Gynecomastia is the abnormal non – cancerous condition of one or both breasts by which males develop breast tissue due to an imbalance of estrogen and androgen hormone activity. It is usually a benign disease but breast cancer can develop in about one percent of cases. Pseudogynecomastia is different from gynecomastia where there is an excess of skin and adipose tissue in the male breasts without the development of true breast glandular tissue. Pseudogynecomastia is commonly present in obese men.
In gynecomastia there is breast development in males can occur during three phases of life.
- The first occurs shortly after birth in both males and females. This is partly caused by the high levels of estradiol and progesterone produced by the mother during pregnancy, which stimulates newborn breast tissue. Another situation is due to the increased conversion of steroid hormone precursors to sex steroids. It can stay for several weeks after birth and can cause mild discharge in the breast called “witch’s milk”.
- Puberty marks the second situation where gynecomastia can occur physiologically. In fact, up to 60 percent of boys have clinically diagnosed gynecomastia by the age of 14. It is mostly bilateral, asymmetrical, and can occur unilaterally. Pubertal gynecomastia usually disappears within 3 years of onset. At an early age, the pituitary gland releases gonadotropins at night and stimulates testicular production of testosterone during the early morning. Estrogens rise throughout the whole day.
- The third situation in which gynecomastia is frequently seen in older age. Although the exact mechanisms by which this can occur have not been fully identical, evidence shows that it may result from increased peripheral aromatase activity.
SIGNS AND SYMPTOMS
Signs and symptoms of gynecomastia include:
- Swollen breast tissue
- Breast tenderness
- Pain or tenderness
- Nipple discharge in one or both breasts
Gynecomastia is catalyzed by a decrease in the amount of the testosterone hormone as compared with estrogen. Several things can interfere with the hormone balance, including the following.
Natural hormone changes
The hormones testosterone and estrogen control sex characteristics in both males and females. Testosterone controls male traits, such as body hairs and muscle mass. Estrogen controls female traits that include the growth of breasts. Most people think of estrogen as a female hormone, but men also produce it is normally small quantities. If male estrogen levels are too high or out of balance with testosterone levels can cause gynecomastia.
- Anti-androgen medicines used to treat prostate cancer, enlarged prostate, and other conditions
- AIDS medications.
- Anti-anxiety medications, such as diazepam
- Tricyclic antidepressants
- Ulcer medications, such as cimetidine
- Cancer treatment.
- Heart medications, such as digoxin and calcium channel blockers.
- Stomach-emptying medications, such as metoclopramide
- Street drugs and alcohol
- Amphetamines used to treat hyperactivity disorder
- Methadone (Methadose, Dolophine)
- Health conditions
- Hypogonadism- This condition interferes with normal testosterone production, such as Klinefelter syndrome or pituitary insufficiency can also be associated with gynecomastia.
- Aging – Hormonal changes that occur within normal aging can cause gynecomastia, especially in men who are overweight or obese.
- Tumor- Some tumors, like those involving the testes, pituitary gland or adrenal gland, can produce hormones that alter the male-female hormone balance.
- Hyperthyroidism – The condition in which the thyroid gland produces too much thyroid hormone called thyroxine.
- Kidney failure – People treated with dialysis have experience gynecomastia due to hormonal changes.
- Liver failure and cirrhosis – Changes in hormone levels related to liver problems and cirrhosis medications are associated with gynecomastia.
- Malnutrition and starvation – When the body is deprived of proper nutrition, the testosterone levels decrease while estrogen levels remain the same this causing hormonal imbalance. Gynecomastia can also occur when normal nutrition resumes.
- Herbal products – Plant oils, such as lavender or tea tree, used in shampoos, lotions, or soap have been associated with gynecomastia.
The risk factors for gynecomastia include:
- Older age
- Use of anabolic steroids
- Health conditions, like liver and kidney disease, hormonally active tumors, thyroid conditions, and Klinefelter syndrome.
The gynecomastia includes:
- Emotional problems
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There are a few factors that can control the risk of gynecomastia:
- Don’t use these drugs for example steroids and androgens, amphetamines, heroin, and marijuana.
- Avoid alcohol.
- If you are taking medication known to cause gynecomastia, stop that medicines and consult with your doctor to change this medication.
Dr. Vaidya Karanvir Singh is the younger Vaidya in Chandigarh Ayurved & Panchakarma Centre. He is the fourth generation in his family who is practicing as a general consultant in Ayurved & Panchakarma treatment at Chandigarh. In his practice, he had treated more than 1 Lakh Plus patients worldwide.