Gynecomastia in men symptoms. Gynecomastia in men

Is a condition that causes hypertrophy (enlargement) breast in boys and men, on one or both sides of the chest. This happens due to hormonal changes in the human body. This deviation can occur in infants ( normal phenomenon), adolescents and men of middle and older age. When a pathology occurs, the breast gland can increase in diameter from a few centimeters to 10 cm.

Gynecomastia should be classified into two types: FALSE (lipomastia) and TRUE... If in the first variant the visual breast enlargement is only a consequence of the accumulation of fat without proliferation (tissue overgrowth), then in the second variant the iron in the breast area increases and is a signal for an early visit to the attending physician. Do not delay the appointment with the doctor, as the reasons for which there is this pathology, quite a lot and it is important to determine the etiology of the disease as early as possible.

Prevalence of gynecomastia in boys, adolescents, men

According to various medical studies, about 40% of young men and 60% of men over the age of 50 face this pathology. As a rule, three age phases are distinguished.

FIRST PEAK... It occurs in infancy or in the neonatal period with the manifestation of breast pathology in 60-90% of cases. This is due to the high levels of estradiol and progesterone produced by the mother during pregnancy. During pregnancy, the placenta converts maternal and fetal DHEA (dehydroepiandrosterone) and DEA-SO4 (dehydroepiandrosterone sulfate) into estrone (E1) and estradiol (E2). E1 and E2 enter the fetal bloodstream and then stimulate breast proliferation, resulting in transient neonatal gynecomastia. Typically, this pathology in infants regresses within 2-3 weeks after birth.

SECOND PEAK... It occurs during puberty and has a prevalence in 4% to 69% of young men in adolescence. All people, whether men or women, possess female hormones (estrogens) and male hormones (androgens). During puberty, levels of these hormones can fluctuate and be severely abnormal, resulting in a temporary state of super-high estrogen concentration. Gynecomastia pubertal usually begins between the ages of 10-12 and peaks between 13-14 years. Often, the pathology regresses within 18 months and rarely occurs in men aged 17 and older.

Gynecomastia, which occurs in normally growing infants and boys during puberty, and which resolves on its own over time, is called physiological gynecomastia. Gynecomastia, caused by temporary changes in hormone levels, usually goes away on its own in six months to two years. Permanent genital gynecomastia - develops during puberty and lasts more than two years.

THIRD PEAK... It is observed in men of more mature age, especially in the period of 50-80 years with a probability of 24-65%. Senile gynecomastia is commonly associated with increased obesity during aging. Adipose tissue is the main tissue in which androgens are converted to estrogens. Higher levels of estrogen in older men are associated with increased activity of cytochrome P19 (CYP19) in adipose tissue. Additional factors are a decrease in testosterone levels and the use of drugs that can alter the concentration or action of androgen or estrogen.

The causes of gynecomastia. What diseases can cause gynecomastia?

Gynecomastia occurs due to various circumstances, but always due to hormonal changes. They are usually associated with different ratios of estrogen to androgen, where estrogen prevails over androgen. Some of the common reasons are:

Puberty

Adolescence, during which testosterone levels rise significantly. In some cases, during puberty, an aromatase enzyme comes into play, converting "excess" testosterone into estrogen. Fortunately, in most cases, adolescent gynecomastia is characterized by only a temporary enlargement of the mammary glands. Pathology occurs periodically, but disappears when the hormonal background stabilizes.

Androgen insensitivity (Morris syndrome)

Congenital lack of sensitivity to androgens. This disease is genetic and is expressed in the impaired functioning of the gene responsible for androgen receptors. At the same time, the physique of a man with Morris syndrome develops according to the female type and gynecomastia is an inevitable symptom.

Pituitary tumors

The pituitary gland, due to its role as the main regulator of hormonal processes in the body, in case of malfunctioning, can significantly increase the level of estrogen. And sometimes completely - to stop the production of endogenous testosterone. Also, adrenal neoplasms can be attributed to this category.

Benign and malignant testicular tumors

In these neoplasms, there is a significant increase in the number of Leydig cells, which are partially responsible for the production of prolactin and estrogen.

Fasting, hard diets

Nutrient deficiencies can cause gynecomastia due to decreased levels of gonadotropin and testosterone combined with normal production of estrogen from the adrenal glands.

Stress

Constant stress also causes breast hypertrophy in men. At the same time, the level of cortisol and estradiol increases, the production of testosterone also decreases, and all this leads to an imbalance and possible disruption of the functioning of the endocrine system.

Type 1 diabetes mellitus

Men with this diagnosis can develop diabetic mastopathy, which is severe diffuse enlargement of the mammary glands on one or both sides. In this case, there is inflammatory process with characteristic lymphocytic infiltration of the tissue surrounding the milk ducts and lobules of the mammary glands.

Cirrhosis of the liver

Liver cirrhosis is also the cause of abnormal enlargement of the male mammary glands. This is caused by an increase in the production of androstenedione (A) in the adrenal glands, a high level of aromatization of androstenedione to estrone, an increased conversion of estrone to estradiol, as well as a decrease in the clearance of adrenal androgens from the liver and an increase in globulin that binds sex hormones. All this leads to a decrease in the level of free testosterone. Excessive alcohol consumption also disrupts the hypothalamic-pituitary-testicular axis, which leads to a decrease in the level of the male sex hormone in the blood serum. In addition, spironolactone is often used to treat patients with cirrhosis. The diuretic has antiandrogenic activity and may increase the symptoms of gynecomastia. Also, neoplasms in the liver can lead to gynecomastia due to increased aromatase activity in the tumor itself.

The use of drugs, pharmacological preparations, in particular anabolic steroids or gonadotropin

Gynecomastia often occurs while taking psychotropic (antidepressants, neuroleptics) or antiparkinsonian drugs. True, in the latter case, it has a different, so-called prolactin origin. This is due to the fact that many psychotropic drugs significantly affect dopamine, which promotes prolactin release. Also, it is worth noting the use of high anabolic steroids, which are able to affect the levels of estrogen and androgen, thereby causing an increase in the mammary glands. Among the popular ones are:,, etc.

Male hypogonadism

Primary hypogonadism can lead to a decrease in T-production, a compensatory increase in luteinizing hormone, stimulation of Leydig cells, inhibition of 17,20-lyase and 17-hydroxylase activity, increased aromatization of testosterone to estradiol, and, finally, an increase in the ratio of estradiol to testosterone. Klinefelter's syndrome (a form of male hypogonadism) is associated with gynecomastia in about 80% of cases and is the only cause of the condition that additionally causes an increased risk of breast cancer (the risk increases 10-20 times). In addition, exogenous testosterone is often used in the treatment of this disease. Unfortunately, testosterone treatment can actually cause the side effect of gynecomastia, being flavored with the hormone estradiol.

Hyperthyroidism

An illness in which functioning is impaired thyroid gland and there is an increased stimulation of the production of thyroid hormones. Gynecomastia occurs in 10-40% of men with Graves' disease. This is often caused by direct stimulation of peripheral aromatase, as elevated Luteinizing Hormone (LH) levels increase estradiol levels and T-production of Leydig cells. In addition, it often increases, leading to an increase in the concentration of estradiol. In cases of hyperthyroidism, the mammary glands return to normal after the euthyroid state is restored.

Renal failure and dialysis

Gynecomastia occurs in about 50% of patients with renal failure, mainly due to Leydig cell dysfunction. This disease leads to hormonal abnormalities, in particular to a decrease in testosterone, an increase in estradiol and LH levels, and a moderate increase in the sensitivity of prolactin receptors. It is possible to get rid of such hormonal disorders through kidney transplantation. In addition, hemodialysis itself (a method of purifying blood using an apparatus) can cause gynecomastia. Patients with renal insufficiency have severe dietary restrictions immediately before the procedure itself. This leads to malnutrition and weight loss, from which male sex hormones are reduced. This becomes the starting point for breast hypertrophy. In renal transplant patients, gynecomastia may also be side effect medicines such as cyclosporine.

What medications cause gynecomastia?

Various medications cause up to 25% of gynecomastia cases and can be classified according to their hormone-like action.

Type 1 drugs act like estrogens and include:

• diethylstilbestrol (DEB),
• oral contraceptives,
• phytoestrogens
• and etc.

Type 2 drugs include:

• gonadotropins,
• and etc.

The third type of drugs includes:

• metronidazole,
• cimetidine,
• flutamide,
• cyproterone acetate,
• bicalutamide.

Preparations of the fourth type:

• isoniazid (INH),
• methyldopa,
• captopril,
• tricyclic antidepressants (TCAD),
• diazepam,
• cannabis.

Spironolactone is a steroidal anti-mineralocorticoid and is one of the drugs most associated with gynecomastia. It increases the aromatization of testosterone to estrodiol, reduces the production of male sex hormone in the testes, displaces testosterone from sex hormone binding globulin (SHBG) and increases the metabolic clearance of the test. It also binds to the androgen receptor, blocking testosterone and dihydrotestosterone from binding or displacing them from its receptors.

However, not all drugs of the same class cause gynecomastia: while the calcium channel blockers nifedipine and verapamil have the highest causal rate of gynecomastia, diltiazem has the lowest frequency. Cimetidine reduces the 2-hydroxylation of estradiol, which increases the concentration of active estradiol.

How do I know if I have gynecomastia? Diagnosis of gynecomastia

The primary diagnostic method, carried out before going to a specialist, is palpation - probing the breast for any suspicious seals. The classic feature of gynecomastia is the enlargement of the male mammary gland in the form of soft, compressible and mobile subcutaneous tissue, which can be seen by palpation in the areola. Also, a noticeable increase in the diameter of the areola and asymmetry of the breast tissue is possible.

Of course, the above factors are not the only symptom of gynecomastia. There may also be a burning sensation, bloating and other unpleasant sensations in the nipple area. Neoplasms in most cases respond to touch with pain. As a rule, gynecomastia is bilateral, that is, covering both mammary glands, although there are cases of unilateral manifestations.

Further actions are ultrasound, mammography of the mammary glands and finding the cause of the disease, which are indicated above. One of the most important reasons for diagnosis is to rule out breast cancer (even though it is extremely rare in men).

To find out the reasons, the patient is interviewed for taking pharmacological drugs that affect the hormonal background. With hypogonadism and other endocrine disorders, it is necessary to conduct a study of the testicles, pituitary gland and adrenal glands. In general, in order to start treatment, rather lengthy studies are required to identify possible contraindications and, if necessary, prepare the patient for surgery.

A doctor to contact when symptoms occur - ENDOCRINOLOGIST.

Histology

Histological studies have shown that the glandular changes in the breast tissue in men during gynecomastia are the same regardless of their origin, although the degree of damage to the glandular membrane depends on the intensity and duration of the hormonal disruption. Early stages gynecomastia is characterized by ductal hyperplasia (proliferation and lengthening of the ducts), an increase connective tissue, increased peridecular inflammation, intense perideductive edema, and stromal fibroblastic proliferation. All of this usually occurs in the first 6 months after onset and also correlates with pain or hypersensitivity. At later stages (after 12 months), there is a pronounced stromal fibrosis, a slight increase in the number of ducts, a slight proliferation of the epithelium and the absence of an inflammatory reaction. Therefore, pain or tenderness at this stage is unusual. Medical treatment may be more effective if implemented during the early proliferative phase (in the first 6 months), before the glandular structure is replaced by stromal hyalinization and fibrosis.

How is gynecomastia treated? Common treatments

It is most effective to eliminate gynecomastia in the first two years. Treatment is accompanied, first of all, by the normalization of the hormonal background, and only then, if necessary, surgery is performed. The only exceptions are those cases when gynecomastia is a consequence of the postponed transition period. In such situations, you can do with physical activity during the day.

For hormonal gynecomastia, antiestrogens or aromatase enzyme blockers (known drugs like clomiphene or anastrazole) are prescribed. Tamoxifen can be used to treat gynecomastia pain in adults. Anastrozole has a beneficial effect in the treatment of gynecomastia caused by aromatase excess syndrome and Pütz-Jagers syndrome.

Drug treatment for steroid-induced gynecomastia

If we talk about gynecomastia caused by the use of anabolic steroids and other hormonal drugs, anestrogens or aromatase inhibitors are used. In some cases, steroids are used on the course in order to neutralize the side effects of pharmacological drugs. But do not forget that the already formed seals do not lend themselves to pharmacological treatment. All that drugs are capable of is prevention, relieving symptoms, and stopping further progression of the disease without surgery. In this regard, they should be used during the course of steroids, as a prophylaxis. Recommended drugs in this and similar cases are:

• Tamoxifen is an estrogen blocker, most often used at the end of the course. Directly on the course is not recommended, since it tends to reduce the effectiveness of steroids. It is a cheap and affordable drug, but it is recommended for use only in the absence of other drugs, since it has a large number of side effects and high toxicity.
• - a drug with a principle of administration similar to tamoxifen. However, at the same time it has clear advantages over it, since it practically does not have side effects and relatively non-toxic. The only drawback is the high price, rare occurrence in pharmacies and sports pharmacology stores, as well as a large number of fakes.
• Anastrozole is a remedy with a different principle of action, which consists in preventing the conversion of excess testosterone into estrogens. Unlike the previously mentioned drugs, it can be used directly on the course of anabolic steroids. It is widely available and has many relatively inexpensive analogues. Related drugs such as letrozole, exemestane and aromazine are also sometimes used.

It should be borne in mind that the use of these drugs without a doctor's prescription is a risky idea, due to the fact that a thorough examination and identification of possible contraindications are carried out before their appointment. Taking blockers and aromatase inhibitors (as well as anabolic steroids) in bodybuilding and other sports is an amateur activity associated with tangible risks.

Surgical removal of gynecomastia (surgery)

Surgical approaches to the treatment of gynecomastia include subcutaneous mastectomy, liposuction-assisted mastectomy, laser-assisted liposuction, and laser lipolysis. Liposuction alone may be sufficient if the breast enlargement is solely due to excess adipose tissue without significant glandular hypertrophy. In the case of "false" gynecomastia, liposuction is also used. Complications of mastectomy can include:

• hematomas,
• surgical wound infection,
• asymmetry of the breast,
• changes in breast sensation
• areola or nipple necrosis,
• seroma,
• noticeable or painful scars and contour deformities.

In its "classic" version, the operation is the creation of a small incision under the nipple, followed by excision and removal of the mammary gland and adipose tissue adjacent to it. Surgical treatment gives good cosmetics and is well tolerated by the patient. Recently, newer, less invasive methods have appeared that require a minimal surgical incision, in which a person recovers faster, and the risks of local complications are minimized.

Due to the constant improvement of medicine, another method has appeared - laparoscopic, which is more gentle. It consists in creating a small puncture in the armpit and then inserting a laparoscope there, which further excises the mammary gland, and then in parts or completely pulls it out through the hole formed. Such an operation, in comparison with the first option, has a shorter recovery period and does not leave any cosmetic marks after healing.

If the disease is not too pronounced (neoplasm of small or medium size), the intervention is carried out under local anesthesia, combined with sedation of the patient with mild tranquilizers. At the same time, the person remains conscious and can go home after the operation on the same day.

In more difficult situations, expressed by a large focus of gynecomastia, as well as a significant amount of adjacent adipose tissue, general anesthesia... Consequently, the patient must then be hospitalized in order to exclude inflammatory complications and ensure a gentle recovery from anesthesia.

In both cases, driving and drinking alcohol are not recommended after surgery. You should also remove physical activity for a short period of time in order to ensure high-quality healing of damaged tissues. In addition, for the same purposes, it is prescribed to wear special compression underwear.

Sometimes surgery, for certain reasons, may be contraindicated. For example, in the case of true severe gynecomastia, preliminary elimination of hormonal causes is required. When high degree obesity - first of all, weight loss to acceptable values. Other reasons for refusing to intervene:

• Mild gynecomastia during adolescence, symptoms of which last less than 6 months. The operation is indicated only in extreme cases, for example, with serious hormonal abnormalities.
• Gynecomastia with the potential to develop cancer. In this case, the operation is not recommended, as it can serve as an impetus for the active growth of cancer cells. In this regard, preliminary stabilization of the course of the disease and long-term monitoring of the patient's condition are required.
• Inflammatory processes, diseases internal organs, decreased immunity and contraindications to taking drugs required for use in the operational and postoperative period.
• False gynecomastia, not associated with the presence of a true one. In this case, ordinary weight loss is recommended. An exception can only be an appeal to a plastic surgeon, who can prescribe an aesthetic operation to pump out excess subcutaneous fat in the chest area.

Other treatments

In some cases, radiation therapy and tamoxifen are used to prevent gynecomastia. They help prevent the development of breast enlargement and chest pain in prostate cancer patients who will receive androgen deprivation therapy. The effectiveness of these treatments is limited after the onset of gynecomastia and is therefore most effective in prophylaxis.

Pathophysiology

The main cause of gynecomastia is believed to be an altered imbalance between estrogen and androgen hormones, caused by an absolute increase in estrogen production and a relative decrease in androgen production. Estrogen acts as a breast growth hormone, and therefore, excess estradiol in men leads to breast enlargement, inducing hyperplasia of the epithelial ducts, elongation and branching of the ducts, proliferation of periductal fibroblasts and vascularization. Elevated serum estrogen levels in men can be derived from tumors different typesproducing estrogen (Leydig or Sertoli cells, chorionic gonadotropin (hCG) or adrenocortical tumors) or, most often, from extraganal aromatization of androgens to estrogens. Local tissue factors in the breast can also be important, for example, increased aromatase activity, which can cause excessive local production of estrogen, decreased estrogen degradation, and altered levels or activity of estrogen or androgen receptors. These data mean that the resulting gynecomastia may be the result of various neoplasms in the human body. That is why, during the diagnosis, additional tests are possible to detect tumors.

Although receptors prolactin (PRL) are present in the male breast tissue, hyperprolactinemia can lead to gynecomastia through effects on the hypothalamus, causing central hypogonadism. The activation of prolactin receptors also leads to a decrease in androgens, as well as an increase in estrogen and progesterone receptors in breast cancer cells. If these processes occur in the male breast tissue, it can lead to gynecomastia. The roles of PRL, progesterone, and other growth factors (GFs) such as insulin-like growth factor I (IGF-I) and epidermal growth factor (EGF) in the development of gynecomastia are unclear.

Is gynecomastia associated with breast cancer in men?

Men with gynecomastia have a five-fold higher risk of developing breast cancer compared to the general male population. It is believed that gynecomastia itself is not a precancerous condition, but rather that the hormonal changes (relative increases in estrogen, lower androgen levels) that produce gynecomastia in adult men also increase the risk of breast cancer.

conclusions

Gynecomastia can be both a relatively minor symptom associated with hormonal changes in adolescence, and a sign of serious, sometimes life-threatening diseases. One way or another, any of its types and reasons requires an early visit to a doctor. And the earlier this treatment occurs, the better, therefore, as gynecomastia tends to progress over time.

People who use drugs (in particular, steroids) that can affect the hormonal profile should be smart and follow all possible preventive measures. They should also understand that gynecomastia is not only a simple enlargement of the mammary glands, but also a symptom that contributes to the development of benign and malignant neoplasms.

Educational video: GYNECOMASTY - what you did not know!

An increase in the mammary glands in men is formed as a result of the growth of adipose or glandular tissue. The disease can be either one- or two-sided. Lumpiness of the breasts often develops during puberty, after which it goes away on its own. Often, the violation occurs in athletes, for example, bodybuilding practitioners, due to the lack of exercise and the use of anabolic steroids. So that the hormonal balance does not shift to the side female hormones, you need to carefully select the training program for the course.

The breast gland can increase from 1 to 10 cm. Symptoms of the disease are expressed in chest compaction, painful sensations during palpation and a feeling of heaviness. In the absence of a result from conservative treatment, surgical intervention is indicated, since advanced gynecomastia can develop into breast cancer. The disease mkb-10 has the number N62. The army and gynecomastia are quite compatible, therefore, with such a diagnosis, there is no delay.

Disease classification

Exist false and true form of the disease. In some cases, they can be combined, for example, with dyspituitarism in adolescents. The first form includes pseudo-gynecomastia, that is, breast enlargement with fatty deposits in boys or men, when there are no alveolar formations in the tissues.

True gynecomastia it happens physiological and pathological... The first form includes newborn, adolescent and senile gynecomastia. Pathological develops when kind of genetic and iatrogenic diseases, hormonal and somatic diseases, genetic disorders, and paraneoplastic dysfunction (cancer testicular, breast, kidney, etc.).

Stands out diffuse (extensive) and nodal (partial) prevalence of the disease.

Unilateral male gynecomastia usually develops with increased local sensitivity of the breast to blood estrogens. The mammary gland on the left is more often affected. Double-sided the form of the disease means that both breasts are affected at the same time, although the intensity of the disorders is usually different.

There are 3 stages of development:

1. Developing - the first period lasting about 4 months. The changes are reversible and conservative therapy is sufficient.
2. Intermediate the form can last up to 1 year. Breast tissue changes.
3. Fibrous - fat cells are deposited in the mammary gland, and mature connective tissue is formed, reverse development is impossible.

Clinically, there are 4 degrees of gynecomastia:

I degree - the least subareolar nodosity;
II degree - the seal is smaller than the areola;
III degree - the node has the volume of the areola;
IV degree - the lump is larger than the pigmented area around the nipples.

By size, conditionally allocated moderate (up to 6 cm), the average (up to 10 cm) and expressed (more than 10 cm) education. Calculate it by the formula, taking into account the height and circumference of the gland.

Symptoms and Signs

Due to fetoplacental blood and a large volume of maternal estrogens in children, including girls, transient gynecomastia may develop after birth. This phenomenon is characteristic of a large part of newborns; over time, the pathology goes away on its own.

The pubertal transient form of the disease, as a natural phenomenon, is observed in 35-85% of boys during puberty. At this age, guys usually have a minimal, slightly noticeable enlargement of the mammary glands. Bilateral enlargement is usually noted; in the case of unilateral education, the asymmetry can be quite strong.

The reasons for this form of gynecomastia are not fully understood. It has been found that during puberty, the production of estrogen is higher than testosterone, this contributes to hormonal imbalance. There is an opinion that the ratio of gonadotropins and PRL is to blame. Since the secretion of FSH is released when the secretion of FSH increases, the number of testicular cells increases, and the secretion of LH reaches the "male" level only after 2 years. In this case, a slight overgrowth of the milk ducts occurs. Of course, this causes mental discomfort and anxiety in the young man: instead of the desired maturity, feminization occurs. The young man tries to hide gynecomastia, avoids sports, hesitates to undress in front of his peers. As a rule, after 6-18 months, all symptoms disappear spontaneously.

The juvenile form of the disease can be hereditary, but fathers often forget about the presence of such disorders in their past, which complicates the collection of anamnesis. Usually, no treatment is required during puberty, you just need to wait a bit.

At this age, only with persistent gynecomastia, breast enlargement persists. Moreover, this form practically does not lend itself to conservative therapy and often requires surgery. According to statistics, approximately 1/3 of adults of the stronger sex have gynecomastia, manifested by the proliferation of the ducts of the mammary gland and stroma. This is due to the impact of environmental, pathopharmacological and other factors.

Brief interesting data
- Lenehin first described gynecomastia in 1771.
- The disease got its name from two Latin words gyne - woman and mastos - breast.
- During puberty, gynecomastia is observed in 50 - 70% of adolescents and up to 70% of older men.

Often, doctors do not pay enough attention to the problem of the disease, which leads to late treatment and the formation of large nodes. This causes great discomfort for young men and can even lead to suicide attempts. The operation does not help to eliminate the defect and does not help to mask the anomaly. Since postoperative scars often provoke increased interest in women in the future. Against this background, the development of depression is possible. Often, the clinic of gynecomastia is supplemented by violations of sexual development - testosterone is produced inappropriately for age, delay or, conversely, premature development of the penis and testicles, obesity, the formation of a eunuchoid phenotype or feminization.

Severe complications are expressed in the development of a female type, an unnatural distribution of subcutaneous adipose tissue and supination of the forearms. This is due to the defeat of the central part of the regulation of the reproductive system.

Complications

Gynecomastia, untreated for more than a year, can undergo fibrosis (scarring), making drug therapy difficult. Also, the disease can leave serious psychological consequences and contribute to the emergence of an inferiority complex.

The most dangerous complication is the degeneration of gynecomastia into cancer. According to statistics, 20-60% of cases of malignant breast tumors in men are formed against the background of the disease.

After surgical intervention possible signs such as skin tears, breast asymmetry, infectious complications, scarring or scars. Serious disorders requiring reoperation are extremely rare.

Overweight men of mature age may develop insufficient blood supply after removing a large amount of tissue, which leads to necrosis of the nipple. His sensitivity, when changing the usual position, sometimes decreases or completely disappears.

Causes of the disease

The formation and work of the mammary glands is influenced by estrogens, androgens, prolactin, growth hormone, pituitary gonadotropic hormones. They consist of two sections: secretory and interstitial.

Allocate interstitial transformation with the deposition of fat cells, proliferation of connective tissue and parenchymal with proliferation of milk ducts. The first type is associated with the influence of testosterone, estrogen and progesterone. The second form is prolactin, since there is an excessive production of prolactin.

Studies have shown that the condition of the mammary glands in women is affected by the same hormones as in men. Gynecomastia is accompanied by an increased accumulation of estradiol in the body. Long-term disease leads to fibrosis and hyalinization of the gland tissue.

Gynecomastia is a pronounced symptomatic manifestation of absolute or relative hyperestrogenemia. Estrogens are produced in the body of any healthy man, but an increase in their secretion or exogenous administration is a pathology. The role of the hormone prolactin in the development of gynecomastia is not fully understood, but nevertheless, we must not forget that it increases the sensitivity of target organs (kidneys, liver, etc.).

During pregnancy, as in the fetus, the conception of the mammary glands will take place, due to a set of sex chromosomes, it is he who can be the result of sensitivity to hormonal influences.

From all that has been said, we can conclude that the causes of gynecomastia may lie in an increase in the production of estrogens and PRL, impaired metabolism of estrogens, androgens in the liver, increased tissue sensitivity to them, functional hyperprolactinemia, regular contact with drugs containing estrogens or blocking androgens.

Some diseases of organs and systems can contribute to the development of gynecomastia: liver cirrhosis, hyperthyroidism, trauma chest or its defeat by herpes infection, adrenal tumor, diabetes, pulmonary tuberculosis, renal and hepatic failure, HIV infection.

Diagnostics

Lump and nodules of the mammary gland can be detected by palpation, which is very painful. At the same time, their consistency, symmetry, size are assessed. Also, with the help of probing, an increase in lymph nodes, the condition of the nipples, their displacement and mobility, adhesion with other tissues are diagnosed. Gynecomastia is often accompanied by secretion from the nipple, which is usually serous colostrum, and profuse galactorrhea rarely develops.

First of all, the doctor tries to determine false gynecomastia or true, pathological or physiological. He will definitely clarify how long ago the breast began to grow and whether the process is progressing. The development of symptoms of erectile function, hypogonadism, fertility and sexual desire are revealed. Diagnostics includes the determination of the location of the subcutaneous fat, the nature of hair growth and tone of voice, examination of the genitals.

It is necessary to take tests for the level of hormones in the blood: PRL, LH, testosterone, FSH, TSH, estradiol, hCG. It is also necessary to examine creatinine, liver enzymes and evaluate the results of a chest and breast x-ray (mammography), in some cases ultrasound of the testicles is indicated. Patients with incomplete puberty undergo CT or MRI of the adrenal glands.

Treatment

Gynecomastia should be treated by an endocrinologist or mammologist.

First of all, it is necessary to establish and eliminate the cause of the disease. For example, if gynecomastia is a consequence of taking a drug, it is enough to cancel it or replace it with another.

Usually, up to 6 months, the disease is simply monitored and an independent regression is expected. If it does not occur, then they try to get rid of the enlargement of the mammary glands with the help of hormonal treatment: clomiphene, testosterone, tamoxifen and danazol. Gynecomastia in adolescents is usually treated with bromocriptine. Aevit and vitamin B1 are also shown.

Surgical removal (mastectomy) is carried out only in case of a pronounced cosmetic defect, if there is a suspicion of the development of cancer or in the absence of a result from conservative treatment. Mammoplasty helps remove breast tissue to form a bed under the nipple to prevent retraction.

Prevention

Prevention of the disease consists in the careful selection of medications, refusal from anabolic steroids, leading a healthy lifestyle without drugs, alcohol and overeating and excluding the causes that can provoke gynecomastia. Treatment should be started as early as possible, since the longer the course, the higher the likelihood of becoming cancer... A man's diet should be dominated by wholesome and plant foods.

Traditional methods of treatment

At home, the patient must follow all the doctor's recommendations. Unfortunately, folk remedies are powerless in the treatment of gynecomastia. In order to normalize the psychological background, you can brew sedative herbs or use them in tincture (motherwort, peony, valerian).

Nowadays, this pathology has become widespread among men of different ages. During gynecomastia, the diameter of the mammary glands can increase from 1 to 15 centimeters, which is often accompanied by pain, discomfort, and some other complaints.

Sometimes the disease disappears on its own, after a certain period of time. If this does not happen, doctors resort to conservative treatment or surgery.

Causes of gynecomastia in men - at what age does pathology most often occur?

The main reason for the ailment in question is an imbalance of male and female hormones in the body. Several factors can provoke a similar phenomenon:

1. Diseases of the male genital organs, against which there are disruptions in the production of testosterone

These pathologies can be congenital or acquired in nature:

• Absence of one / two testicles in a newborn.
• Abnormalities in testosterone processing.
• Klinefelter's syndrome, in the course of which there are sexual dysfunctions.
• Injury to the testicles.
• Infection of the genitourinary system.
• Violation of blood circulation.
• Malignant neoplasms on the testicles.

2. Increase in the level of estrogen in the blood

This pathology can be provoked by the following ailments:

• Tumor damage to the lungs.
• True hermaphroditism.
• Some forms of adrenal cancer (carcinoma, adenoma).
• Choriocarcinoma.
• Pathological neoplasms in the testicular area.

3. Errors in the work of internal organs

• Serious chronic disorders associated with the functioning of the kidneys, liver (cirrhosis, hepatitis, intoxication). Such diseases negatively affect the state of male sex hormones: they are not capable of utilization, and over time they are transformed into estrogens.
• Improper nutrition, regular malnutrition.
• Pathologies of the thyroid gland, pituitary gland, which affect hormonal levels.
• Obesity.

4. Taking some medications, which in the future may provoke gynecomastia (as a side effect)

• Diuretics: veroshpiron.
• Preparations for normalization blood pressure: amlodipine, nifedipine, kapoten, enap.
• Antimicrobial and antifungal medicines: metronidazole, isoniazid.
• Medicines used for gastrointestinal pathologies: omeprazole, cimetidine.
• Substances that affect the psyche: antidepressants, amphetamines.
• Certain essential oils (lavender, tea tree).
• Drugs that are used in the treatment of HIV-infected.

Why is gynecomastia dangerous - all the risks and complications

This pathology is dangerous with the following phenomena:

• Firstly this disease negatively affects the psyche and behavior of the patient. In cases where there is a slight increase in the breast, patients often react neutrally to the defect. However, with pronounced symptoms, especially when it comes to adolescents, complexes form in boys, which do not always disappear even after the elimination of the disease. Therefore, it is very important to start treatment on time to minimize the risk of developing mental trauma.
• With prolonged (about a year) neglect of the ailment in question, connective tissue proliferates. In the future, this may lead to the fact that conservative therapy will be ineffective, and the only way out in this situation is surgical intervention. The postoperative period with gynecomastia can be fraught with various exacerbations.
• If the patient does not take any measures to eliminate this pathology, over time it can develop into a more serious disease - breast cancer.

Symptoms of gynecomastia in men - types of gynecomastia

Based on the location, the disease in question is:

• One-sided. Defective processes affect one breast. The second mammary gland functions normally and does not change.

• Bilateral. It occurs 3 times more often than unilateral gynecomastia and is characterized by symmetrical deformation of both mammary glands.

Depending on the age at which this ailment is diagnosed, the following types of gynecomastia are distinguished:

• Gynecomastia of newborns

It is present in almost every baby and is a consequence of the ingress of the mother's hormones into the fetal circulatory system. Often no treatment measures not required - the pathology disappears on its own in 14-30 days after the birth of the baby.

With the type of gynecomastia under consideration, the mammary glands slightly increase, become rough to the touch. Sometimes there are complaints about the appearance of cheesy discharge from the nipples.

• Gynecomastia during puberty

This defect occurs in every second undergrowth as a result of hormonal changes in the body. During these changes, the amount of female sex hormones exceeds the level of testosterone. Usually, at the end of puberty, everything returns to normal.

• Gynecomastia of the elderly

The most common type of gynecomastia that occurs in men after their 50s. Again, the culprit here are male sex hormones, which with aging cease to be produced in sufficient quantities. A similar phenomenon provokes an imbalance of testosterone and estrogen in the blood.

If gynecomastia is due to age-related changes (except for the neonatal period), the symptoms of the disease will be as follows:

• Growth of the mammary gland from 2 to 15 cm in diameter.
• Enlargement of the nipple, areola (up to 30 mm), change in their color.
• Unpleasant sensations when wearing clothes.
• Hypersensitivity in the nipple area.

If gynecomastia occurs against the background of pathological neoplasms, the overall picture will be supplemented by the following symptoms:

• Pain in the chest area.
• Rapid increase in the size of the mammary glands.
• Complaints of discomfort associated with distention in the area of \u200b\u200bthe defect.

If the ailment in question has developed due to the accumulation of prolactin in the pituitary gland, the following disorders will occur:

• Malfunctions of the central nervous system.
• Impotence.
• Decrease in the number of motile sperm.

Sometimes breast enlargement occurs as a result of the accumulation of fat cells in the breast area. In such cases, they talk about false gynecomastia (pseudogynecomastia) ... Often, a similar pathology is diagnosed in people who are obese.

Diagnosis of gynecomastia in men

For an accurate diagnosis, the following activities are performed:

1. Collecting information about the patient's life

In the process of this procedure, the following is specified:

• The fact of the presence of hereditary pathologies.
• Information about drug and alcohol addiction.
• Dynamics of breast enlargement.
• Whether the patient has been taking medication for a long time.

2. Physical examination of the patient's condition

Includes several manipulations:

• Examination of the breasts and genitals.
• Feeling of the abdomen.
• The quality of development of secondary sexual characteristics.

This type of research involves consultation with an endocrinologist.

3. Laboratory methods gynecomastia research involves the delivery of such tests:

• ... It is needed to determine the level of bilirubin, creatinine, ALT and some other indicators.
• The study of the hormonal background.
• Checking the quantitative composition of thyroid hormones.
• Testing blood for the level of prostate-specific antigen.

4. Instrumental diagnosis of this male disease may include:

• Ultrasound of the mammary glands. It makes it possible to establish the nature of the pathology (true or false gynecomastia).
• An ultrasound examination of the axillary lymph nodes is performed when there is a suspicion of cancer. For the same purpose, a biopsy of the mammary glands can be prescribed.
• Computed tomography of the adrenal glands, MRI of the pituitary gland is prescribed for poor blood counts for hormones. Such research methods are required when there is a suspicion of the presence of a malignant tumor, respectively, in the adrenal glands or the pituitary gland.
• Ultrasound of the scrotal organs. Carried out to exclude / confirm testicular cancer.

The patient must undergo an ultrasound examination of the thyroid gland.

All treatments for gynecomastia in men - when is surgery necessary?

The tactics of therapeutic measures for the ailment under consideration provides for the elimination of the reasons that provoked its occurrence:

• If gynecomastia is the result of severe overeating after a long hunger strike, the ailment disappears by itself after adjusting the diet.
• For the treatment of pathology in adolescents, hormonal drugs are used: danazol, tamoxifen, etc.
• With hormonal imbalance, medications are used that block the effect of female sex hormones on the mammary glands. It is possible to increase the amount of male sex hormones through injections of testosterone replacement mixtures (omnadren, sustanon).
• If the ailment has formed against the background of taking certain medications, after they are canceled, the modified male breast gradually returns to normal. No additional therapy is usually needed for this.

Surgical intervention for gynecomastia is required in the following cases:

1. Drug therapy was unsuccessful.
2. The specified pathology was provoked by a pathological neoplasm. In this case, surgeons resort to

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Gynecomastia is an enlargement of the mammary gland in men due to the growth of glandular or adipose tissue, caused by hormonal imbalance in organism. Gynecomastia is manifested by an increase in the size and compaction of the breast, an unpleasant feeling of heaviness and soreness when probing. In some cases, breast augmentation is physiological and can go away on its own without any treatment. In other cases, conservative therapy is performed. If conservative treatment is ineffective or the person is not satisfied with the aesthetics of their own body, a surgical operation is performed during which tissue is removed breast completely.

Brief description of gynecomastia

The name of the disease "gynecomastia" is derived from two Latin words - gynes (woman) and mastos (chest). That is, the literal translation of the term "gynecomastia" is a woman's breast, which is quite consistent with the main external manifestation of the essence of the disease. After all, gynecomastia is a benign increase in the size of the mammary glands in men. Simply put, the stronger sex grows female breasts.

Breast enlargement can occur due to the proliferation of ducts and glandular tissue or due to fatty deposits. If the breast is enlarged due to the growth of glandular tissue, then gynecomastia is considered true, and the increase in breast volume due to fatty deposits is false gynecomastia.

The severity of breast augmentation can be different - from 1 to 10 cm, and involve one or both mammary glands. Symmetrical lesion of both mammary glands at the same time is more common, an increase in only one breast with gynecomastia is quite rare. Enlarged mammary glands with gynecomastia usually look like slightly drooping female breasts of a small size.

The development of gynecomastia of any type is based on an imbalance of sex hormones with a predominance of estrogens. That is, any diseases medications, drugs and other items that can lead to the fact that estrogen in a man's body will be more testosterone can cause gynecomastia.

The fact is that the predominance of estrogens leads to the fact that they begin to affect the tissues sensitive to them, which include the ducts of the mammary glands. Under the influence of estrogens, the breast tissue, which is in its infancy in men, begins to actively grow, forming the breast. That is, there is a process similar to what is happening in the body of young girls during puberty, when their breasts begin to grow, the pelvic bones increase, etc.

Normally, breast formation does not occur, since the estrogens present in the man's body do not have an activating effect on the breast tissue for two main reasons. Firstly, there are very few estrogens, so their effect on the glandular tissue of the breast is not able to remove the latter from the embryonic state in which it is located. Secondly, estrogens are suppressed by a large amount of testosterone, which is produced in the male body and determines the characteristic sexual characteristics. But if for some reason the amount of estrogens increases, and they begin to prevail over testosterone, then the growth of tissues that are normal in the male body in an embryonic state is activated. As a result, the feminization of the man occurs, that is, female sexual characteristics appear, which include the breast.

Thus, gynecomastia develops if estrogen prevails over testosterone in a man's body. Moreover, the reason for the hormonal imbalance is not important, since gynecomastia is triggered precisely by an increase in the content of estrogen relative to testosterone.

During gynecomastia, there are three successive stages, such as proliferating, intermediate and fibrous... At the stage of proliferation, the process of proliferation of ducts and glandular tissue of the mammary gland takes place, which lasts an average of 4 months. Further in the intermediate stage, lasting 4 - 12 months, the maturation of the mammary gland occurs. In the fibrous stage, dense connective tissue and fatty deposits appear in the mammary gland, which completes the complete formation of the organ. Accordingly, during the first 4 months, a person notices that his breasts are growing, and then fixes its compaction.

Treatment for gynecomastia can be conservative and surgical. In all cases, they first resort to conservative therapy, which allows you to stop the progression of the process and, in many situations, achieve complete "resorption" of the already formed breast. Surgical treatment of gynecomastia is performed only if there is a tumor mass in the breast or man not satisfied with the appearance of the chest for aesthetic reasons. In the presence of a tumor in the mammary gland, surgery for gynecomastia is mandatory. But operations to remove breasts for aesthetic reasons are not always performed, since in many cases the appearance of the chest after surgery may be even worse than before.

Conservative treatment, started in the proliferating stage, allows you to achieve complete involution and disappearance of the breast, since all changes are still reversible. Conservative treatment is initiated at an intermediate stage, lets just stop the progression of the process, but to achieve the reverse of involution and disappearance have grown breasts is possible only in rare cases. Conservative treatment at the fibrous stage also only allows you to stop the progression of the process, but it is impossible to achieve with its help the disappearance of the breast under any circumstances. This means that in order to eliminate the formed breast, it will be necessary to resort to surgery, during which the glandular and adipose tissue is removed.

Gynecomastia - photo

This photograph shows a young man with gynecomastia before surgery (left) and after removal of the breast (right).

This photograph shows a man with severe gynecomastia.

Classification and characteristics of the varieties of the disease

Currently, depending on the nature of the causative factor and the type of tissues that form the overgrown mammary gland, gynecomastia is divided into four main types:
1. Physiological gynecomastia;
2. True gynecomastia;
3. False gynecomastia;
4. Idiopathic gynecomastia.

Some scientists and doctors distinguish only two main types of gynecomastia - true and false, while physiological and idiopathic are classified as true variants. However, in world practice, the above classification is used. We consider these differences between the classifications to be not fundamental, since regardless of whether idiopathic and physiological gynecomastia are included in the true ones or are distinguished into separate varieties, their essence and characteristics are unchanged. To avoid classification confusion, we will consider the characteristics of all types of gynecomastia in separate subsections with corresponding names.

Physiological gynecomastia

Physiological gynecomastia is a variant of the age norm, in which there is an overgrowth of glandular tissue and mammary ducts. It is not a sign of any disease, it goes away on its own, as a result of which it does not require special treatment. Physiological gynecomastia occurs in males during the age periods in which hormonal changes occur.

So, there are the following options for physiological gynecomastia that occur at different age periods in males:

• Gynecomastia of newborns;
• Gynecomastia in adolescents (pubertal);
• Senile gynecomastia.

Gynecomastia of newborns appears in infants-boys of the first days of life and goes away on its own within 2 - 4 weeks. Usually, gynecomastia is observed in 60 - 80% of newborn boys and is caused by the effects of maternal estrogens, which penetrate to it through the placenta. When all the estrogens that have entered the baby's blood from the mother's body during pregnancy are utilized, gynecomastia will disappear, and the mammary glands will involution, turning into completely flat formations with protruding small nipples.

Gynecomastia in adolescents also called pubertal, because it occurs at puberty, in which the child's puberty occurs and cardinal hormonal changes are noted. In boys aged 12-15 years, gynecomastia is observed in 30-60% of cases, and, as a rule, both mammary glands are enlarged. But in rare cases, gynecomastia affects only one breast. The resulting asymmetry is very noticeable. Sometimes a whitish fluid is released from the nipples of enlarged breasts.

This type of gynecomastia is a variant of the age norm, it goes away on its own within 1 - 2 years and does not require treatment. However, if after 2 years the gynecomastia has not passed, then it is called persistent, is considered pathological and, accordingly, requires treatment.

Unfortunately, the exact causes of adolescent gynecomastia have not yet been established. But we know that in the early stages of puberty in boys, estrogens are produced in larger quantities compared with testosterone, which is the triggering factor for the development of the time gynecomastia. While estrogens prevail over androgens in the body of a young man, he will have gynecomastia. But when the balance of hormones returns to normal, involution will occur and the grown breasts will subside.

In principle, teenage gynecomastia is not a pathology, but may cause serious psychological and sexual disorders in a teen who experiences fear because of the "wrong" appearance. Therefore, a boy with gynecomastia needs psychological help and moral support for the entire period until his body returns to its normal state. However, parents should remember that if a boy has no other signs of puberty against the background of gynecomastia (growth of hair on the body, armpits, pubis, voice changes, etc.), then breast augmentation is a symptom of severe endocrine diseases, such as hormone-producing tumors of various localization.

Senile gynecomastia develops in men aged 55 - 80 years due to a decrease in testosterone production. Due to a decrease in testosterone levels, estrogens begin to prevail, as a result of which gynecomastia develops. Usually, both breasts are enlarged. The involution of senile gynecomastia is rare, but this condition is a variant of the norm, so it is almost never treated.

False gynecomastia

False gynecomastia is also called pseudogynecomastia or adiposomastia... With false gynecomastia, the enlargement of the mammary glands occurs due to the deposition of fat under the skin in the areola of the nipple. The difference between false gynecomastia from all its other types (true, physiological and idiopathic) is an increase in the mammary glands due to the deposition of fat. And in other types of gynecomastia, an increase in mammary glands occurs due to the growth of glandular tissue and ducts.

As a rule, false gynecomastia develops against the background of general obesity and can be significantly expressed.

True gynecomastia

True gynecomastia is an enlargement of the mammary glands due to the growth of glandular tissue and ducts, is a pathology and requires treatment. True gynecomastia develops when estrogen prevails over androgens in a man's body. However, hormonal imbalance is only a triggering factor and providing necessary conditions for the growth of glandular tissue and breast growth. Accordingly, the causes of gynecomastia are factors that cause hormonal imbalance. And the reasons causing hormonal imbalance with the prevalence of estrogen levels over androgens are very diverse, and therefore the range of factors that can lead to true gynecomastia is wide.

It has now been found that the causes of true gynecomastia can be the following factors:

• The production of large amounts of estrogen by hormonally active tumors of the testicle, liver or lungs (for example, germinomas, leydigomas, etc.);
• Insufficient utilization of estrogens in the liver in severe diseases of this organ (for example, in cirrhosis, chronic hepatitis, etc.);
• Taking medications that increase estrogen and suppress testosterone production (for example, anabolic steroids, glucocorticosteroids, estrogen medications, cardiac glycosides, drugs, ACE inhibitors, calcium channel blockers, Spironolactone, Furosemide, Diazepam, Reserpine, Theophylline, and dr.
• Hyperthyroidism ( elevated level thyroid hormones in the blood) or hypothyroidism (decreased levels of thyroid hormones in the blood);
• Androgen deficiency due to underdevelopment of the genitals in genetic diseases (Klinefelter syndrome, Reifenstein, etc.);
• Testicular feminization syndrome;
• Hermaphroditism;
• Prostatitis;
• Diseases of the adrenal glands;
• Obesity;
• Acromegaly;
• Hypogonadism;
• Disruption of the testicles due to injury, orchitis, infectious diseases or exposure to ionizing radiation;
• Castration;
• Brain damage (consequences of traumatic brain injury, Parkinson's disease, syringomyelia, epilepsy, meningoencephalitis, Friedreich's disease, pituitary tumors, etc.);
• Continuous use of plasmapheresis against the background of chronic renal failure.

Idiopathic gynecomastia

Idiopathic gynecomastia is a variant of true gynecomastia in which it is not possible to find out the cause of the disease.

Gynecomastia in women

Strictly speaking, gynecomastia in women does not exist, since this term refers exclusively to breast growth in men. But in everyday life, the phrase "gynecomastia in women" usually means an increase in the mammary glands at different periods of life. The fact is that breast growth in girls at the stage of puberty does not scare anyone, but the increase in mammary glands in other periods of life causes concern and is called "gynecomastia".

However, it is wrong to call breast growth in women gynecomastia. Indeed, in women during their lives, fat is deposited in the mammary glands, connective tissue grows, the number of glands increases during pregnancy, which can lead to natural breast enlargement. It is such completely normal and physiological processes that are unreasonably and incorrectly called "gynecomastia". But women should remember that they don't have gynecomastia.

Representatives of the fair sex have completely different diseases of the mammary glands, which in no way correlate with breast growth, so you should not be afraid of just an increase in breasts that are not combined with any other symptoms of ill-being in the body. And too large a breast size in women is not called gynecomastia, but hypertrophy.

Gynecomastia - causes

So, the following factors can be the causes of true and idiopathic gynecomastia:

1. Tumors localized in the testes, liver, lungs.

2. Breast tumors.

3. Severe liver disease (cirrhosis of the liver, chronic hepatitis).

4. Chronic renal failure with regular hemodialysis.

10. Congenital dysfunction of the adrenal cortex.

11. Fasting dystrophy or obesity.

12. Exposure to radiation.

13. Disorders of the hypothalamus (dysregulation of the adenohypophysis, etc.).

14. Diseases in which the function of the pituitary gland is impaired:

• Hypogonadism;
• Acromegaly;
• Itsenko-Cushing's syndrome;
• Tumors of the pituitary gland (adenoma, prolactinoma, etc.);
• Increased intracranial pressure.

15. Disruption of the brain structures that regulate the production of hormones:

• After traumatic brain injury;
• Against the background of parkinsonism;
• Against the background of epilepsy;
• Against the background of syringomyelia;
• After meningoencephalitis;
• Against the background of Friedreich's disease.

16. HIV infection.

17. Leprosy.

18. Abrupt cessation of sports activities against the background of previous intense training.

19. Active nutrition after a long period of abstinence from food.

20. Chest injury.

21. Herpes zoster in the chest area.

22. Alcohol and drug abuse, especially opium, methadone, heroin and marijuana.

In addition, gynecomastia can be triggered by taking the following medications:

• Estrogens (Estrace, Gynodiol, Alora, Esclim, Senestin, Premarin, Estratab, combined oral contraceptives);
• Antiandrogens (Buserelin, Flutamide, Finasteride, Androkur, etc.);
• Gonadotropin preparations (for example, Chorionic gonadotropin, etc.);
• Testosterone preparations with long-term use (Testosterone propionate, etc.);
• Anabolic steroids (Methandrostenolone, Phenobolin, etc.);
• Glucocorticosteroids (Prednisolone, Dexamethasone, etc.);
• Spironolactone (Veroshpiron, Aldacton, Urakton, etc.);
• ACE inhibitors (Enalapril, Perindopril, Lisinopril, Captopril, etc.);
• Calcium channel antagonists (Nifedipine, Verapamil, Amlodipine, etc.);
• Cardiac glycosides (Digoxin, Korglikon, Strofantin, etc.);
• Anti-tuberculosis drugs (isoniazid);
• Tricyclic antidepressants (Imipramine, Amitriptyline, Doxepin, etc.);
• Benzodiazepines (Phenazepam, Diazepam, etc.);
• Proton pump inhibitors (Omeprazole, Ranitidine, Cimetidine);
• Antineoplastic drugs (Vincristine, Mielosan, etc.);
• Tranquilizers (Hydroxyzine, Benaktizin, Buspirone, Meprobamate, etc.);
• Antipsychotics (Risperidone, Sulpiride, Tiaprid, Azaleptin, etc.);
• MAO inhibitors (Iproniazide, Nialamide, Fenelzine, Eprobemide, Moclobemide, etc.);
• HIV medications (Amprenavir, Empricitabine, etc.);
• Amiodarone;
• Busulfan;
• Methyldopa;
• Penicillamine;
• Rauwolfia;
• Reserpine;
• Theophylline;
• Phenytoin;
• Phenothiazine;
• Ethionamide.

Gynecomastia caused by medication is not pathological and resolves on its own after stopping the use of the drug, which provoked the growth of the mammary glands in men.

Gynecomastia - signs

The main symptom of gynecomastia is the enlargement of the mammary glands so that they look like small breasts of women. With gynecomastia, the mammary glands can increase from 2 to 15 cm in diameter. At the same time, according to the size of the mammary glands, the diameter of the areola of the nipple also increases, expanding to 3 - 4 cm. The pigmentation of the areola increases.

When palpating, the mammary glands can be dense, with nodular formations inside. Also, when feeling the breast, there may be a slight soreness. The overgrown breast tissue is tightly fixed to the pectoral muscles and skintherefore, attempts to move the seal to either side or pull the skin over them are useless. In rare cases, colostrum-like fluid is released from the nipples of gynecomastia. Also, sometimes men feel a feeling of pressure in the mammary glands and discomfort when clothes rub against their nipples.

In the clinical course of gynecomastia, there are three successive stages:

• Stage I (proliferation) - lasts about 4 months and is characterized by a progressive increase in the size of the mammary glands. At this stage, all changes are reversible, and if you start conservative treatment, you can achieve complete "resorption" of the grown breast in all cases.
• Stage II (intermediate) - lasts 4 - 12 months and is characterized by the maturation of the grown breast tissue. At this stage, the changes are difficult to reverse, therefore, conservative treatment rarely makes it possible to achieve involution of the already grown breast.
• Stage III (fibrous) - lasts a long time and is characterized by the proliferation of connective tissue and fatty deposits in the mammary gland. At this stage, the changes are irreversible, and conservative treatment allows only to stop the progression of the disease, but it is impossible to achieve involution of the grown mammary glands with its help.

The signs of gynecomastia are the same at stages 2 and 3, and at the first stage they differ in that the mammary glands progressively increase in size.

Depending on the size of the mammary gland, gynecomastia is divided into weak, moderate and expressed... To determine the size of gynecomastia, the circumference of the mammary gland and its height are measured, after which the index is calculated. If this index is less than 6, then gynecomastia is weak, index 6 - 10 - moderate gynecomastia, index more than 10 - pronounced.

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Treatment

General principles of therapy

Physiological gynecomastia is not treated because it goes away on its own after the normalization of hormonal balance in the body. Fatty gynecomastia does not require treatment, since it is completely safe, and therefore its therapy is carried out only at the insistence of the patient, who wants to eliminate the grown mammary glands for aesthetic reasons. In this case, a liposuction operation is performed, during which the fatty tissue is removed and the breast takes on a normal shape.

For the treatment of pathological and idiopathic gynecomastia, conservative and surgical methods are used. Conservative treatment should be comprehensive and aimed at simultaneously eliminating the underlying disease that provoked gynecomastia and stopping the effects of estrogens. Often, when the underlying disease cannot be treated (for example, taking medications, etc.), gynecomastia is treated with drugs that suppress the effects of estrogens. Surgical treatment is resorted to only if conservative therapy was ineffective within 2 years of its implementation, and the person insists on the complete removal of the grown mammary glands for cosmetic reasons.

If gynecomastia is caused by a tumor formation in the mammary gland, then the only method of therapy is used - an operation to remove the neoplasm.

It is strictly forbidden to squeeze the mammary glands with tight bandages in order to stop the growth of the breast, since this is not only ineffective, but also dangerous due to impaired blood flow.

Conservative treatment without surgery

If gynecomastia is caused by a high level of estrogen, then antiestrogen drugs such as Tamoxifen, Clomiphene, Danazol are used to treat it. In addition, in addition to antiestrogens, drugs of the aromatase inhibitor group are used for therapy, such as Testoplactone or Thiamine bromide. In addition to drugs that suppress the activity of estrogens, injections of vitamin B 1 and Aevita are used in periodic courses of 20 days each. Both antiestrogens and aromatase inhibitors are used in long courses for a maximum of 2 years. If, after 2 years, a satisfactory result of conservative therapy has not been obtained, then surgical treatment of gynecomastia is performed.

If gynecomastia is due to a partial androgen deficiency, then testosterone and chorionic gonadotropin drugs are used for treatment in combination with Halidor. In addition, to enhance the effect of hormonal drugs, it is possible to additionally include drugs that improve cerebral circulation (Cavinton, Cinnarizin, Actovegin, etc.), vitamins and metabolites (vitamin B 6, ATP, glycine, etc.) in the complex treatment.

Gynecomastia Removal Surgery

The operation to remove gynecomastia is performed only in case of ineffectiveness of conservative therapy and, if the patient wishes, to remove the enlarged mammary glands. It should be remembered that the chest after the operation may look even worse than before it, therefore, when deciding on the surgical removal of the mammary glands, you should carefully consider and weigh everything. To maximize the likelihood of a successful outcome of the operation, it is necessary to carefully select a surgeon who has experience in performing such surgical interventions.

Currently, the following types of operations are performed to remove gynecomastia:

• Areola-sparing subcutaneous mastectomy. An incision is made in the area of \u200b\u200bthe areola, and through it, all the tissues of the overgrown mammary gland are removed, after which the skin is sutured, forming a beautiful outline of the chest. With this operation, the areola of the nipples is preserved, the scar is made invisible, which allows you to get a good aesthetic effect after surgical treatment.
• Subcutaneous mastectomy with liposuction. An operation similar to the one described above, but differing in that during the intervention, adipose tissue is removed. The operation is suitable for the treatment of false gynecomastia.
• Endoscopic mastectomy. The operation is performed using endoscopic equipment, during which all tissues of the enlarged mammary gland are removed. Since the operation is accessed through a puncture in the armpit, the scar is invisible and the nipple is preserved, which allows achieving excellent cosmetic results.

The choice of surgery is made by the doctor based on the individual characteristics of the person and the characteristics of gynecomastia.

After operation

After the operation to remove gynecomastia, it is necessary to wear shaping underwear for several days to form a flat breast surface and reduce excess skin. Since the operation does not delete the lymph nodes and muscles, then it is considered to be less traumatic, as a result of which, on days 2 - 3 after surgery, men are discharged from the hospital home. Complete healing of tissues after surgery occurs within 3 - 6 weeks, during which heavy physical activity, overwork, etc. After tissue healing, it is necessary to engage in physical exercises aimed at developing and restoring the functions of the pectoral muscles.

Cost (price) of surgery to remove gynecomastia

The cost of an operation to remove gynecomastia ranges from 40,000 to 120,000 rubles. The spread in prices is due to the policy of the management medical center and its form of ownership (private or public). However, when choosing a medical institution for the removal of gynecomastia, it is recommended to focus primarily not on the cost of the intervention, but on the reviews about the doctor who will perform the operation.

Which doctor should I contact for removal of gynecomastia?

To remove gynecomastia, it is recommended to consult a mammologist-surgeon, plastic surgeon or general surgeon. Unfortunately, in the CIS countries, surgeons have little experience in performing an operation to remove gynecomastia, therefore, surgical intervention can be performed with high quality at a high technical level, but with unsatisfactory cosmetic results, which should be taken into account at the decision-making stage.

Juvenile gynecomastia - description of when surgery is needed (surgeon's opinion) - video

Gynecomastia: Why Breast Removal Surgery? Risks and complications of gynecomastia. The opinion of a plastic surgeon - video

Gynecomastia: causes, mechanism of development, groups and risk factors, which doctor to contact, what are the diagnosis and treatment of the disease (the opinion of a mammologist) - video

Before use, you must consult with a specialist.

The pathology of the mammary glands with unilateral or bilateral increase in size caused by hypertrophy of glandular or adipose tissues in medicine is called gynecomastia.

It is manifested by an increase, thickening of the gland, accompanied by a feeling of heaviness and pain on palpation. Regress on their own, with the ineffectiveness drug therapy requires surgical treatment.

With the long-term existence of the disease, there is a risk of developing a malignant tumor of the mammary glands in a man. The mammary glands with gynecomastia reach from two to ten centimeters in diameter. The frequency of occurrence is: in adolescents 14-15 years old - from 50 to 60%, in young men - about 50%, in elderly men - from 60% to 70%.

What it is?

Gynecomastia is a disease characterized by enlargement of the mammary glands in men. May occur in healthy newborn boys, during adolescence, and in older men. Such gynecomastia is called physiological, does not require any specific treatment and goes away on its own.

Sometimes there is a pathological type of the condition in question.

Classification

In accordance with the spread of hypertrophy, the following types of gynecomastia are distinguished:

• unilateral, in which only one breast enlarges;
• bilateral, characterized by the growth of both glands.

In medicine, the following forms of gynecomastia are distinguished:

1. True, which is manifested by the proliferation of stromal and glandular tissues. Feeling in the nipple area can reveal a seal.
2. False, which is also called lipomastia, occurs in obese men. It is not dangerous to health.
3. Mixed, in which both forms take place. There are two types of it: in the first case, glandular tissue predominates, in the second - adipose tissue.

In addition, gynecomastia can be diffuse and nodular. The first does not pose a health hazard and can quickly regress. But the presence of a nodular form can cause the development of breast cancer. Therefore, if a dense formation is found, the occurrence of discharge with an admixture of blood from the nipples, an increase in lymph nodes in the armpit area, it is necessary to urgently consult a doctor.

Causes of gynecomastia in men and adolescents

Gynecomastia occurs against a background of hormonal disorders, when the level of female sex hormones (estrogens) is significantly increased compared to the level of male sex hormones (androgens). In most cases, gynecomastia occurs in newborns - in 80% of cases. Swelling of the mammary glands in this case is associated with the action of the mother's estrogens, which entered the baby's body even in its intrauterine development. As a rule, gynecomastia in newborn boys disappears on its own by the age of one month.

if we consider gynecomastia as a symptom of a serious pathology, then it can appear in men with the development of the following diseases:

• choriocanceroma;
• bronchogenic lung cancer;
• true hermaphroditism;
• a tumor of the adrenal glands of a feminizing nature (adenoma or carcinoma);
• chronic renal failure;
• hyperthyroidism - increased thyroid function;
• hyperprolactinemia - a consequence of the pathology of the pituitary gland;
• malnutrition and hunger;
• cirrhosis of the liver;
• obesity;
• testicular pathologies that are accompanied by a decrease in testosterone production - for example, anorchia (absence of one or two testicles), Klinefelter syndrome, defects in testosterone synthesis, decreased blood flow in the testes, benign / malignant neoplasms, orchitis, mumps, and trauma.

In addition, the pathological condition under consideration can be a side effect of a number of drugs:

• Ranitidine, Omeprazole - antiulcer drugs;
• Dopegit is an antihypertensive drug;
• Nizoral, Metrid - antifungal agents;
• Veroshpiron - diuretic and antiandrogenic agent;
• tranquilizers - for example, Realnium or Seduxen;
• tea tree oil;
• Amlodipine, Verapamil - calcium channel blockers used to treat hypertension;
  Kapoten, Diroton - angiotensin-converting enzyme inhibitors, which are used to treat hypotension and heart failure;
  hormonal drugs for the treatment of prostate cancer;
  preparations for antiretroviral therapy with human immunodeficiency virus.

Gynecomastia pubertal (adolescent) can occur in boys between the ages of 12 and 14, due to temporary changes in hormone levels. As a rule, in this case, both breasts will increase, sometimes discharge from the nipples is observed. Usually, within a maximum of 2 years, the state of the hormonal background in a teenager stabilizes, and gynecomastia disappears on its own. There are cases when pubertal gynecomastia persists for more than 2 years - doctors will classify it as persistent.

In old age (50-80 years), gynecomastia is also physiological in nature, and its appearance is due to the fact that, due to age-related changes, the level of estrogens (female sex hormones) in men increases.

Symptoms and stages of gynecomastia

Based on the complaints of men, doctors distinguish a group characteristic features gynecomastia (see photo):

1. There are episodes when men notice a slight discharge from the nipples, similar to breast milk.
2. In men, libido decreases, sexual activity fades, the first signs of erectile dysfunction appear.
3. The timbre of the vocal cords changes.
4. The growth of hair, characteristic of the male type of hair growth, decreases.
5. The man becomes prone to depression and mood swings.
6. An increasing sensation of discomfort and heaviness in the area of \u200b\u200bthe mammary glands, accompanied by occasional slight itching and bursting in the chest.
7. Lack of painful sensations. Pain syndromeAs a rule, it is not marked.
8. A man may notice swollen and thickened areas in his breasts. Immediately from two sides or only one.
9. A sharp increase in breast size. Rapid growth up to 5–15 cm is possible, but gynecomastia with enlargement of glands of no more than 3–4 cm is more common.
10. In parallel with the growth of hypertrophy, expansion of the nipple areas may occur. At the same time, they acquire a dark shade and become more pronounced.

During gynecomastia, there are three stages:

1. Developing (proliferating) - initial changes, the first 4 months, when the reverse development of gynecomastia is possible with appropriate drug treatment;
2. Intermediate - characterized by the maturation of the glandular tissue; runs from 4 months to a year;
3. Fibrous - the appearance of connective and adipose tissues in the mammary gland is noted; regression pathological process almost impossible.

The appearance of bloody discharge from the nipple, lumps in the gland, changes in the skin of the gland, ulceration, enlarged axillary lymph nodes makes one suspect breast cancer.

Diagnostics

At an in-person appointment, the patient is probed the breast tissue and axillary lymph nodes. Based on palpation, the doctor can make a preliminary diagnosis, and to confirm it, he will prescribe additional diagnostic procedures to the patient:

• Mammography
• Breast biopsy
• Computed tomography of the adrenal glands

It is compulsory to take blood for laboratory research, which will determine the level:

• Testosterone
• Estradiol
• Luteinizing hormone
• Thyroid stimulating hormone
• Prolactin
• Chorionic gonadotropin

Patients can seek help from a therapist, surgeon, urologist and endocrinologist. Consultation of highly specialized specialists will allow you to develop a competent treatment strategy.

What does gynecomastia look like in men: photo

The photo clearly shows how gynecomastia manifests itself in men:

Complications

Gynecomastia that persists for more than 12 months can undergo scarring (fibrosis), which makes drug treatment extremely difficult.

Another complication of gynecomastia is psychological consequences, more often they occur in adolescents, if breast augmentation is the cause of inferiority complexes.

How is gynecomastia treated?

Physiological types of gynecomastia usually disappear spontaneously and do not require medical correction. Sometimes hormones may be prescribed to suppress high estrogen concentrations in adolescents with physiological gynecomastia. Treatment of pathological gynecomastia is determined by the underlying disease that caused the enlargement of the mammary glands.

Surgical treatment for gynecomastia is carried out in cases where conservative therapy is ineffective or it is obviously clear that drug treatment will not give the desired result (for tumor lesions).

Gynecomastia treatment without surgery

Only a doctor can prescribe medication for gynecomastia without surgery. Self-prescribing hormone replacement therapy is prohibited due to the possible aggravation of symptoms or side effects.

The treatment uses drugs that can be taken at home:

1. Testosterone or dihydrotestosterone - prescribed for patients with low levels of this male hormone (elderly men, adolescents).
2. Clomiphene is an antiestrogen that normalizes hormones.
3. Tamoxifen (Nolvadex) is a selective estrogen receptor modulator. It is prescribed for severe and painful forms of gynecomastia.
4. Danazol - a synthetic derivative of testosterone, lowers the production of estrogen by the testes. It is used extremely rarely in therapy.
5. Testolactone is a drug with antiestrogenic action.
6. Tamoxifen - Used to treat breast cancer.

You can also try folk remedies. The basic principle traditional medicine in the treatment of male gynecomastia - the use of plants that reduce the production of female hormones and stimulate the production of male hormones.

Means used by herbal medicine at home:

1. Ginseng root is a natural stimulant of testosterone synthesis. Eat a piece of root every day, chewing thoroughly and mixing it with your saliva. The tool does not have the most pleasant taste, but it effectively helps. Additionally, it stimulates potency.
2. Tincture for men's health - designed to regulate hormones, improve potency. Mix 50 g each of ginkgo biloba leaves, yohimbe bark, fresh oat straw with a liter of alcohol. Insist 2 weeks in a dark place, strain, store in the refrigerator. Take 30 drops 3-4 times a day for a course of 2 months.
3. Lovage - strengthens the body, improves digestion, treats hormonal disorders. The root of the plant contains phytosterol, which normalizes prostate function. Grind 100 g of lovage root, fill with a bottle of red wine, warm until foam appears, leave for 3 days. Strain, take 50 ml every evening one hour after dinner.
4. Herbal remedy for gynecomastia, weak potency, infertility. Combine 100 g of ginseng root, 50 g each of licorice root and raspberry leaves. Pour a tablespoon of the mixture with two glasses of boiling water, let cool, strain. Have a drink in the day. The course of treatment will be 2-3 months.

If a malignant process is diagnosed, an urgent operation is required.

Breast removal surgery

If conservative therapy does not bring the desired results, or in the case when it is already clear after the diagnosis is made that drug treatment will not lead to success, surgery is performed. It consists in excision of the breast and the subsequent restoration of its physiological contour.

The operation is indicated in such cases:

• significant increase in glandular tissue;
• pathology persists more than a year;
• too obvious cosmetic flaw.

For gynecomastia, the following types of mastectomies are performed:

1. Endoscopic, in which an incision is made in the armpit area. Most often it is performed with a slight breast augmentation.
2. Subcutaneous. A periareolar incision is performed, in which the areola is preserved.
3. Subcutaneous with liposuction procedure.

All kinds of operations are well tolerated by patients. As a rule, rehabilitation does not take a lot of time. True, in the first few days men have edema and hematomas, some patients feel a little discomfort in their chest.

The rehabilitation period for each patient is individual, but the final result can be observed 3 months after the operation.

After surgery, wearing a special slimming underwear is shown for 1.5–3 weeks - it helps to reduce the skin and helps to shape the muscle contour correctly. Even minimal physical activity must be excluded throughout the month.

Forecast

Gynecomastia of newborns and adolescents is characterized by a favorable course. In the postpubertal period, gynecomastia disappears within 2 years in 75% of young men, in the next 3 years - in another 15%.

The outcome in pathological forms of gynecomastia depends on the possibility of eliminating the cause of the disease. Prognostically, drug gynecomastia is more favorable, and gynecomastia caused by chronic diseases is less favorable.

Long-term course of gynecomastia increases the likelihood of breast cancer in men.