynecomastia from breast cancer (rare in males). Testicular ultrasound if a testicular tumor is suspected. Chest X-ray or CT if a lung tumor is suspected. Management of Gynecomastia Observation: Pubertal gynecomastia typically resolves spontaneously within 6–12 months. Observation is recommended if the condition is mild and non-progressive. Treat Underlying Causes: Discontinue offending medications or substances. Treat systemic diseases (e.g., liver or kidney disease, hyperthyroidism). Address hypogonadism with testosterone replacement therapy. Medical Therapy: Used if gynecomastia is painful, progressive, or causes significant distress. Selective Estrogen Receptor Modulators (SERMs): Tamoxifen: Effective for reducing breast tissue size and pain. Raloxifene: Alternative with fewer side effects. Aromatase Inhibitors: Anastrozole: Reduces estrogen production (less effective than SERMs). Testosterone Therapy: For men with low testosterone levels and symptoms of hypogonadism. Surgical Treatment: Considered for severe, long-standing, or distressing cases. Options include: Liposuction: Removes excess fat. Mastectomy: Removes glandular tissue (subcutaneous approach minimizes scarring). Psychological Support: Counseling or therapy for body image concerns or emotional distress. Complications of Gynecomastia Physical discomfort or persistent tenderness. Psychological and social difficulties, including anxiety and depression. Rarely, male breast cancer (consider in older men or with atypical presentation). Prognosis Physiological gynecomastia often resolves without intervention. Pathological cases improve with appropriate treatment. Surgical outcomes are typically excellent for persistent cases. Key Takeaways Gynecomastia is common and often benign. Identifying and addressing the underlying cause is crucial. Medical and surgical treatments are available for symptomatic or distressing cases.