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For women, their breasts might be their greatest asset, if the same thing appears on men, it can be a cause for major embarrassment. Gynaecomastia, has its origin in the Greek language. Gynae means woman, while mastos means breasts. Gynaecomastia orMale Breast Enlargement is defined as the enlargement of male breast glandular tissue and is one of the most common breast problems occurring in males. This condition can be most often seen in young boys or older men.In this series, we will be looking at what gynaecomastia is, what causes it, how it should be diagnosed and managed and how it can be treated.

Epidemiology of Gynaecomastia:

  • The condition is actually much more common than many people might think.
  • The condition is prevalent in around 30% men, at some stage in their life
  • It usually peaks in three age groups, the first being in early infancy, then around puberty in adolescent boys and the last peak in older men around 50-80 years of age.
  • Breast cancer and gynaecomastia have only a single percent possibility.

Signs of Gynaecomastia:gynecomastia

The signs actually vary from person to person – in certain cases, there is only a small amount of extra tissue, right around the nipples. However, in the more severe cases, the breasts are truly prominent. It is seen in both breasts, most of the time, but rarely there can be cases, where only one breast is affected. In some cases, the breasts are tender and ache on being touched.

Pathophysiology of Gynaecomastia:

In the female body, it is the presence of oestrogen that leads to the formation of breasts and it is the job of androgens to inhibit the same. It is the ratio of both that is most important and should there be an imbalance, there could be a problem. This imbalance in the ratio normally happens when there is insufficient testosterone or too much oestrogen.

So the main reasons that could lead to gynaecomastia include:

  • Conditions which lead to an increase in oestrogen levels
  • Conditions which lead to a decrease in testosterone levels
  • Conditions which affect the SHBG or sex hormone binding globulin, leading to the imbalance of oestrogen and testosterone
  • Conditions which lead to an enhanced conversion of androgen into oestrogen
  • Conditions that lead to a resistance against androgens.

Causes of Gynaecomastia:

There are several causes for gynaecomastia and they can be categorised as:

Pathological

  • In certain cases, there is a lack of testes, which is why there is no production of testosterone. When there is no testosterone, there is the formation of breasts or in the case of men, gynaecomastia.
  • When there is a resistance to androgen or there is an increase in the oestrogen levels in the body.
  • WA condition known as Klinefelter’s or XXY Syndrome – there is an increased risk for breast cancer in this condition and is found to be the cause for gynaecomastia in close to 80% men.
  • Trauma, castration or tumours in the testicles. It has also been proven that adrenal tumours could also lead to gynaecomastia, because there is a release of oestrogen in this condition.
  • Renal failure and requirement for dialysis
  • Hermaphroditism and congenital adrenal hyperplasia, which is a condition in which both androgen and oestrogen levels are high.
  • Liver conditions such as cirrhosis, wherein there is an increased production of androstenedioneand increased conversion into estrogen, which in turn leads to gynaecomastia.
  • In certain conditions, an excess production of thyroid can also lead to gynaecomastia.
  • Ectopic hCG or human chorionic gonadotrophin production : this hormone is present in pregnant females and is usually absent in normal males. Sometimes some cancers like lung, renal, liver tumours can produce hCG which inturn leads to gynaecomastia.

Medication

It might come as a surprise to many, but it is medicines that lead to up to twenty five percent cases of gynaecomastia. Here is a look at some of the medications that could cause the condition:

  • Medicines that are meant to inhibit the synthesis of testosterone, such as metronidazole, spironolactone, ketoconazole and even chemotherapy.
  • Medicines that are meant to inhibit the action of testosterone, such as flutamide, Dutasteride, Finasteride, cyproterone, bicalutamide, H2 receptor antagonists and in some cases, marijuana.
  • Medicines that are supposed to enhance the action of oestrogen, including diethylstilbestrol, phenytoin, clomifene and organic remedies which contain phytoestrogens.
  • Anabolic steroids or an excess of testosterone replacement treatment
  • Medications that can increase the prolactin levels, such as metoclopramide, antipsychotics and verapamil
  • Other medicines that could lead to gynaecomastia include antiretrovirals, methyldopa, amphetamines, theophylline, amiodarone, isoniazid and diazepam.

Other causes

Some of the other prominent causes of gynaecomastia include:

  • Injury to the spinal cord
  • People suffering from type 1 diabetes could face gynaecomastia
  • When you are overweight or obese, there could be an increase in the oestrogen levels in the body, causing the tissues in the chest area to grow.
  • The condition is often seen in newborn babies, because a certain amount of oestrogen travels through the placenta from the mother to the baby. This condition however, is temporary and will disappear in a matter of weeks.
  • Puberty is a time, when the body is undergoing several changes and there could be an imbalance in the hormones too. This is why gynaecomastia often presents itself during adolescence. Once the hormonal levels are balanced, the condition does tend to disappear.
  • As age progresses, the production of testosterone reduces, and many a times, this combined with excess weight leads to gynaecomastia.
  • In very rare cases, over consumption of alcohol can lead to gynaecomastia.

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