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Losing weight, eating a healthy diet, and avoiding substances that contribute to hormonal imbalances can help reduce or prevent gynecomastia. The treatment approach depends on the severity of the condition and the underlying cause. For more severe cases, medical treatment or surgery may be necessary. Certain SSRI medications have been linked to gynecomastia. Indeed, trials revealed that testosterone is not effective compared with placebo. Because gynecomastia usually regresses spontaneously, if the appropriate work-up does not reveal any considerable underlying pathology, reassurance and periodic follow-up are recommended at 6-month intervals. Pseudogynecomastia and true gynecomastia can be differentiated by physical examination, as described above. However, the yield of cells taken in a gynecomastia biopsy is often insufficient, because gynecomastia is a predominantly fibrous lesion. Mammography (MMG) is the primary imaging method used when there is any suspicion of cancer. Patients with aromatase excess syndrome are characterized by increased E2 levels, pre-pubertal gynecomastia, accelerated bone age in childhood and reduced final adult height due to premature epiphyseal fusion. Excessive estrogen secreted from ovarian component may cause gynecomastia by inhibiting intra-testicular cytochrome P450 C17 activity, leading to decreased testosterone production. However, large-cell lung carcinoma, gastric carcinoma, renal cell carcinoma and rarely hepatoma can lead to the ectopic production of hCG, causing gynecomastia.4,11 In pre-adolescent males with hCG-secreting hepatoblastoma, precocious puberty can also occur. In renal transplantation patients, gynecomastia can also be a side effect of medications, such as cyclosporine. Renal failure leads to hormonal abnormalities, in particular decreased T, increased E2 and LH levels and a modest increase in PRL. The adrenal cortex continues to produce estrogen precursors that get aromatized in the extra-glandular tissues, resulting in an estrogen to androgen imbalance. Primary hypogonadism can lead to decreased T production, compensatory LH increase, Leydig cell stimulation, the inhibition of 17, 20-lyase and 17-hydroxylase activities, elevated aromatization of T to E2 and finally an increase in the ratio of E2 to T. Patients who develop re-feeding gynecomastia are therefore often described to be undergoing a ‘second puberty’. In the lead re-feeding gonadotropins are increased, leading to T secretion and E2 production, which mimics normal puberty. If you’re concerned about how long you’ve had gynecomastia or it’s causing you distress, reach out to your healthcare provider. Days may feel like weeks when you’re living with gynecomastia, especially if it’s affecting how you view yourself. Substances, including amphetamines, marijuana and heroin, may also cause gynecomastia. Drugs used to treat prostate cancer and breast cancer can reduce testosterone levels, leading to gynecomastia and breast pain. Stopping medications and treatment of existing medical problems or health conditions that cause enlarged breasts in men also are mainstays of gynecomastia treatment. The most important distinction with gynecomastia is differentiation from male breast cancer, which accounts for about 1% of overall cases of breast cancer. The primary symptom of gynecomastia is an enlargement of the male breasts, which involves enlargement of glandular tissue rather than fatty tissue. Gynecomastia results from an imbalance in hormone levels in which levels of estrogen (female hormones) are increased relative to levels of androgens (male hormones). When oestrogen rises or testosterone levels drop drastically, abnormal development of breast tissue takes place. It is recommended that physicians follow the algorithm for gynecomastia in patients under the age of 50 years, unless one of the atypical criteria shown in Figure 1 is met. In patients with pseudogynecomastia the fingers will not meet any resistance until they reach the nipple. In true cases of gynecomastia, the physician will feel a disc or candy96.fun firm tissue that is concentric with the nipple-areolar complex. In several studies, prophylactic RT was found to be effective in preventing gynecomastia and mastodynia in patients with prostate cancer.2,11 However, although the high radiation doses may improve pain, they are less effective in reducing the volume of the tissue. In one study of the use of Tmx, 69% of prostate cancer patients in the high-dose bicalutamide (150 mg/day) group had gynecomastia, but this was reduced to only 9% in the group receiving both bicalutamide and Tmx (10-20 mg/day).30,31,32 Tmx must be continued throughout the anti-androgen therapy, since its effects do not persist after it has been discontinued. Anti-estrogens–In recent years, anti-estrogens have been increasingly used to decrease the stimulatory effects of estrogen on the male breast. Dehydrotestosterone (DHT) is a non-aromatizable androgen that has been approved for the treatment of gynecomastia in some countries and was found to be effective in uncontrolled studies.17,18 Danazole is a weak androgen that inhibits the secretion of LH and FSH from the pituitary.
