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Gynecomastia (cont.)

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How do I know if I have gynecomastia (diagnosis)?

The definition of gynecomastia is the presence of breast tissue greater than 0.5 cm in diameter in a male. As previously discussed, gynecomastia is the presence of true breast (glandular) tissue, generally located around the nipple. Fat deposition is not considered to be true gynecomastia.

In most cases, gynecomastia can be diagnosed by a physical examination. A careful medical history is also important, including medication and drug use. If there is a suspicion of cancer, a mammogram may be ordered by a health care practitioner. Further tests may be recommended to help establish the cause of gynecomastia in certain cases. These can include blood tests to examine liver, kidney, and thyroid function. Measurement of hormone levels in the bloodstream may also be recommended in some cases.

What treatment drugs and surgery procedures reduce or cure the condition?

Gynecomastia, especially in pubertal males, often goes away on its own within about six months, so observation is preferred over specific treatment in many cases. Stopping medications and treatment of existing medical problems or health conditions that cause enlarged breasts in men also are mainstays of treatment.

Medical treatments also are available to specifically address the problem of gynecomastia, but data on their effectiveness are limited, and no drugs have yet been approved by the U.S. Food and Drug Administration (FDA) for treatment of gynecomastia. Medications that have been used to treat gynecomastia include:

  • Testosterone replacement has been effective in older men with low levels of testosterone, but it is not effective for men who have normal levels of the male hormone.
  • Clomiphene can be used to treat gynecomastia. It can be taken for up to 6 months.
  • The selective estrogen receptor modulator (SERM) tamoxifen (Nolvadex) has been shown to reduce breast volume in gynecomastia, it was not able to entirely eliminate all the breast tissue. This type of therapy is most often used for severe or painful gynecomastia.
  • Danazol is a synthetic derivative of testosterone that decreases estrogen synthesis by the testes. It works by inhibition of pituitary secretion of LH and follicle-stimulating hormone (FSH), substances that direct the sex organs to produce hormones. It is less commonly used to treat gynecomastia than other medications.

Medications are more effective in reducing gynecomastia in the early stages, since scarring often occurs after about 12 months. After the tissue has become scarred, medications are not likely to be effective, and surgical removal is the only possible treatment. Reduction mammoplasty (breast reduction surgery) has been used in severe cases of the condition, long-term gynecomastia, or in cases in which drug therapies have not been effective to help restore a normal breast appearance.

Typically, gynecomastia is not associated with long-term problems.

How long does it take for gynecomastia to go away?

Although pubertal gynecomastia typically regresses on its own, in rare cases it may persist, requiring treatment. Gynecomastia that is present over the long term (12 months or more) may undergo scarring (medically termed fibrosis), making treatment with medications much more difficult if not impossible to achieve a response.

Psychological consequences can occur if the breast enlargement is pronounced or is a source of embarrassment.

Can gynecomastia be prevented?

Gynecomastia that occurs because of hormonal fluctuations with growth or aging cannot be prevented. Gynecomastia related to medical conditions can only be prevented to the extent that the underlying or responsible condition can be prevented.

Are gynecomastia and male breast cancer related?

Men with gynecomastia have about a five-fold greater risk for developing male breast cancer when compared with the general population. It is believed that the gynecomastia itself is not a precancerous condition, but rather that the hormonal changes (relative increase in estrogens, lower levels of androgens) that produce gynecomastia in adult men also increase their risk of developing breast cancer.

REFERENCES:

Ansstas, G., MD. "Gynecomastia." Medscape. Updated: Mar 21, 2017.
<http://emedicine.medscape.com/article/120858-overview>

Brinton LA, Carreon JD, Gierach GL, McGlynn KA, Gridley G. Etiologic factors for male breast cancer in the U.S. Veterans Affairs medical care system database. Breast Cancer Res Treat. 2009 Mar 29.


Medically Reviewed by a Doctor on 5/18/2017

Source: MedicineNet.com
http://www.medicinenet.com/gynecomastia/article.htm

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