Gynecomastia is a condition of male breast enlargement due to disproportion of estrogen-to-androgen ratio. True gynecomastia is usually differentiated from excessive adipose tissue deposition with the firm consistency and its tenderness upon palpation. This condition can occur as a normal physiological process or pathologic conditions such as excessive oestrogen or androgen deficiency. Occasionally, some long term medications such as Spironolactone, Phytoestrogens, Digitalis or Ketoconazole can cause gynecomastia and it is reversible after stopping the medications.
Physiological gynecomastia happens in newborn due to transplacental transfer of oestrogen from mother to the baby, during the earlier stage of puberty where the oestrogen-to-androgen ratio is high, and in individuals who have a higher amount of fatty tissue with elevated aromatase activity. However, gynecomastia can sometimes be an indicator for a doctor to suspect for underlying diseases. Gynecomastia can be a characteristic feature such as Klinefelter syndrome, androgen insensitivity disorders, Sertoli cell tumour, Peutz Jeghers syndrome, congenital adrenal hyperplasia, hyperthyroidism, feminizing adrenal tumours, chronic liver disease and obesity. Hence, it is always good to be aware of your own health. If you are suffering from this problem, you can always book an appointment by DoctoronCall to get your health checked.
Around 2/3rd of the pubertal boys and half of the hospitalized men will have a certain extent of gynecomastia, thus detailed investigations will not be conducted unless the patient also present with other symptoms of relevant diseases. Furthermore, this enlargement will revert back to normal over several months once the primary causes are treated and controlled, so specific treatment for gynecomastia will not be needed in most of the case.
However, one’s mental health will be affected by this condition. They will lose their confidence because they are troubled with their physical appearance, eventually leading to severe anxiety or depression. On top of that, some men will suffer from severe pain from the proliferation of glandular tissues, impairing their daily activities even walking can be a source of pain. Studies revealed that there is a relatively higher risk for a man with gynecomastia to develop breast cancer than a normal man, although the absolute risk is very low. Therefore, if a man is suspected of breast cancer, severe psychological or cosmetic problem, or continued growth with tenderness, treatment has to be commenced to prevent further consequences.
There are two main treatment modalities which are surgery and medications. Surgery is the most effective resolution for patients with chronic gynecomastia. Surgical treatment is divided into two main techniques which are liposuction and mastectomy. In liposuction, the surgeon only removes the adipose tissue but not the glandular tissue whereas in mastectomy, the surgeon will remove the glandular tissue with small incisions. Some surgeons will choose to combine both techniques if gynecomastia is too severe.
In patients with painful gynecomastia and in whom surgery cannot be performed, anti-oestrogen medications such as Tamoxifen or Raloxifene can be prescribed by the physicians after a thorough examination. This group of medication is effective in reducing the pain and breast tissue size in over half of the patients, especially patients with prostate cancer who are receiving anti-androgenic treatment, but it is less likely to yield for a complete regression. In the earlier proliferative phase, physicians may prescribe aromatase inhibitor, Anastrozole to slow down the proliferation rate, but it is proved to be ineffective in men with established gynecomastia.