Gynecomastia - causes, symptoms and effective treatments

What is gynecomastia and how does it manifest itself?

Gynecomastia is an excessive growth of the mammary gland in men, which manifests itself as a visible enlargement of one or both breasts. It is the most common condition affecting the male breasts, which results from both excess glandular tissue, fatty tissue and a combination of the two. Although gynecomastia is not a cancerous condition, its appearance raises concern and causes considerable mental and physical discomfort.

What are the types of gynecomastia?

Gynecomastia takes different forms depending on which tissue undergoes hypertrophy. There are three main types of gynecomastia:

• Gynecomastia type I (glandular) - there is an excessive growth of glandular tissue without an increase in adipose tissue. It usually has a hormonal basis.
• Gynecomastia type II (glandular-fatty) - the most common form, in which breast enlargement is due to both excess glandular and fatty tissue.
• Type III gynecomastia (adiposity, pseudogynecomastia) - breast enlargement is mainly due to accumulation of adipose tissue without excessive proliferation of glandular tissue. It is usually associated with overweight or obesity.

Physiological gynecomastia - when does it occur naturally?

In some cases, gynecomastia is the result of natural hormonal changes and does not require treatment. Three periods of a man's life can be distinguished, during which it appears most often.

1. Newborns - about 60-90% of male newborns show transient enlargement of the mammary glands as a result of maternal hormones (estrogen). It usually subsides within a few weeks after birth.
2. Adolescence (13-14 years) - gynecomastia can appear in boys during the hormonal storm, when estrogen levels temporarily exceed testosterone levels. In most cases, it regresses spontaneously within 2 years.
3. Older age (over 50) - is associated with a natural decrease in testosterone levels and an increase in the estrogen ratio, which can lead to breast gland hypertrophy.

Although physiological gynecomastia usually does not require treatment, if it persists for a long time or occurs in adult men, it is worthwhile to perform diagnostics to rule out health problems and implement appropriate management.

What are the causes of gynecomastia?

Gynecomastia is a condition with a complex etiology that can result from both physiological, hormonal and genetic factors, as well as chronic diseases. The mechanism leading to enlargement of the mammary glands in men is an imbalance between estrogens (female hormones) and androgens (male sex hormones, mainly testosterone). An excess of estrogens or a deficiency of androgens can result in hypertrophy of the glandular tissue of the breast.

Endocrine disorders and endocrine diseases

The most common cause of gynecomastia is hormonal imbalance, which can result from puberty or aging. Endocrine diseases are also a possible cause.

• Hyperthyroidism (hyperthyroidism) - excess thyroid hormones can increase estrogen production and contribute to gynecomastia.
• Hypogonadism (testicular hypogonadism) - leads to reduced testosterone levels and excess estrogen, which promotes the growth of glandular tissue. It can result from testicular diseases, such as Klinefelter's syndrome, testicular trauma or cancer.
• Liver and kidney diseases - cirrhosis of the liver and chronic kidney failure disrupt hormone metabolism, leading to increased estrogen levels and an increased risk of gynecomastia.
• Tumors - some tumors (e.g., tumors of the adrenal glands, testes, pituitary gland) lead to overproduction of estrogen and the development of gynecomastia.

Obesity and excess body fat

Pseudogynecomastia (lipomastia) is a condition in which breast enlargement in men results not from excess glandular tissue, but from fatty tissue. It is a common problem in overweight and obese individuals. In addition, fat tissue contains the enzyme aromatase, which converts testosterone into estrogen. Thus, the greater the amount of adipose tissue, the greater the risk of gynecomastia.

It is worth remembering that highly processed foods, excess simple sugars and lack of physical activity increase the risk of obesity and hormonal disorders that promote the development of gynecomastia.

Drugs and psychoactive substances

Some drugs and stimulants also cause gynecomastia as a side effect. Among the most common substances are:

• drugs that affect sex hormones, including: anti-androgens used to treat prostate cancer (e.g., flutamide, bicalutamide), anabolic steroids, often used in bodybuilding, which, when discontinued, cause testosterone levels to fall and estrogen levels to rise, but also some drugs used in hormone therapy for transgender people, as well as estrogens and drugs containing phytoestrogens;
• Cardiovascular and neurological drugs, including but not limited to: calcium channel blockers used in hypertension, certain antiepileptic drugs (e.g., phenytoin), drugs used to treat peptic ulcer disease (e.g., ranitidine, omeprazole);
• stimulants and psychoactive substances, most notably: alcohol, excessive consumption of which damages the liver, disrupting hormone metabolism, also marijuana can disrupt hormonal balance, as well as heroin and amphetamines affect testosterone and estrogen levels, increasing the risk of gynecomastia.

Idiopathic factors, i.e. gynecomastia without a clear cause

In some cases, gynecomastia occurs without a clear cause. Then we speak of idiopathic gynecomastia, which can be the result of individual genetic predisposition, as yet unknown hormonal mechanisms and the complex influence of environment and lifestyle.

Symptoms and diagnosis of gynecomastia - how to detect and correctly diagnose it?

Proper diagnosis of gynecomastia requires a comprehensive approach - from medical history and physical examination to specialized laboratory and imaging tests. It is particularly important to exclude serious conditions such as breast cancer, testicular tumors or endocrine diseases, which can cause similar symptoms. Early diagnosis is important for effective treatment and improving the patient's quality of life.

Symptoms of gynecomastia - what should you pay attention to?

• Visible enlargement of one or both breasts - this symptom can occur symmetrically or asymmetrically, when one breast is larger than the other.
• Breast tenderness and pain - some patients experience gynecomastia with discomfort or soreness when touched.
• Sclerosis in the areola of the nipple - in some cases, lumpy thickening can be felt in the breast, which requires detailed diagnosis.
• Changes in breast structure - gynecomastia can cause increased skin elasticity and a feeling of fullness in the chest.

Diagnosis of gynecomastia - how does the doctor diagnose the condition?

The first step in the diagnosis of gynecomastia is a detailed medical history, which allows the doctor to determine the possible causes of the problem. During the interview, the specialist collects information on when the symptoms appeared and how long they lasted. An important aspect is also the evaluation of pain and tenderness of the breasts, as well as the presence of other complaints. The doctor analyzes the patient's previous health status, taking into account past illnesses, possible hormonal disorders, as well as medications and supplements used that may affect the body's hormonal balance.

An important part of the diagnosis is also an evaluation of lifestyle, eating habits and possible use of alcohol, drugs or anabolic steroids, which can contribute to gynecomastia. In addition, the doctor investigates whether the patient's family has had similar cases, which may indicate a genetic predisposition to the condition. A thorough medical history forms the basis for further investigation and allows for the selection of an appropriate diagnostic and treatment path.

After the history, the doctor performs a palpation examination of the breasts to assess:

• magnification size and symmetry,
• The texture of the tissue - whether fatty, glandular or mixed lesions predominate,
• The presence of nodules, induration or lesions,
• The condition of the nipples and areolae,
• The presence of enlarged lymph nodes,
• Secondary sexual characteristics - evaluation of the testes and hair to detect possible hormonal disorders.

Blood tests to confirm gynecomastia

To confirm the diagnosis and determine the cause of gynecomastia, the doctor orders blood tests to help assess hormone levels and the functioning of the organs responsible for their production.

Testosterone and estradiol levels are tested to determine the ratio of androgens to estrogens, which can detect hormonal disorders that promote mammary gland hypertrophy. Gonadotropins FSH and LH are responsible for regulating testicular function, so their determination can help diagnose endocrine problems. Prolactin levels can detect hyperprolactinemia, which can be one of the factors leading to gynecomastia.

In addition, the study of thyroid hormones (TSH, FT3 and FT4) allows assessment of the function of this organ, since its disorders affect hormonal management and lead to proliferation of the glandular tissue of the breast. Tumor markers (hCG and AFP) are analyzed to exclude testicular tumors. Assessment of liver and kidney function is also important, as these organs are involved in hormone metabolism. For this purpose, liver tests (ALT, AST, bilirubin) and kidney tests (creatinine, urea) are performed, which help detect possible conditions that may affect the development of gynecomastia.

Imaging studies - assessment of breast structure

In some cases, the doctor also orders imaging tests to assess the structure of the breast tissue and rule out tumors.

• Ultrasonography (ultrasound) of the breast - allows you to accurately assess whether breast lesions are glandular, fatty or cancerous. It is the primary imaging study in the diagnosis of gynecomastia.
• Mammography - used in situations where breast cancer is suspected, especially in men over 50.
• Biopsy - performed when suspicious nodules are found to take a tissue sample for histopathological examination.
• Testicular ultrasound - if testicular cancer is suspected as the cause of gynecomastia.
• Computed tomography or magnetic resonance imaging (CT/MRI) - may be necessary to detect adrenal or pituitary tumors.

Treatment of gynecomastia - effective therapies

Successful treatment of gynecomastia depends on the cause of the condition, the severity of the condition and the individual characteristics of the patient. Depending on the situation, drug therapy, causal treatment and, in more advanced cases, liposuction or surgical removal of excess tissue are used. The professional care of specialists allows the selection of the appropriate method to guarantee lasting results and improve the patient's quality of life.

Causal treatment - elimination of primary health problems

In cases where gynecomastia is the result of other conditions, it is important to treat the original complaint. It is also important to identify the medications that may be causing the problem. In some cases, changing the medications used or discontinuing them is enough to bring about a reduction in enlarged glandular tissue. 

Pharmacological and hormonal treatment - when are drugs used?

In some cases of gynecomastia, drug treatment is an essential part of therapy, especially in its early stages. Anti-estrogen drugs work by blocking estrogen receptors, reducing the effects of female hormones on the male body. Aromatase inhibitors, on the other hand, inhibit the conversion of testosterone to estrogen, reducing excessive levels and restoring hormonal balance.

In cases of hypogonadism (testosterone deficiency), therapy includes administration of the hormone, which helps to reduce breast gland hypertrophy and balance hormone levels. However, drug treatment is effective mainly in the early stages of gynecomastia - with advanced lesions, surgical methods are usually necessary.

Liposuction - effective removal of excess body fat

In cases where gynecomastia is fatty in origin and breast enlargement is the result of excess fat, liposuction is an effective solution. The procedure involves liposuction of accumulated fat in the chest area, which allows for rapid improvement in appearance and restoration of male figure proportions.

Liposuction is a minimally invasive procedure, after which patients can return to normal activities relatively quickly. The procedure does not require a long period of convalescence, and the results are visible almost immediately after the swelling subsides. This method is particularly recommended for patients whose gynecomastia is fatty in nature (pseudogynecomastia), and not due to excess glandular tissue.

Surgical removal of tissue - an effective solution in advanced cases

If the gynecomastia is glandular or mixed, and drug treatment is unsuccessful, surgical removal of glandular and adipose tissue is necessary.

The procedure involves precise removal of the hypertrophied breast gland through small incisions in the nipple area, which reduces the visibility of scars. In many cases, surgical treatment of gynecomastia is combined with liposuction to achieve the best aesthetic result. After the procedure, patients can usually return to normal activities within a few days, and the full effects are visible after a few weeks.

FAQ

Can gynecomastia resolve on its own?

Yes, in some cases gynecomastia is physiological and resolves spontaneously. This applies to newborns, boys in puberty and older men, in whom the changes are due to temporary hormonal disturbances. If gynecomastia does not regress within a few months or years, it is worth consulting a doctor.

How to recognize gynecomastia?

Diagnosis includes a detailed medical history, physical examination and laboratory tests to help determine hormone levels (testosterone, estrogen, prolactin, FSH, LH, TSH). If necessary, the doctor may recommend a breast ultrasound, mammogram or biopsy to rule out other causes of mammary gland hypertrophy.

What treatments are available for gynecomastia?

Treatment depends on the cause and severity of gynecomastia. Pharmacological treatment is used, but also plastic surgery procedures such as liposuction or surgical removal of glandular tissue.

Can gynecomastia return after treatment?

If the cause of gynecomastia has been removed, the risk of recurrence is minimal. However, it is worthwhile to lead a healthy lifestyle and avoid factors that promote gynecomastia.

Can gynecomastia be dangerous to health?

Gynecomastia itself is not a life-threatening condition, but it can cause physical and psychological discomfort. However, it is important for the doctor to rule out other conditions, such as cancers of the testicles, adrenal glands or breast, which can produce similar symptoms.

Can gynecomastia result from exercise or inactivity?

Lack of physical activity and excess body fat can lead to pseudogynecomastia, or breast enlargement resulting from fat accumulation. In this case, weight reduction and regular physical activity will significantly improve the appearance of the chest.

Can diet help treat gynecomastia?

Yes, a proper diet aids treatment, especially if the gynecomastia is due to excess body fat. A diet rich in protein, vegetables, healthy fats and low-processed foods helps with hormonal regulation and fat reduction. It is also recommended to give up products rich in phytoestrogens like soy and beer, which can raise estrogen levels in the body.

What are the psychological effects of gynecomastia?

Many men struggling with this problem experience psychological discomfort, so in some cases psychological consultation may be helpful.

What is the recovery like after surgical removal of gynecomastia?

After surgery, patients usually return to normal activity after a few days, but the full recovery period takes about 4-6 weeks. During this time, it is recommended to wear compression garments, avoid intense exercise and take care of proper wound healing.

Does gynecomastia surgery leave scars?

Modern surgical techniques keep scarring to a minimum, as incisions are made in invisible areas, such as around the areola of the nipple. In many cases, scarring is almost unnoticeable once fully healed.

Can gynecomastia be the result of stress?

Although stress in itself does not cause gynecomastia, it does affect hormones, leading to increased cortisol levels, which can upset the balance between testosterone and estrogen. Long-term stress combined with an unhealthy lifestyle can increase the risk of gynecomastia.

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