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Gynecomastia

The body maintains its health in a certain balance thanks to the functions of all biological systems. Disruptions that arise under the influence of various factors that lead to a disruption of the balance between biological systems cause health problems. The system that controls and regulates the functioning of all tissues of the body is the endocrine system, which is responsible for the regulation of hormones. One of the health problems caused by disruptions in the endocrine system is gynecomastia.

What is Gynecomastia?

Gynecomastia refers to the abnormal development of breast tissue in men due to various reasons. Clinically, gynecomastia is used to describe all conditions in which the breast tissue grows in volume. If the part of the breast tissue that is specialized to produce milk develops in male physiology, gynecomastia is categorized as a disorder. Other than this, obesity The growth of breast tissue due to an increase in adipose tissue throughout the body is called pseudo- or pseudo-gynecomastia.

Gynecomastia can develop at any age; however, it is more common in infancy, adolescence and older men. Although it usually does not cause a clinical condition that requires medical treatment, it can cause an undesirable appearance in patients and can seriously negatively affect the quality of life psychologically and socially. For this reason, various medical treatments and surgical methods have been developed to eliminate gynecomastia.

What Causes Gynecomastia?

The functions of all tissues in the body are regulated by hormones produced by the glands of the endocrine system. Disruption of the balance between hormones results in disruption in the functions of tissues and/or changes in tissue structures at various levels. Breast tissue is also sensitive to certain hormones in the body.

Postpartum milk secretion in women depends on the completion of the development of the mammary glands and the triggering of postpartum milk production under the influence of certain hormones. The development of breast tissue during puberty and the production of postpartum milk is ensured by the effect of estrogen and progesterone hormones. The increase in estrogen and progesterone hormone levels in the blood at certain rates initiates the development of the glands in the breast and causes the breast to grow in volume.

Since the main hormone of the endocrine system in men is testosterone, the effect of estrogen and progesterone hormones in the system is very small. However, if the level of testosterone in the blood decreases for various reasons or if the level of estrogen hormone increases, some tissues in the male body may undergo changes. As a result of an increase in the hormone estrogen, male breast tissue develops abnormally and increases in volume. This condition is called gynecomastia.

Accordingly, gynecomastia can be seen in the following cases due to a disruption in hormone balance:

Physiological Causes

In infancy, childhood, adolescence and older ages, as a result of rapid changes in hormone levels, short-term, self-limiting and then resolving gynecomastia may develop. Gynecomastia due to physiological causes can be encountered in the following periods:

  • In newborn babies, depending on the level of estrogen hormone in the placenta, breast tissue growth compatible with gynecomastia may be seen.
  • During breastfeeding, the estrogen hormone in breast milk passes to the child and relatively increases the amount of estrogen in the blood and may cause temporary gynecomastia.
  • Since the balance between testosterone and estrogen changes frequently during puberty, breast tissue may temporarily develop in the direction of gynecomastia.
  • In parallel with the weakening of testosterone production in older men, the effect of estrogen and progesterone may be strengthened with the decrease in the effect of testosterone on tissues, causing gynecomastia.

Diseases

  • Liver diseases: Gynecomastia may develop in some disorders of the liver, one of the organs responsible for the body’s hormone balance. Likewise, some of the drugs used to treat cirrhosis can also cause this condition.
  • Hyperthyroidism The thyroid gland has important functions in regulating the amount of hormone carrier proteins in the blood. Hipertiroidi In the case of hyperthyroidism, the increase in the amount of carrier proteins in parallel with the increase in thyroid hormones weakens the effect of testosterone and facilitates the development of gynecomastia.
  • Chronic kidney failure: In patients undergoing dialysis treatment for chronic renal failure, the treatment may affect hormone levels and cause the development of gynecomastia.
  • Cancer: Tumors in the testicles, pituitary gland and adrenal gland can trigger the production of estrogen or progesterone, leading to the development of gynecomastia.
  • Genetic diseases: In some genetically based diseases such as Kleinfelter syndrome, gynecomastia may be seen due to congenital hormone imbalance.

Medicines

Some corticosteroids, antibiotics, hormone therapies, heart disease medications, HIV treatment medications, antidepressants, ulcer medications or psychiatric medications containing amphetamines can cause gynecomastia by increasing estrogen and progesterone levels as a side effect.

What Symptoms Does Gynecomastia Cause?

In patients with gynecomastia, some clinical symptoms may be seen in addition to the increase in breast volume. In this context, the following symptoms may accompany the clinical picture in patients with gynecomastia:

  • Increase in breast size and volume,
  • Tenderness or pain in the breast tissue,
  • Discharge, milk secretion or blood from the nipple,
  • Uncomfortable tenderness of the nipple.

How is Gynecomastia Diagnosed?

Gynecomastia can usually be diagnosed based on the patient’s history and physical examination. In cases where there is a gap in the diagnostic process, imaging methods such as ultrasound or mammography can be used to evaluate the breast tissue in detail. A blood test can also be performed to evaluate hormone levels for the diagnosis of gynecomastia. In the physical examination, the development of the glands in the breast tissue and the development of the nipple (areola) tissue are examined, and the fat content in the breast tissue is determined. In the diagnostic process, it is aimed to rule out conditions such as pseudo-gynecomastia, which can increase the volume of fat tissue in the breast, breast cancer and abscesses that develop secondary to infections of the breast tissue.

An important part of the diagnostic process in a patient with gynecomastia is the diagnosis of health problems that may cause gynecomastia. For this purpose, certain blood tests, computed tomography or magnetic resonance imaging, ultrasonography to examine the testicular tissue and, if necessary, biopsy of suspicious tissues may be planned.

What is done in Gynecomastia Treatment?

Although gynecomastia usually does not pose a significant health problem in patients, it may be considered to be treated with various methods since it is an unwanted physical change. Apart from this, in gynecomastia due to liver and kidney failure and endocrine diseases, treating the underlying cause is very important for health.

In gynecomastia due to physiological processes in puberty or childhood, breast growth may regress without any treatment. Therefore, follow-up may be recommended in cases of gynecomastia due to physiological causes. In periods of 3 to 6 months, the size change in breast tissue can be monitored. Temporary gynecomastia seen during puberty usually regresses completely in 2 years.

In cases of gynecomastia detected due to drug use, the responsible drug may need to be replaced with an alternative treatment or discontinued. In the medical treatment of gynecomastia, drug therapies are often used to inhibit the sensitivity of breast tissue to hormones.

Since the use of drug therapy is limited in clinical practice due to its serious side effects, interventional methods are generally used in the treatment of gynecomastia. In this respect, mastectomy surgery, which defines the surgical removal of excess breast tissue, is the most common method of treatment. Which treatment will be applied is decided on a patient basis, based on the patient’s personal preference and the physician’s evaluation.  In addition to treatment practices, avoiding the use of drugs and products that can trigger the development of gynecomastia is also extremely important for treatment success.

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