Definition
The term gynecomastia refers to the occurrence of, usually benign, enlargement of the mammary gland in men. In general, gynecomastia is not an independent clinical picture. This enlargement of the mammary glands in men is rather a possible accompanying symptom of various systemic diseases.
In addition, an increase in volume of the male breast can occur during treatment with medication. In these cases, it is a so-called adverse drug reaction. Generally, from a medical point of view, a distinction is made between two forms of gynecomastia, real and fake gynecomastia: For the affected man, such changes in the area of the breast represent major problems.
Most patients find the female breast features embarrassing and unsightly, the consequences are often psychological problems and increasing social withdrawal. The presence of a gynecomastia also has an increasingly disturbing influence on the partnership and self-confidence.
- False gynecomastia is caused by pure fat deposits in the breast tissue (for example, due to severe overweight or in the sense of a normal aging process).
- A true gynecomastia is the proliferation of glandular tissue.
Which doctor treats such a thing?
Men who notice that their breasts are growing should always consult a doctor who can clarify the causes and rule out a malignant disease. The family doctor or urologist will take a detailed medical history and can refer the patient to the respective specialists. An endocrinologist (hormone doctor) carries out a special blood test to determine the hormone status, since an imbalanced hormone balance is often the cause of gynecomastia. A gynaecologist or radiologist examines the breast using ultrasound (breast ultrasound) to rule out cancer. If the diagnosis of a real gynecomastia is confirmed and the patient wishes to have the excess breast tissue surgically removed, a plastic surgeon will perform the operation.
Forms
In medicine, changes in the male breast are divided into two classes. They are called normal (physiological) and pathological changes. The class of physiological breast volume increases includes Abnormal (pathological) increases in breast volume are all included in the group of true gynecomastia.
They are therefore “growths” of glandular tissue, not fatty tissue deposits. Pathological gynecomastia itself is not a disease, but only a symptom of a disorder within the organism. The trigger can be a lack of male sex hormones (androgens) or an excess of female hormones (estrogens).
The growth of the mammary gland tissue can also be stimulated in the long term by chronic diseases, such as acute and/or chronic kidney failure, renal insufficiency, liver failure and alcohol addiction. In addition, genuine gynecomastia can occur as an adverse drug reaction in the course of drug therapy. The relevant drugs include hormone preparations, acid blockers (for example cimetidine, ranitidine and omeprazole), calcium antagonists, some neuroleptics and many other drugs.
In addition, in very rare cases, the presence of a tumorous change in the breast (breast cancer) in men can also lead to an increase in glandular tissue.
- Newborn gynecomastia: Female hormones of the mother, which enter the organism of the unborn child via the placenta (placenta), trigger an increase in glandular tissue. Within the first months after birth, the excess breast tissue usually recedes completely.
- Pubertal gynecomastia (see below) : It is caused by the enormous hormonal change during adolescence and is triggered by the increased conversion of hormone precursors into female sex hormones (estrogens).
This form of gynecomastia does not completely disappear in all affected boys.
- Age-related gynecomastia: This type of gynecomastia is also induced by changes in the hormone balance. In contrast to adolescent gynecomastia, however, this change is related to the increasing proportion of fatty tissue compared to the decreasing body mass. As a result, the conversion of male sex hormones (androgens) into female hormones (estrogens) in the fatty tissue increases.
As the concentration of estrogens within the organism increases, the number of androgens decreases.This fact is mainly related to the decreasing functionality of the testicles.
- Overweight: This can also lead to an increase in volume in the area of the breast. In these cases, however, it is not an increase in glandular tissue but rather in fatty tissue deposits.
Long-term alcohol abuse leads to men losing their typically male appearance and getting enlarged breasts. Excessive alcohol consumption can lead to inflammation of the liver and eventually liver cirrhosis, in which it hardens the liver and can no longer function normally.
As a result, certain hormones are no longer broken down and testosterone is increasingly converted into female sex hormones. Alcohol also inhibits the release of the sex hormone producing hormones in the brain, which means that there is generally less testosterone in the body. In addition, alcohol activates an enzyme (aromatase) that converts male sex hormones into female sex hormones and thus leads to an excess of estrogen.
As a result, men become “feminine” and develop gynecomastia. Very often young men are affected by gynecomastia during puberty, this is called pubertal gynecomastia. More than 60% of all cases of gynecomastia affect adolescents during puberty.
This is a norm variant, as the beginning production of sex hormones during puberty causes the hormone balance to be disrupted. Oestradiol, the precursor of the female sex hormone estrogen, is used to produce testosterone in men. In some cases, the concentration of estradiol can rise faster than that of testosterone, and thus the effect of estradiol, which stimulates the growth of the mammary gland, predominates.
Testosterone has the opposite effect. Pubertal gynecomastia can occur on one or both sides and usually regresses spontaneously within two to three years. In rare cases, however, it can persist and manifest itself as a true gynecomastia.
Pubertal gynecomastia is not a disease and requires no treatment. However, especially at this sensitive age, an enlarged breast can be a heavy emotional burden for the affected adolescents and can be accompanied by a high level of suffering. Gynecomastia often develops in strength athletes and bodybuilders who take anabolic steroids or testosterone to build up muscles.
In these cases the cause is hormonal. Testosterone can be converted in the body to estradiol, a female sex hormone. Oestradiol causes an increase in the size of the mammary gland, leading to gynecomastia.
The causes of an increase in breast tissue (gynecomastia) can be many and varied and vary between the different types. In almost all forms of this increase in breast volume, however, the hormone system plays a decisive role. In many cases, this is due to an increased responsiveness of the breast gland tissue to female sex hormones, the estrogens.
In addition, an increased concentration of estrogens within the organism can stimulate the glandular tissue to grow. These increases in concentration can in turn be triggered by pronounced metabolic disorders, diseases of the pituitary gland (hypophysis and/or hypothalamus) or hormone therapies. Taking anabolic steroids can also lead to the formation of gynecomastia.
Gynecomastia can also be provoked during puberty or in the presence of an estrogen-producing testicular tumor. In addition, male sex hormones can also have an influence on the growth of the mammary glands. In this case, however, an androgen deficiency plays a decisive role in the development of gynecomastia.
The reduced production of male sex hormones can be the result of an underfunction of the testicles or age-related. In addition, diseases of other organs can be the cause. These gynecomastia-inducing diseases include hyperthyroidism or hypofunction of the thyroid gland, cirrhosis of the liver or a disturbance in kidney function.
Regardless of organ defects, the intake of high hormone levels through food can also lead to the development of gynecomastia. The consumption of hormone-treated meat plays a decisive role. An increase in breast tissue on both sides can be attributed to one of the above-mentioned reasons in the majority of cases. If, however, a unilateral gynecomastia is present, the presence of a tumor (breast carcinoma; breast cancer) must be urgently excluded.
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