From the Research
Introduction to Gynecomastia
Gynecomastia is a benign enlargement of male breast tissue, resulting from an imbalance between androgens and estrogens at the breast tissue level 1. This condition is common in boys during puberty and in aging men, causing psychological problems due to breast enlargement and accompanying pain.
Etiology of Gynecomastia
The etiology of gynecomastia can be attributed to both physiologic and nonphysiologic causes, including:
- Hypogonadism
- Altered estrogen-to-androgen ratio
- Drug use
- Herbal products
- Endocrine tumors or dysfunctions
- Non-endocrine diseases
- Idiopathic causes 2, 3
Clinical Presentation of Gynecomastia
Gynecomastia is characterized by the proliferation of mammary glands, leading to the development of dense subareolar tissue 2. The clinical presentation may include:
- Breast enlargement
- Pain
- Tenderness
- Psychosocial effects, particularly among adolescents
Diagnosis and Evaluation
Evaluation of gynecomastia must include:
- Detailed medical history
- Clinical examination
- Specific blood tests
- Imaging
- Tissue sampling 4 The aim of diagnosis is to confirm the condition, identify the underlying etiological factor, and classify the severity of gynecomastia to guide treatment.
Treatment Options
Treatment options for gynecomastia may include:
- Reassurance
- Weight loss
- Pharmacotherapy with tamoxifen
- Surgery, combining liposuction and mammary adenectomy 3, 5
- Administration of androgens for men with hypogonadism
- Antiestrogen therapy for men with endogenous overproduction of estrogens
- Discontinuation of medications that may cause breast enlargement, such as spironolactone 5
Caveats and Considerations
It is essential to note that most cases of gynecomastia are benign and may resolve spontaneously 2. However, in some cases, gynecomastia may be a sign of an underlying serious illness or a medication side effect. A thoughtful approach to diagnosis and treatment is necessary to improve patient outcomes and satisfaction.