Gynecomastia: causes, treatment, prognosis – NetDoktor
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What are the causes of gynecomastia?
Normal testosterone levels in young adult males are approximately six nanograms per milliliter of blood (ng/ml) and normal estrogen levels are 20 to 40 picograms (pg/ml). This results in a testosterone/estrogen quotient of around 200-300.
The mammary gland tissue reacts very sensitively to fluctuations in the male hormone balance, so that imbalances promote breast growth. All things that interfere with this balance are therefore considered risk factors for the development of gynecomastia.
Physiological gynecomastia
Physiological gynecomastia is caused by an altered balance between female sex hormones (oestrogens) and the male sex hormone (testosterone). The proportion of the female messenger substance, which is always circulating in the body in small amounts in men, increases. However, these changes do not always result from pathological processes, but sometimes occur naturally in certain phases of life:
neonatal gynecomastia
About 60 percent of all male newborns have a small breast base in the first few weeks. This is temporary and disappears again after a few weeks or months. Male babies come into contact with female hormones during pregnancy and in the first few weeks of their lives: estrogen is passed on to the child through the placenta and breast milk. The child’s liver does not break down this hormone as efficiently at the beginning. Therefore, there is a slight breast formation.
pubertal gynecomastia
During puberty, some boys’ breasts grow because the balance of sex hormones changes. Due to the serious changes in the hormone balance, it happens that female sex hormones are also increasingly formed. Since adipose tissue plays a role in the conversion of the male sex hormone testosterone to female estrogen, pubertal gynecomastia is more common in overweight adolescents.
old-age gynecomastia
With age, the proportion of body fat increases and the production of testosterone decreases. The enzyme aromatase, which is particularly abundant in adipose tissue, converts testosterone to estrogen. Both effects favor the growth of mammary gland tissue. This form of breast growth is also more common in overweight people.
Pathological gynecomastia
Breast growth in men may also be an indication of a pathological process in the body that disturbs the hormone balance, or that takes place directly in the breast itself.
Hereditary gynecomastia
Some men have a problem in the production or processing of hormones. For example, enzymes do not form certain precursors of the male hormone, or both testicles – the main producers of testosterone – are missing. The doctor gets the first indications of this form of gynecomastia in the patient consultation, because “men with breasts” are then often already known in the family.
Sometimes sections of the genetic material DNA are missing, or the (female) X chromosome is duplicated (Klinefelter syndrome). Then it happens that the breast, pelvis and buttocks are female and at the same time male sexual characteristics are present. Such deviations in the genetic material usually arise during the production of sperm and the egg cell or during their fusion (fertilization).
chronic diseases
The liver breaks down hormones, especially estrogen. A liver disease such as cirrhosis of the liver may lead to an excess of female hormones and subsequently to gynecomastia.
A diseased kidney can also cause gynecomastia. A functional disorder (renal insufficiency) changes the filter function and thus affects the hormonal balance. With severe malnutrition, such as that which occurs in anorexia, testosterone levels drop drastically and the liver stops working at full capacity. If a normal diet follows such a starvation phase, the hormone level is still disturbed for a certain time, which promotes gynecomastia.
The loss of one or both testicles also sometimes changes the ratio of testosterone and estrogen to such an extent that the mammary gland tissue grows stronger. There are also other diseases that change the hormone balance, such as an overactive thyroid gland (hyperthyroidism).
cancers
Tumors are clusters of cells that have lost their normal function. Some tumors produce effective amounts of hormones themselves, so that an excess of these messenger substances circulates in the body. Sometimes these are sex hormones that may stimulate breast growth. In this case one speaks of “paraneoplastic symptoms” (neoplasia = new tissue formation).
Mammary gland cancer (mammary carcinoma) also occurs in men. This is much rarer than in women and is therefore often recognized late. The acute, unilateral occurrence is typical. In contrast to gynecomastia, in which the breast tissue is rather soft, elastic and evenly distributed around the areola, the breast tissue in breast cancer is usually firm and unevenly distributed.
Medication, drugs or personal care products
A fairly common cause is the external supply of hormones or substances that affect the hormonal balance. Some heart medications, antibiotics or antidepressants also change hormone metabolism. In addition, long-term heavy alcohol or drug consumption (marijuana, heroin) is a possible cause of a hormone imbalance with gynecomastia.
Small amounts of artificial female hormones are found in some skin and hair care products and enter the bloodstream through the skin or scalp. Certain chemical substances contained in lavender or tea tree oil are suspected of having an estrogen-like effect. More studies are needed to confirm a possible association with gynecomastia.
pseudogynecomastia (lipomastia)
It is important to differentiate gynecomastia from pseudogynecomastia (lipomastia). In the case of pseudogynecomastia, the glandular tissue does not increase, but instead fat accumulates in the breast. Pseudogynecomastia occurs mainly in people who are very overweight and obese (adiposity). You can use your BMI (Body Mass Index) to estimate your overweight.
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