Causes and risk factors
All males have male hormone testosterone as well as small amount of female hormone called oestrogen which controls growth of breast tissue. Gynecomastia can be caused by hormonal changes i.e. when the levels of oestrogen increases. Medicines like anti anxiety medications, overuse of drugs like marijuana, opioids, or excessive alcohol intake can lead to this condition. Anabolic steroids or androgens called as ‘androgenic anabolic steroid induced [AAS induced] gynecomastia’ is seen in athletes or men working in the gym and consuming anabolic steroids. Disorders like hypogonadism, hyperthyroidism, liver or kidney disease, kleinfilter’s syndrome are responsible for developing gynecomastia. Risk factors include being overweight, adolescent boys or old age.
Clinical presentation
Patient presents with varied signs such as from small amount of extra tissue around nipple to more prominent breasts. It starts as rubbery firm mass underneath the nipple and spreads over breast area. There is enlargement of glandular tissue and not the fat tissue. There can be swollen breast area and tenderness in affected region. It may be unilateral as well as bilateral swelling. Nipple discharge can also be present.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Routine blood tests are recommended. Blood tests for sex hormones, blood markers for testicular cancer, breast cancer may be done. Imaging studies such as mammogram, CT scan, MRI of chest, breast and testicular ultrasound may be useful for further evaluation. In some cases breast tissue biopsy is advised to rule out other diseases.
Treatment
Treatment depends upon the underlying cause if any , whether the condition is going to continue and cosmetic concerns. No treatment is required for patients where the condition is going to be temporary i.e. pubertal age. If the cause is found and treated early, it can stop breast tissue enlargement and reverse the condition. If the condition is caused due to overuse of drugs, stoppage of the same can help correcting it. Medical treatment consists of anti oestrogenic medicines which reduce oestrogen, increase testosterone and attains oestrogen testosterone balance reducing gynecomastia. Surgical treatment includes liposuction which removes breast fat, but not the breast tissue; Mastectomy which removes the breast gland.
Other Modes of treatment
The other modes of treatment can also be effective in treating gynecomastia. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating gynecomastia.
