The onset of gynecomastia is a very uncomfortable situation for any male. The term Gynecomastia, also known colloquially as “man boobs,” refers to a common condition affecting men and boys across the globe where their breast tissue grows and acquires an abnormal size. Although gynecomastia is much more prevalent in newborns, pubescent children and in older men, it can, however, affect otherwise healthy men at any time.
In the vast majority of cases, gynecomastia is not a severe problem. However, it can be significantly distressing and psychologically challenging to cope with. Various studies conducted on the subject found that gynecomastia negatively affects self-esteem, as well as other areas of emotional health in males.
Apart from the psychological and social stresses and it can cause on affected males; gynecomastia can also cause patients to experience pervasive breast pain.
Some cases of sudden onset gynecomastia go away on their own. For example, studies report that the signs and symptoms of up to 75% of cases of pubertal gynecomastia disappear within one to three years. If gynecomastia persists, there are various treatments available. Before we discuss these, however, let’s take a closer look at the factors that might give rise to this insidious condition.
WHAT CAUSES BREAST GROWTH IN MALES?
Let’s get one thing clear first; gynecomastia is not caused by excess fat due to excess weight or obesity. When male breast tissue appears more abundant than usual but is caused by the accumulation of subcutaneous fat, the condition is called pseudo-gynecomastia. These cases can be quickly resolved by exercising, lowering total body-fat percentages and developing the pectoral muscles.
However, when an underlying pathology causes gynecomastia, exercising or losing weight will not help you get rid of this condition.
Another critical fact to keep in mind is that, in itself, gynecomastia is not a disease but instead a sign or symptom of an underlying imbalance in normal hormonal physiology. Specifically, this imbalance manifests at the breast tissue level in males when estrogenic action increases relative to androgenic activity. To further understand the mechanisms that cause the onset of gynecomastia, it is essential to have a clear understanding of the physiology of androgen and estrogen synthesis in males. The Mayoclinic symptoms and causes.
Testosterone secretion begins in the testicles and is regulated by the Luteinizing Hormone or LH. At the pituitary level, testosterone alters sensitivity to the gonadotropin-releasing hormone, or GnRH; which in turn, increases production of LH. Daily, the testes secrete 6 milligrams of testosterone into blood plasma, whereas only six micrograms estradiol and 2.5 micrograms of estrone are secreted directly by the testicles.
The majority of a male’s circulating estrogens are synthesized through extra-glandular conversion of estrogenic precursors found in the liver, kidneys, and tissues such as fat, muscle. The central mechanism of action behind this synthesis is the aromatization of testosterone into estradiol and androstenedione into estrone. While circulating freely, most of these sex hormones, especially androgens, are bound to Sex Hormone Binding Globulin, or SHBG. Sex hormone molecules that remain unbound can freely cross cellular membranes and interact with specific receptors in various androgen-sensitive target organs. Therefore, any interference in this process that causes an androgen-estrogen imbalance can potentially trigger the onset of gynecomastia.
The pathophysiology of gynecomastia can then be described by sudden increases in estrogen production, elevated tissue concentrations of estrogens, or breast tissue sensitivity, an androgen deficiency, or a combination of all these factors.
It is important to note that sometimes the administration of medicinal therapies is responsible for the development of abnormal breast tissue growth in males. Prescription and recreational drug use have been positively linked to gynecomastia.
Some of the drugs known to be associated with gynecomastia are:
- Antibiotics such as Ketoconazole, Metronidazole, Isoniazid, and Ethionamide.
- Antiulcer drugs such as Cimetidine, Ranitidine, and Omeprazole.
- Chemotherapeutic Agents such as Methotrexate, and Vinca Alkaloids.
- Cardiovascular drugs such as Captopril, Verapamil, Diltiazem, and Digitoxin.
- Psychoactive drugs such as Diazepam, Haloperidol, and Tricyclic Antidepressants.
- Recreational drugs such as Amphetamines, Heroin, Methadone, and Marijuana.
The majority of patients suffering from gynecomastia do not typically require treatment. In the case that drug use is the causal factor for its development, merely discontinuing the use of the triggering agent is enough to cause regression of the condition. In case of gynecomastia that develops during puberty, just waiting is usually the course of action. Most cases of pubertal gynecomastia clear up on their own within three years of the onset date.
In the case that an underlying pathology is to blame, treating the issue will usually result in a diminishing of the patient’s gynecomastia. Hepatic dysfunction and hyperthyroidism are amongst the most common pathologies known to trigger abnormal breast tissue growth in males.
RESTORING HORMONAL BALANCE
Low Testosterone is a factor in restoring Hormonal Balance. Plastic surgery is still the most effective but also the MOST expensive treatment for gynecomastia, with complete removal of the affected glandular tissue, in conjunction with liposuction of adipose tissue, being the most common procedure. However, medical therapy with androgens, anti-estrogens, and aromatase inhibitors, is sometimes attempted.
“Direct” testosterone therapy has proven disappointingly ineffective due to its peripheral aromatization into estrogen. The use of proper Testosterone Supplements with the a certain exercise routine can be effective. In some studies, non-aromatizable di-hydro-testosterone therapy has yielded better results, especially when injected intramuscularly. In one study, up to 75% of subjects experienced a significant reduction in breast tissue volume with minimal side effects. Additionally, Testo-lactone, which is a peripheral aromatase inhibitor, has shown promise as well.
Unfortunately, one of the most prominent characteristics of gynecomastia is that the longer the condition has been present, the less likely it is to reach a favorable resolution. In some cases, irreversible hyalinization or fibrosis eventually develops. Therefore, in most cases, medicinal therapy is not the optimal course of action, especially if the condition has been present for longer than one year.
The fact that multiple physiological factors may be at play during the development of gynecomastia also complicates the medicinal therapy route. Thankfully, since gynecomastia is usually benign and often resolves on its own, therapy is not necessary for most patients. However, if pain is present or the condition begins to place undue stress upon the patient’s psyche, more aggressive treatment options should be considered and discussed with a healthcare professional.
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- Wikipedia Gynecomastia
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