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  Male Gynecomastia  
 
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Conditions that suggest it | Contributing risk factors | Recommendations

 

Gynecomastia is a common disease of the male breast where there is a benign glandular enlargement of that breast at some time in the male's life. It usually consists of the appearance of a flat pad of glandular tissue beneath a nipple which becomes tender at the same time. The development may be on one or both breasts. There is rarely a continued growth of the breast tissue; ordinarily the process is of brief duration and stops short of the production of permanent enlargement of the breast. Gynecomastia is found only in males, and the signs can appear any time in a male's lifetime. It is the leading breast disorder in males and it accounts for 60% of all disorders of the male breast. About 85% of male breast masses are due to gynecomastia and 40% of the cases affect pubescent boys.. Approximately 40% of normal men and up to 70% of hospitalized men have palpable breast tissue. Active gynecomastia in autopsy data is between 5 and 9%. In one study, more than 80% of hospitalized patients with a body mass index (BMI) of 25 or greater had gynocamastia. About 70% of pubertal males required no treatment. If the threshold for judging that the breast is enlarged is set at 2cm in diameter, the incidence is 32 to 36% in normal aged men 17 to 58 years.

Further information on this subject can be found here.
 

 
 

Conditions that suggest Male Gynecomastia:
 
 
Symptoms - Glandular  Gynecomastia

Counter-indicators:
  Absence of gynecomastia
 
 

Risk factors for Male Gynecomastia:
 
 
Hormones  Elevated Estrogen, Male
 Higher levels of estrogen and lower levels of free testosterone in males may be associated with pubertal or post-pubertal gynecomastia (male breast enlargement), particularly in older individuals and in patients with chronic liver disease or hyperthyroidism [(Robert K. Murray, MD, Ph.D., Daryl K. Granmer, MD, Peter A. Mayes, Ph.D., D.Sc., Victor W. Fodwell, Ph.D., Harper’s Biochemistry, 25th Edition, Appleton & Lance, Stanford, Connecticut, 2000, Pages 596-597).]

  Low Testosterone Level
 The basic mechanisms of gynecomastia are a decrease in androgen production, an absolute increase in estrogen production, and an increased availability of estrogen precursors for peripheral conversion to estradiol.

Symptoms - Glandular

  History of gynecomastia
 
 

Recommendations for Male Gynecomastia:
 
 
Diet  Alcohol Avoidance
 Several studies indicate a potential role for prolactin and estrogen in the pathogenesis for feminization. Male alcoholic patients frequently show evidence of feminization that is manifested by gynecomastia, spider angiomata, palmar erytherma and changes in body hair patterns. Alcoholic men show a positive association between the presence of clinically apparent gynecomastia and elevated circulating levels of prolactin. The gynecomastia found in alcoholic patients is characterized by a proliferation of the stroma and ducts that are known to be estrogen-positive.

Hormone

  Estrogen-balancing Medications
 Males with gynecomastia often have an elevation of plasma levels of estrogen which is believed to be due to peripheral conversion of weak adrenal androgens to estrogen.

  Testosterone
 Gynecomastia is a common condition in athletes who use steroids or testosterone to build muscle. The condition is caused by the aromatization of testosterone into estrogens. Gynecomastia may be avoided through the use of dihydrotestosterone instead of other forms of testosterone. It can actually even be applied as a treatment for gynecomastia. A further advantage of dihydrotestosterone is that increased levels of the hormone are correlated to increased sex drive and increased sexual function.


Not recommended:
  Melatonin
 One case of painful gynecomastia has been reported involving a 56 year old man who had been suffering from amyotrophic lateral sclerosis and was taking 1 to 2mg melatonin per day over a 1 1/2 year period. As the gynecomastia disappeared after melatonin use was discontinued, it was suspected that the melatonin caused this side effect.

Lab Tests/Rule-Outs

  Test / Monitor Hormone levels
 Estradiol is the growth hormone of the breast, and an excess of estradiol leads to the proliferation of breast tissue. Under normal circumstances, most estradiol in men is derived from the peripheral conversion of testosterone and adrenal estrone. The basic mechanisms of gynecomastia are a decrease in androgen production, an absolute increase in estrogen production, and an increased availability of estrogen precursors for peripheral conversion to estradiol.

Surgery/Invasive

  Surgery
 Often no cause is found for the disorder and the gynecomastia may not resolve on it's own. In these cases, surgery is frequently the best solution.
 
 


KEY
Strong or generally accepted link
Proven definite or direct link
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
May have adverse consequences