Endocrine disorders and hormonal imbalances can spoil the life of any person. There are many reasons for this. All violations affect the appearance, behavior, sensations of a person and biochemical processes in the body. A disease that can turn strong, courageous and strong men into feminine ones is called gynecomastia. What is gynecomastia? What might cause it? How to detect and treat gynecomastia?
Gynecomastia is a hormonal disorder that is accompanied by an increase in the size of the mammary glands in men. This increase is determined visually or by palpation. There are 3 peak incidences for gynecomastia.
The first peak is in the neonatal period. This is due to the action of the mother's estrogens on the male fetus in the womb. Such gynecomastia disappears within 3-4 weeks after the birth of a boy.
The second peak is the period of puberty. 35-70% of adolescents aged 11 to 16 may experience gynecomastia. This is due to a physiological decrease in the content of free testosterone, which is caused by an increased content of estradiol. Gynecomastia at puberty disappears approximately 1 year after its onset.
The third peak occurs in men who have crossed the milestone of 50 years. This is due to hormonal changes in the male body and is the norm.
Oncological malignant processes of the breast in men are hundreds of times less common than in women. On average, the disease falls on the age of 56 years. Gynecomastia is true and false, in which adipose tissue predominates in the mammary gland. Also, gynecomastia can be both symmetrical and asymmetric.
What causes gynecomastia in men?
Gynecomastia appears with an increased content of estrogens in the blood. The increase in estrogen can be absolute and relative.
Absolute increase in estrogens:
• Taking drugs that contain estrogens. This is often seen in prostate cancer.
• Testicular tumor is a rare type of tumor that grows from Leydig cells. Tumor cells secrete estradiol. The tumor is benign in 90% of cases. The decrease in the production of LH and testosterone is carried out according to the feedback principle. This leads to low testosterone levels. This further exacerbates the already disturbed balance of sex hormones.
• Tumors of the adrenal glands that secrete estrogens.
• Carcinomas of various localizations and germ cell tumors. With an increase in human chorionic gonadotropin, the production of testosterone by the testicles is stimulated. Its excess is metabolized into estrogens in adipose tissue.
Reasons for the relative increase in estrogen concentration:
• Primary hypogonadism (eg, in Klinefelter's syndrome).
• Age-related hypogonadism. Occurs as a result of an age-related decrease in the release of testosterone by the testicles. The level of estradiol remains within the normal range.
• Hypogonadotropic hypogonadism. If the release of estrogen by the adrenal glands is preserved, the secretion of testosterone decreases. This is the cause of relative hyperestrogenemia.
• Refeeding syndrome. This syndrome was first noticed during the Second World War, when after prolonged malnutrition or starvation, with the resumption of normal nutrition, gynecomastia occurred in men. Such gynecomastia disappeared on its own after 2 years of rational nutrition.
• Kidney failure, dialysis. With renal failure, the level of hormones such as LH, estradiol, prolactin increases with a simultaneous decrease in testosterone.
• Chronic liver failure. With a decrease in the activity of metabolic processes in the liver tissue, an increased aromatization of androgens into estrogens occurs. The concentration of free testosterone decreases as a result of increased levels of SHBG (sex hormone binding globulin).
• Hyperthyroidism. Gynecomastia occurs in 15-40% of men with hypothyroidism, which is explained by excessive aromatization with androgen.
• Hyperprolactinemia. An excess amount of prolactin in the blood plasma stimulates the epithelial cells of the mammary glands to proliferate, and also suppresses the production of gonadotropic hormones. This leads to secondary hypogonadism and gynecomastia.
• HIV infection. The mechanism of this reason is still not clear. But it is known that against the background of an increased content of prolactin, the mammary glands in men increase symmetrically on both sides.
• Iatrogenic gynecomastia. While taking certain medications, hormonal disorders can occur, including gynecomastia in men. Thus, 20-25% of the total number of men with gynecomastia have an iatrogenic cause.
As a result of these causes, breast tissue proliferates due to the predominance of estrogen stimulation, and adipose tissue also hyperplasias.
What are the criteria for the diagnosis of gynecomastia?
To make a diagnosis of gynecomastia, you need to collect an anamnesis with clarification of such questions: how long has the breast enlargement been observed, has body weight changed? You also need to find out the presence or absence of pain or tightness in the chest, whether the patient took any medications and which ones, whether he observed changes in sexual function, whether there are symptoms of thyrotoxicosis.
Laboratory examination consists in the study of the level of hormones - prolactin, estradiol, FSH, total testosterone, SHBG, LH, DHEA-S, TSH, free T4, hCG. You also need to look at the concentration of liver enzymes and creatinine in a biochemical blood test. It is impractical to do mammography for men because of the very low diagnostic efficiency.
Ultrasound of the scrotum and mammary glands, MRI/CT of the adrenal glands are of diagnostic value. To exclude an oncological malignant process in the mammary glands, a FAB (fine needle aspiration biopsy) is done.
Aspects of the treatment of gynecomastia in men
In the treatment of gynecomastia associated with other diseases, therapy is aimed at this cause. Iatrogenic - stop drugs. Treatment of gynecomastia against the background of hypogonadism is carried out with testosterone preparations - omnadren, sustanon, nebido, androgel, human chorionic gonadotropin.
Gynecomastia drug treatment:
Apply selective estrogen receptor modulators - tamoxifen. The recommended dose is 20 mg/day. Danazol is a drug with androgenic activity to reduce the production of FG and FSH by the pituitary gland. The drug preserves the secretion of other hormones in the pituitary gland. A drug that does not aromatize into estrogen is also used - Mesterolone.
Since the effectiveness of drug treatment of gynecomastia has not been sufficiently studied, the duration of the therapeutic course without positive dynamics should not exceed 6 months. The sooner treatment is started, the more likely the positive effect of therapy.
The most common treatment for gynecomastia today is surgery. The indication for surgical intervention is the absence of positive dynamics after conservative therapy of gynecomastia for 2 years. Also, the operation is indicated for persistent pubertal gynecomastia, in which there is an increase in the gland by 5 cm or more and for 3 years.
In case of drug treatment, the patient must undergo examinations 2 months after the start of treatment to monitor the progress.
Thus, it is important to take drugs only as prescribed by the doctor and under his strict supervision. At the first signs of gynecomastia, it is important to immediately consult a doctor, as this will significantly increase the chances of a quick cure.
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