DR MAXWELL ADEYEMI
Gynecomastia is an increase in the amount of breast tissue in men or boys, usually caused by an imbalance of the hormones oestrogen and testosterone. It may affect one or both breasts.
Boys going through puberty and older men can develop gynecomastia due to changes in hormone levels. However, there are other causes.
Gynecomastia is usually not a serious problem but may cause pain, swelling and discomfort in the breast. It can also be a source of embarrassment to the affected person.
The risk factors for developing gynecomastia include:
-Use of anabolic steroids or androgen to enhance athletic performance.
-Certain health conditions including liver and kidney disease, thyroid disorders and hormone active tumours.
CAUSES OF GYNECOMASTIA
Testosterone and oestrogen control sex characteristics in men and women. While testosterone controls the male features, oestrogen controls the female traits.
Men, just like women, produce oestrogen though in small quantities. However, when male oestrogen gets too high or is out of balance with testosterone levels, it can cause gynecomastia.
-More than half of male infants are born with enlarged breasts owing to the effects of hormones from their mother. This usually resolves and goes away within two to three weeks after birth.
-Hormone changes during puberty also causes gynecomastia and, in most cases, the swollen breast tissue will go away within six months to two years.
-Older men can develop gynecomastia. The prevalence peaks between the ages of fifty and sixty-nine. At least one in four men in this age group is affected.
Some medications can trigger breast tissue enlargement or gynecomastia.
-Anti androgen medications used to treat prostate cancer and prostate-related conditions, such as finasteride [Proscar, Propecia] used for enlarged prostate.
-Anabolic steroids normally prescribed by doctors for certain conditions are also used illegally by athletes to build muscles and enhance performance.
-HIV/AIDS medications – certain drugs used to treat people with HIV infections and Acquired Immune Deficiency Syndrome, known as highly active antiretroviral therapy such as efavirenz [Sustiva] are commonly associated with gynecomastia.
-Anti anxiety medications and tranquillizers, or sleeping pills such as diazepam [valium] can also cause this condition.
-Tricyclic antidepressant such as Amitriptyline, used to treat depression and other ailments, can trigger gynecomastia
-Antibiotics – a number of antibiotics such as metronidazole [flagyl] can also cause gynecomastia.
-Antifungal agents such as ketoconazole [Nizoral] used in treating fungal infections.
-Ulcer medications such as cimetidine.
-Cancer medications used in chemotherapy.
-Heart medication such as digoxin as well as calcium channel blockers such as amlodipine, felodipine, nifedipine and nicardipine.
Alcohol, amphetamine, marijuana, heroin, methadone
Several health conditions and diseases can cause gynecomastia as part of their presenting symptoms.
Hypogonadism –This condition interferes with normal testosterone productions, disorders such as Klinefelter’s syndrome and pituitary insufficiency are commonly associated with gynecomastia.
Ageing –Hormone changes that occur in older men especially those who are overweight and obese.
Obesity, which causes the body to produce more oestrogen as fatty cells can act as independent endocrine organs.
Tumours – Cancers of the testes, adrenal glands or pituitary gland can produce hormones that alter the male-female hormone balance and trigger enlargement of breast tissues.
Hyperthyroidism –This happens when the thyroid gland produces too much thyroid hormones known as thyroxine, and growth hormones that control growth and sexual development, which in turn may create an imbalance in other body hormones.
Kidney failure – Persons who undergo dialysis experience hormone changes that can cause gynecomastia.
Liver disease – Liver failure and liver cirrhosis, in addition to medications used in these conditions, may cause alterations in hormone levels which can lead to gynecomastia.
Malnutrition and starvation –When the body is deprived of adequate nutrition, testosterone levels drop while oestrogen levels remain the same, causing a hormonal imbalance that may trigger gynecomastia.
Herbal products – Plant oils such as tea tree or lavender used in shampoos, soap or lotion have been associated with gynecomastia.
In investigating and evaluating this condition, certain tests are helpful in order to determine the cause of gynecomastia. These may include:
-Blood tests, including hormone profiles and liver-function tests.
-Computerised tomography scan [CT Scan]
-Magnetic Resonance Imaging [MRI]
Most cases of gynecomastia resolve over time even without treatment. If the cause is found to be due to an underlying medical condition, such medical ailment will need to be treated.
Those that are caused by medication or drugs will need to be addressed by stopping such medication or the offending drug.
Some cases may require treatment with certain hormone therapy.
In some instances, surgical intervention may be warranted such as liposuction – removal of breast fat, or mastectomy which is the removal of breast tissue.
Affected people may also need to be referred to an endocrinologist, a specialist that deals with hormones and how they affect the body and body organs.
Gynecomastia can be embarrassing to boys and men and can result in avoiding situations in which the chest is bare such as in swimming pools, beaches or gymnasiums. This can lead to anxiety, stress and depression and sometimes may warrant the need for counselling.
Gynecomastia is not breast cancer, as some person may be scared to believe. Though uncommon, men do get breast cancers. However, breast cancer usually will affect one breast and not both at the same time [though it’s not impossible to affect both].
Contact Dr Maxwell on 363-1807 or 757-5411.