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Andrology - male diseases >>>> Gynecomastia: causes of development and treatment methods

Gynecomastia: causes of development and treatment methods.

An increase in the size of the mammary gland in men is called gynecomastia. This disease is considered quite common and is more often observed in adolescence (about 70% of cases) or in men over forty (about 30% of cases).

The mammary glands of newborns of both sexes look the same, but the further development of the mammary glands is influenced by hormones: estrogens and progesterone. In boys, the further development of the mammary glands is inhibited by the hormones androgens, which has a great influence on the ratio of androgens and estrogens in the male body and their disorders are the causes of gynecomastia.

There are several factors that influence the development of gynecomastia:

  • Change in the ratio of estradiol and testosterone,
  • Violation of the inhibitory effect of androgens (resistance to androgens),
  • Hyperprolactinemia, when the secretion of GnRH is inhibited by an excess of prolactin,
  • Testicular tumors that increase the secretion of estrogen,
  • Primary hypogonadism (insufficient androgen secretion),
  • The result of anorexia or other malnutrition associated with malnutrition, when gynecomastia occurs during the period of recovery and normalization of nutrition (when the secretion of testosterone and gonadotropic hormones is disrupted due to malnutrition (in this case, a reversible disorder)),
  • A sharp decrease in physical activity in athletes,
  • Prolonged stressful conditions,
  • Taking testosterone medications (not controlled), which converting to estrogens, can cause gynecomastia,
  • Taking certain anticancer drugs that cause primary hypogonadism
  • Taking psychotropic drugs, many of which cause secondary hypogonadism, hyperprolactinemia,
  • Medicines that provoke gynecomastia due to hormonal effects (cardiac glycosides, androgen receptor blockers),
  • Diseases: thyrotoxicosis, alcoholic cirrhosis of the liver, hypothyroidism, pituitary tumors, adrenal tumors,
  • Postmenopausal changes in hormonal levels in men after 40 years.

Gynecomastia is true when an increase in breast size occurs due to a layer of glandular tissue. About false gynecomastia say when the increase in breast volume is due to the fatty tissue layer. Combined gynecomastia is characterized by an increase in both glandular and adipose tissue. Usually, the volume of both breasts increases, but sometimes there are cases when only one breast swells or asymmetric swelling of both glands occurs. With the help of ultrasound, it is possible to establish which tissue overgrowth occurs in the area of the breast.

Treatment of gynecomastia is based on ultrasound data, the results of a study of hormonal levels and the identification or presence of other diseases in the patient's history that provoke its development. With gynecomastia in adolescence, treatment is not carried out, but wait 1-4 years, when the hormonal balance is formed, and gynecomastia itself regresses. For false gynecomastia due to obesity, a weight loss diet and exercise to burn excess subcutaneous fat are recommended. True gynecomastia, not associated with the physiological processes of puberty or menopause, is treated by regulating hormonal levels, treating endocrine diseases and, if necessary, by means of mastectomy (removal of the mammary gland).

If there is a large accumulation of adipose tissue in the breast area, a lipectomy is performed in parallel with the mastectomy and the adipose tissue is removed. The operation is performed subcutaneously or endoscopically; with or without plastic nipple halos. The operation does not require a long hospital stay and special rehabilitation, except for the weekly postoperative period, when it is recommended to wear a chest-tightening underwear to tighten the skin and shape the muscle tissue in the chest area. With plastic areola, the nipple is worn for a month. Full recovery with the possibility of physical activity or sports will occur in 1-2 months.

The prognosis for the treatment of gynecomastia is favorable if its development is not delayed in time, since prolonged untreated gynecomastia can lead to breast tumors, including malignant ones.


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