The first signs of gynecomastia in men. Gynecomastia in men: classification, symptoms and treatment methods. Self-examination is carried out as follows:

Pathology of the mammary glands with a unilateral or bilateral increase in size, caused by hypertrophy of glandular or fatty tissues, is called gynecomastia in medicine. Gynecomastia in men is manifested by enlargement and thickening of the gland, accompanied by a feeling of heaviness and pain on palpation. It regresses on its own; if drug therapy is ineffective, it requires surgical treatment.

If the disease persists for a long time, there is a risk of developing a malignant tumor of the mammary glands in a man. The mammary glands with gynecomastia reach from two to ten centimeters in diameter. The frequency of occurrence is: in adolescents 14-15 years old - from 50 to 60%, in young men - about 50%, in elderly men - from 60% to 70%.

The disease causes not only physical inconvenience, but also psychological difficulties.

Classification of gynecomastia

In medicine, there is true gynecomastia and false, i.e. pseudogynecomastia:

True – hypertrophy of glandular tissues and stroma;
False – massive deposition of fatty tissue, an increase in the volume of the mammary gland. It can be seen in obese men.

There is true gynecomastia, as a variant of normal physiology in a certain age period, and pathological, which is a symptom of the presence of a serious pathology in a man’s body.

True physiological gynecomastia is divided into three types:

Gynecomastia in the newborn period - swelling of the glands is observed in 70-90% of newborn babies. The condition is associated with the influence of the mother’s sex hormones, which entered the child’s body in utero. This type of treatment does not require, since a decrease in the mammary glands of the newborn is observed after two to three weeks.
Gynecomastia of the pubertal period is observed in 40-60% of adolescents aged 13 to 14 years and in 70% the mammary glands are enlarged on both sides. This type is caused by an immature reproductive system and the predominance of female hormones over male ones. It regresses on its own within 1-2 years.
Age-related gynecomastia is observed in older men from 50 to 80 years old and is associated with insufficient testosterone production and the predominance of estrogen.

The pathological form is a sign of a serious progressive disease that provokes a decrease in the permissible level of testosterone and an increase in the permissible amount of estrogen. A number of existing reasons for its occurrence:

Testicular disease - anorchia, absence of one or two testicles at birth, defect in testosterone production,
Malignant or benign prostate tumor,
Oncology – adrenal carcinoma or adenoma, tumor of the testicle, stomach, lungs and pancreas,
Hermaphroditism,
Infectious diseases - herpetic breast lesions, epidemic mumps, orchitis, tuberculosis, HIV,
Poor blood flow to the testicles
Injuries in the testicular area,
Cirrhosis,
Thyroid hypertrophy,
Obesity,
Kidney failure
Diabetes mellitus
Pituitary tumor
Cardiovascular failure.

The pathological stage can be caused by long-term use of pharmacological agents:

Diuretics – Veroshpiron,
Hormonal – in the treatment of prostate cancer,
Drugs for the treatment of hypertension and ischemic heart disease - Diroton, Verampil, Dopegit and others,
Cardiac – Digoxin,
Antimycotic, antimicrobial and antibacterial - Trichopolum and Ketoconazole,
Antiviral – in the treatment of HIV infection,
Antiulcers – Omez and Ranitidine,
Drugs – alcohol, drugs,
Tranquilizers - Relanium, Diazepam and Seduxen.

Causes and development of gynecomastia in men

The male mammary gland is an underdeveloped rudimentary organ consisting of a minimal amount of glandular and fatty tissue of the nipple and a short duct. The development and functioning of the glands depend on the influence of the female sex hormone - estrogen and pituitary hormones - prolactin.

The normal amount of estrogen in a man’s body is 0.001% of the androgen content. For various reasons, the percentage of androgens-estrogens changes, increasing the quantitative composition of the latter, and the process of reducing tissue sensitivity to the effects of testosterone also occurs. The influence of estrogens provokes the growth of the male mammary glands, their development according to the female type and the intensive development of glandular tissues, the development of a pituitary adenoma that produces prolactin, the deposition of fatty tissues in the glands and the development of connective tissues. With the disease, the mammary glands become denser and enlarged.

True pathological gynecomastia is caused by the following reasons:

Violation of the estrogen-testosterone ratio in the male body. The condition is observed with a hormonally active tumor of the pituitary gland, stomach, testicles, lungs, adrenal glands, pancreas, inflammatory process in the testicles, prostate adenoma, etc.;
Diseases due to toxicity - liver cirrhosis, cardiovascular or renal failure, injuries in the chest area, HIV infection, herpetic lesions of the chest, normalization of nutrition and others;
Hyperprolactinemia – increased secretion of prolactin, observed with pituitary tumors and hypothyroidism;
Diseases accompanied by a failure of metabolic functions - diffuse toxic goiter, diabetes mellitus, obesity, pulmonary tuberculosis and others;
Taking drugs that have an effect on breast tissue receptors, increasing the reproduction of estrogens, prolactin, etc.;
Drugs;
Alcoholism.

The disease also appears due to genetic and hereditary factors.

Symptoms of gynecomastia

Gynecomastia of the newborn period is marked by slight engorgement and enlargement of the glands, sometimes with colostrum-like discharge. In other types of disease, the glands increase from two to ten centimeters in diameter, and their weight reaches 150 grams. The size of the nipple increases, the areola becomes sharply pigmented and expands to three centimeters in diameter. In special cases, milky discharge from the nipple begins. Usually, the enlargement of the glands is painless, but is accompanied by increased sensitivity of the nipples and discomfort.

Unilateral gynecomastia is accompanied by an increased likelihood of tumor damage to the gland. A hormonally active tumor producing estrogen and gonadotropin causes a transient enlargement of the mammary gland, pain and a feeling of fullness.

Gynecomastia caused by hyperprolactinemia is usually accompanied by impotence and damage to the central nervous system in men.

The disease occurs in three stages:

Developing (proliferating) – an initial change in the first four months, when there is a possibility of reverse development of the disease with proper drug therapy;
Intermediate – lasts from four months to a year and is caused by the maturation of glandular tissues;
Fibrous – characterized by the appearance of connective and fatty tissues in the mammary gland. Process regression is not possible.

If bloody discharge from the nipple area, lumps in the mammary gland, changes in the skin of the gland, or enlarged lymph nodes in the armpit area appear, you should be wary, as these symptoms indicate suspicion of breast cancer.

Gynecomastia caused by hyperprolatinemia affects the central nervous system of men, causing oligospermia and impotence. Impaired potency is observed only with increased estrogen levels and decreased testosterone levels.

With an increased level of estrogen in men, the timbre of the voice changes, becoming high-pitched, excessive tearfulness and irritability are observed, and hair on the body and face disappears.

The pathological appearance is characterized by changes in shape, swelling and swelling of the testicles.

Why is gynecomastia dangerous for men?

The physiological type of pathology is not dangerous and can regress on its own. Teenagers or men are embarrassed by the appearance of their breasts and experience complexes, but by understanding the cause of this condition or working with a psychologist, they gradually smooth out unpleasant anxieties and experiences.

The long-progressing pathological stage not only accompanies the underlying disease, but is also the cause of breast cancer. This oncology is rarely observed in men, but occurs with severe consequences, the same as a malignant breast tumor in a woman.

Signs such as: bloody discharge from the nipple, dense formations, ulcers, changes in the skin, enlarged lymph nodes, should signal a man to immediately contact a surgeon or oncologist.

Diagnosis of the disease

At the first signs, you need to contact an endocrinologist, who will conduct an examination with palpation of the mammary glands and testicles, correctly assess the degree of manifestation of the secondary sexual characteristic, and identify family or drug history. During the examination, it is determined whether the patient has drug or alcohol addiction, the presence of other diseases and the man’s general health.

An experienced specialist will conduct the following research:

Blood test - detects imbalances in hormonal balance,
X-ray of the lungs to exclude the presence of a tumor,
Brain tomography,
Tomography of the adrenal glands and other necessary organs,
Ultrasound examination of the scrotum - to identify a tumor in the testicles,
Ultrasound of the mammary glands and lymph nodes - to detect a tumor in the chest area and to determine the type of disease,
Tumor puncture
Cytological examination to exclude suspicion of a cancerous tumor of the gland.

The liver, which plays an important role in the process, is also not neglected.

Treatment of gynecomastia in men

Physiological types of the disease can disappear spontaneously without drug therapy. To suppress high concentrations of estrogen in adolescents, hormonal drugs are prescribed: Clomiphene, Danazol, Testolactone, Tamoxifen.

If drug therapy does not reduce the size of the mammary glands, surgical intervention - plastic surgery - is required. Breast tissue and fat deposits in the adjacent area are removed.

Treatment of the pathological type is due to the underlying disease that caused the enlargement of the mammary glands. To normalize the testosterone-estrogens ratio, treatment with conservative hormonal therapy is prescribed, which is effective in the first four months after the onset of the disease.

Excess estrogen in a man’s body is treated with anti-estrogenic therapy - tamoxifen, which helps block the effect of estrogen on the mammary glands.

The disease caused by taking medications disappears on its own after they are discontinued, by replacing or reducing the dosage.

Surgery is performed if conservative treatment is ineffective and medications do not give the desired results (for a tumor).

During surgical treatment the following operations are performed:

Subcutaneous mastectomy with areola preservation via para-areolar approach,
Endoscopic mastectomy – for small enlargements of the mammary glands, the operation is performed using an endoscope,
Mastectomy using liposuction, using paraareolar access and removal of adipose tissue.

These operations are well tolerated by patients and the patient recovers after endoscopic and subcutaneous mastectomy in a couple of days.

Limiting physical activity
Special underwear - wear for two to three weeks to correct the muscle contour and correct skin contraction,
Light work – one week after surgery,
Intense loads – every month,
Sports activities – in a month.

Traditional methods in the fight against gynecomastia

Folk remedies for treatment are very effective if used correctly:

Soothing herbs – for significant disorders of the thyroid gland (valerian, peony, motherwort),
Sea cucumber extract,
Bee bread extract,
Golden root, plantain - infusion taken twice a day,
Raspberry leaves, hibiscus, hops, sage - take decoctions in the morning and evening before meals.
Ginseng is a natural stimulant; it is recommended to eat a small piece of ginseng root daily, chewing it thoroughly and mixing it with saliva. The product does not taste very pleasant, but is quite effective, also stimulating sexual potency,
Tincture for regulating hormonal levels and increasing potency - mix 50 grams of oat straw, biloba leaves and yohimbe bark with 1 liter of alcohol. Leave the collection in a dark place for 2 weeks, then strain and store in a cool place. Take 30 drops three to four times a day for 2 months.
Lovage – regulates hormonal imbalance, improves digestion and strengthens the male body. The root of the plant contains phytosterol, which normalizes prostate function. Pour 100 grams of crushed lovage root into a bottle of wine, preferably red, heat until foam forms and leave for three days. Strain and take 50 ml every evening an hour after meals.
Herbal mixture - for gynecomastia, infertility and weak libido. Combine 100 grams of ginseng root, 50 grams of licorice root, 50 grams of raspberry leaves. One tbsp. Pour 500 ml of boiling water over a spoonful of the mixture, cool and strain. Drink throughout the day. Take the collection for two to three months.

These herbs stabilize hormonal levels and reduce the quantitative composition of female hormones.

Any independent steps should be taken only under the supervision of a specialist. Otherwise, there is a risk of not only harming the body, but also aggravating the situation even more, which will lead to the most serious consequences.

Proper nutrition for gynecomastia

The main cause of the pathology is obesity, alcohol, and malnutrition. In order to prevent and get rid of the disease, it is necessary to regulate the diet and diet, and also change habits. A complete diet for men should include:

Complex of vitamins and microelements,
Fish oil and omega 3.6,
Dried fruits, sea fish, nuts and yoghurts,
Squirrels,
Vegetables, fruits, grains.

Prognosis specific to the disease

The physiological course of gynecomastia mostly disappears on its own. In 80% of adolescents, hormonal levels are restored within two to three years.

A favorable prognosis is typical for a disease caused by taking medications. Less favorable - for the type of gynecomastia caused by other progressive diseases. The prognosis for a positive result of treatment of the pathology depends on the severity of the underlying disease, which provoked a hormonal imbalance.

Surgical methods for complex stages of gynecomastia generally completely restore the normal size and shape of the breast.

Unpleasant pathology is caused by both physiological and pathological reasons. In addition to unpleasant physiological sensations, men experience significant emotional depression. To avoid worries due to physiological pathology and pathological gynecomastia, it is necessary to contact a specialist at the first symptoms for examination and further treatment.

Gynecomastia (translated from Greek as female breasts) is a benign enlargement of the mammary (mammary) glands in men. The size of breast formations can range from 1-10 cm, but, as a rule, do not exceed 4 cm in diameter.

Species

There are physiological and pathological gynecomastia.

The first peak of physiological gynecomastia occurs during the neonatal period (60-80%) a few days after birth. This gynecomastia is associated with the circulation of estrogen in the mother’s blood, and goes away on its own within 2-4 weeks.
The second peak of the disease occurs in adolescence (12-14 years) and is caused by hormonal changes in the body. Adolescent gynecomastia disappears after 6-24 months without treatment.
And the third peak occurs in old age (in men 50-80 years old), it is associated with a decrease in testosterone levels and relative hyperestrogenemia (increased levels of female sex hormones).

There is also a distinction between false and true gynecomastia.

The false form of the disease develops due to the proliferation of adipose tissue (for example, with obesity or excessive drinking).
True gynecomastia is the proliferation of glandular and stromal tissue. Both one mammary gland can be affected - unilateral gynecomastia, or both - bilateral gynecomastia. In adolescents, a bilateral form is more often observed.

Reasons

The causes of gynecomastia are very numerous. First of all, true gynecomastia is associated with hormonal imbalance (predominance of estrogens and/or lack of androgens):

congenital hypogonadism (underdevelopment of the testicles);
toxic, radiation or infectious damage to the testicles;
testicular tumor that produces estrogens;
adrenal tumor (increased estrogen synthesis);
dysfunction of the hypothalamus (the part of the brain responsible for the formation of hormones);
genetic diseases (Klinefelter syndrome);
hyperfunction of the thyroid gland (thyrotoxicosis);
liver diseases (cirrhosis) in which estrogens are not destroyed;
choriocarcinoma (a malignant tumor that synthesizes the pregnancy hormone - hCG);
in male athletes with a sudden cessation of physical activity;
malnutrition or hunger;
HIV infection (causes hyperprolactinemia).

In addition, gynecomastia can be a side effect when taking the following medications:

spironolactone;
calcium channel blockers (Corinfar, verapamil);
antihypertensive drugs (capoten, enap);
antibiotics and antifungals (metronidazole, ketoconazole);
hormonal drugs in the treatment of prostate cancer;
drugs and alcohol;
cytostatics (methotrexate);
antidepressants and tranquilizers (Relanium).

Symptoms of gynecomastia

The following clinical picture is typical for gynecomastia:

the mammary gland or glands increase in size, palpation reveals mobile elastic formations and tenderness of the mammary glands,
Patients often complain of a feeling of fullness or heaviness in the chest, enlargement of the nipples (swelling) and their increased sensitivity,
Clear or cloudy discharge from the nipples is possible.

During gynecomastia there are 3 stages:

1. Developing (proliferating) stage - lasts approximately 4 months. When treatment is prescribed, the mammary glands return to their original size.

2. Intermediate stage - lasts from 4 to 12 months. At this time, mammary gland tissue matures, and the mammary glands practically do not return to their previous size.

3. Fibrous stage - characterized by the appearance of mature connective tissue in the mammary gland and the formation of fatty deposits around the glandular tissue. The fibrous stage is irreversible.

Diagnostics

In the diagnosis of gynecomastia, ultrasound of the mammary glands, axillary lymph nodes, as well as mammography and puncture biopsy are used.

In addition, laboratory diagnostics are carried out to determine the level of hormones (testosterone, estradiol, thyroid-stimulating hormone TSH, prolactin, hCG, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

If a testicular tumor is suspected, a testicular ultrasound is performed, and if an adrenal tumor is suspected, a computed tomography scan is performed.

Patients often need consultation with a surgeon, urologist, endocrinologist and therapist.

Treatment of gynecomastia

Treatment of gynecomastia is carried out by oncologists-mammologists and endocrinologists.

First of all, it is necessary to establish and eliminate the cause that led to the disease. Depending on the etiology of gynecomastia, the treatment time varies (sometimes they reach several months). When taking medications that have gynecomastia as a side effect, it is enough to stop them or reduce the dose.

During the first six months, they prefer to monitor the development of the disease. If independent regression of gynecomastia does not occur, conservative hormonal therapy is prescribed:

testosterone (therapy for patients with low levels of this hormone, elderly people);
clomiphene is an anti-estrogen used to stimulate ovulation in female infertility;
tamoxifen - an estrogen receptor blocker (for severe disease and severe pain);
Danazol is a synthetic analogue of testosterone.

Surgical treatment is performed in patients with suspected malignant process and with a pronounced cosmetic effect.

Mammoplasty involves the removal of breast tissue with the formation of a bed under the nipple to avoid its retraction.

Complications

The most dangerous complication of gynecomastia is malignancy (degeneration into cancer) of the tumor. In addition, emotional disturbances and scarring of a long-standing tumor cannot be ruled out.

Prevention and prognosis

The prognosis for gynecomastia in newborns and adolescents is favorable (the disease regresses on its own). In other cases, the prognosis for the disease depends on the causes that caused it and also remains favorable with surgical treatment.

Prevention of gynecomastia consists of maintaining a healthy lifestyle, carefully selecting medications that led to the development of the disease, as well as preventing causes that can cause gynecomastia.

Gynecomastia is a disease in which a man’s mammary gland begins to grow and increase in volume. When feeling it, the man feels pain, the chest seems full and heavy.

Many doctors believe that the only treatment for gynecomastia is surgery. Others argue that gynecomastia in men can be treated without surgery, it all depends on the form of the disease. Only those men whose disease is in advanced stages need surgery.

What is it?

Gynecomastia is an enlargement of breast tissue in men, accompanied by a change in the volume of glands and fatty structures. The breast diameter of a man with gynecomastia reaches 10 centimeters, although this figure often varies from 2 to 4 cm.

Development mechanism

In men, the mammary glands are a vestigial organ that has lost its original purpose in the process of evolutionary development. They consist of adipose tissue, a small amount of glandular tissue with ducts, a nipple and an areola.

The development of glandular tissue and ducts, as well as their functioning, depend primarily on estrogens (female sex hormones) and progesterone, as well as prolactin (a pituitary hormone), which stimulates the formation of estrogen-sensitive receptors in the mammary glands.

Androgens (male sex hormones) are synthesized in the testes and adrenal glands. In peripheral tissue, mainly adipose tissue, under the influence of the aromatase enzyme, they are partially transformed into female sex hormones. In liver cells, estrogens are rapidly destroyed by combining with sulfur and glucuronic acid and are excreted by the kidneys. In the male body, estrogens normally constitute an insignificant fraction (0.001%) of the content of androgens - testosterone and its more active form, dihydrotestosterone.

Under the influence of certain factors, the ratio of sex hormones changes in favor of estrogens, as a result of which changes in the mammary glands corresponding to the syndrome occur. The main causes of gynecomastia are as follows:

an absolute increase in the content of estrogen in the blood, associated with an increase in their production by glands or a hormone-producing tumor;
a relative increase in estrogen (with normal levels in the blood), which is the result of a decrease in androgen levels;
a decrease in the sensitivity of target tissue cells to the effects of androgens with normal levels of female and male sex hormones in the body, as a result of which the effect of estrogens predominates.

Pathological processes can also be the cause of the developing growth of male mammary glands:

deficiency of male hormones;
overproduction of estrogen;
hyperprolactinemia (increased prolactin production);
uncontrolled use of medications, steroids (tamoxifen, creatine, methane, etc.), drugs (marijuana, amphetamines);
breast cancer;
other diseases (liver cirrhosis, overactive or insufficient thyroid gland, renal failure).

Gynecomastia can also appear due to genetic and hereditary factors. Very often it is idiopathic, associated with unknown causes, or is a consequence of obesity or hormonal problems.

If you are experiencing other symptoms in addition to breast enlargement, such as loss of libido, impotence, chronic fatigue or anxiety, you should consult your doctor as these may indicate more serious conditions. Medical diagnosis performed in such cases usually includes analysis of certain hormones in the blood, ultrasound or computed tomography.

Classification

Experts distinguish several classifications of the disease:

Symmetrical, bilateral, and asymmetrical, unilateral, gynecomastia. With the first, both mammary glands are enlarged, and with the second, only one is enlarged. In this case, special attention should be paid to the second option, since this may indicate oncology, especially with hardening of the mammary gland.
False and true gynecomastia. With false glands, they enlarge due to adipose tissue, which is usually a consequence of overweight and obesity, and with true glands, they enlarge due to glandular tissue.

It is customary to distinguish 3 stages of breast disease:

Proliferating, or developing, is the first stage of the disease. Its duration is no more than 4 months. At this stage, the disease can be cured conservatively without resorting to surgery. In addition, the cost of such treatment will be much cheaper than surgery.
The intermediate stage is characterized by the maturation of breast tissue, but it does not disappear. The stage lasts from 4 to 12 months. At this stage, the disease can still be treated with medication if tissue scarring has not occurred.
The fibrous stage is accompanied by the appearance of mature connective tissue in the mammary gland, and fatty deposits begin around the glandular tissue. At this stage, it is almost impossible to return the mammary gland to its previous size.

If you suspect a pathological process in the mammary gland, you should see a doctor, because in the early stages, treatment of gynecomastia brings positive results, and the price of therapy is affordable for any patient.

Why is gynecomastia dangerous?

Physiological gynecomastia is not dangerous and regresses on its own. A boy or man may be embarrassed by the appearance of his breasts and experience some complexes, but understanding the cause of this condition or working with a psychologist can smooth out these unpleasant experiences.

Long-term pathological gynecomastia, in addition to the fact that it accompanies a progressive underlying disease, can cause the development of breast cancer. This cancer is quite rare in men, but is accompanied by the same severe consequences as malignant breast tumors in women.

The appearance of bloody discharge from the nipple, dense formations, ulcerations, changes in the appearance of the skin over the lumps and enlargement of nearby lymph nodes - such signs should alert a man and become a reason for immediate contact with a surgeon or oncologist.

Symptoms of gynecomastia, photos

Gynecomastia is an increase in the size and volume of the mammary glands in men due to hypertrophic processes in glandular and fat cells. Diagnosis of this condition does not present any difficulties, since the altered organs are accessible to visual inspection.

Characteristic symptoms of gynecomastia (see photo):

the appearance of swelling in the nipple area;
spherical formation in the peripapillary region, determined by palpation;
an increase in the volume of tissue in the projection of the pectoral muscles, combined with their sagging;
sore nipples;
discharge when pressing on the nipples.

In total, there are 3 degrees of mammary gland enlargement in men:

first (moderate) – breast volume does not exceed 6 cm.
second (medium) – enlargement of the mammary gland from 6 to 10 cm.
third (pronounced) – the breast increases by more than 10 cm.

What gynecomastia looks like, the photo can be seen below:

Diagnostics

Using various diagnostic methods, a specialist can determine the degree of progression of the disease. The doctor conducts an initial examination and questions the patient about the presence of diseases and alcohol and drug addiction. To clarify the diagnosis, the following studies are carried out:

Blood test - to detect estrogen levels.
Sperm analysis - to assess the condition of the reproductive system and detect signs of feminization.
Breast ultrasound - to determine the structure of the mammary gland, the size of the lesion, and the presence of signs of inflammation.

If a blood test shows an increased level of testosterone, creatinine and prolactin, an ultrasound examination of the testicles is prescribed, which helps determine the stage of development of the disease. Diagnosis can sometimes be made using a chest x-ray.

Treatment of gynecomastia in men

The tactics for treating gynecomastia in men without surgery depends on the cause that caused it.

Physiological gynecomastia of newborns in the vast majority of cases does not require treatment and disappears on its own. Gynecomastia, especially during puberty, often goes away on its own within about six months. Therefore, in the absence of signs of malignancy, observation is preferable in many cases. If there is no positive dynamics within 6 months, drug therapy is usually prescribed.

Independent, uncontrolled use of these drugs without identifying the exact cause of gynecomastia can lead to worsening of gynecomastia, progression of the disease, or severe side effects.

Tamoxifen (Nolvadex), a selective estrogen receptor modulator, is most often used for severe and painful forms of gynecomastia.
Clomiphene is an antiestrogen often used to treat gynecomastia.
Testosterone - prescribed to patients with low testosterone levels, elderly men; for patients with normal testosterone levels, it is usually ineffective.
Danazol is a synthetic derivative of testosterone, reduces the synthesis of estrogen in the testicles, and is used to treat gynecomastia much less frequently than other drugs.

For gynecomastia caused by taking medications, the issue of replacing the drug or reducing the dose is decided. Gynecomastia caused by diseases of internal or endocrine organs requires treatment of the underlying disease.

Gynecomastia in bodybuilding

Nutrition rules

The main causes of the disease are obesity, poor nutrition, and alcohol consumption. The first thing to do to get rid of pathology, and for preventive purposes, is to establish a diet and change eating habits.

A man's nutrition should be complete:

you need to consume all the necessary vitamins and microelements.
You also need to reduce your consumption of fast carbohydrates and fats.
It is extremely important to eat more protein.
eat more vegetables, fruits and grains.
you need to stop consuming sweets and starchy foods.
include fish oil and omega 3, 6 in your diet.
eat foods with a lot of zinc - dried fruits, nuts, yoghurts, sea fish.

With an integrated approach, herbal treatment should be included. It is advisable to drink infusions and decoctions from:

golden root;
plantain;
raspberry leaves;
hibiscus;
hops;
red clover;
sage.

These herbs can stabilize hormonal levels and reduce excess amounts of female hormones.

Surgical treatment

Depending on the prevalence and type of pathological process, the following operations can be performed:

Endoscopic mastectomy: can be performed with minimal breast enlargement, this is a minimally invasive operation, performed using an endoscope;
Areola-sparing mastectomy: performed via para-areolar approach;
Mastectomy with liposuction: performed through a para-areolar approach, additionally removing excess fatty tissue.

Endoscopic and subcutaneous mastectomy are well tolerated by patients. The patient recovers quickly after the operation and after 2 days he can be discharged from the hospital.

In the postoperative period, he must follow a number of recommendations: limit physical activity and wear special underwear for 2-3 weeks to correct the muscle contour and correct skin contraction. After a week, the patient can begin light work, and after a month, more intense physical activity or sports training is allowed.

Forecast

Physiological gynecomastia in most cases is characterized by favorable prognosis and disappears on its own. In 75% of adolescents, hormonal levels are restored within two years.

A more favorable course is typical for gynecomastia caused by taking medications, and a less favorable course for gynecomastia caused by diseases.

Pathology of the mammary glands with a unilateral or bilateral increase in size, caused by hypertrophy of glandular or fatty tissues, is called gynecomastia in medicine.

It is manifested by enlargement and thickening of the gland, accompanied by a feeling of heaviness and pain on palpation. It regresses on its own; if drug therapy is ineffective, it requires surgical treatment.

What is it?

Gynecomastia is a disease characterized by enlargement of the mammary glands in men. It can occur in healthy newborn boys, in adolescence, and in older men. This type of gynecomastia is called physiological, does not require any specific treatment and goes away on its own.

Sometimes there is a pathological type of the condition in question.

Classification

In accordance with the distribution of hypertrophy, the following types of gynecomastia are distinguished:

unilateral, in which only one mammary gland is enlarged;
bilateral, characterized by the growth of both glands.

In medicine, the following forms of gynecomastia are distinguished:

True, which is manifested by the proliferation of stromal and glandular tissues. When palpated in the nipple area, a lump can be identified.
False, also called lipomastia, occurs in obese men. Not hazardous to health.
Mixed, in which both forms occur. There are two types of it: in the first case, glandular tissue predominates, in the second, adipose tissue.

In addition, gynecomastia can be diffuse and nodular. The first does not pose a health hazard and can quickly regress. But the presence of a nodular form can cause the development of breast cancer. Therefore, if a dense formation is detected, discharge mixed with blood occurs from the nipples, or enlarged lymph nodes in the armpit area, it is necessary to immediately consult a doctor.

Causes of gynecomastia in men and adolescents

Gynecomastia occurs against the background of hormonal disorders, when the level of female sex hormones (estrogens) is significantly increased compared to the level of male sex hormones (androgens). In most cases, gynecomastia occurs in newborns - in 80% of cases. The swelling of the mammary glands in this case is associated with the action of the mother's estrogens, which entered the baby's body during its intrauterine development. As a rule, gynecomastia in newborn boys disappears on its own by the age of one month.

If we consider gynecomastia as a symptom of a serious pathology, then it can appear in men with the development of the following diseases:

choriocanceroma;
bronchogenic lung cancer;
true hermaphroditism;
feminizing adrenal tumor (adenoma or carcinoma);
chronic renal failure;
hyperthyroidism – increased function of the thyroid gland;
hyperprolactinemia is a consequence of pituitary gland pathology;
malnutrition and hunger;
cirrhosis;
obesity;
testicular pathologies that are accompanied by a decrease in testosterone production - for example, anorchia (absence of one or two testicles), Klinefelter's syndrome, defects in testosterone synthesis, decreased blood flow in the testicles, benign/malignant neoplasms, orchitis, mumps and trauma.

In addition, the pathological condition in question may be a side effect of a number of medications:

Ranitidine, Omeprazole – antiulcer drugs;
Dopegit is an antihypertensive drug;
Nizoral, Metrid - antifungal agents;
Veroshpiron is a diuretic and antiandrogenic agent;
tranquilizers - for example, Realnium or Seduxen;
tea tree oil;
Amlodipine, Verapamil - calcium channel blockers that are used to treat hypertension;
Capoten, Diroton - angiotensin-converting enzyme inhibitors that are used to treat hypotension and heart failure;
hormonal drugs for the treatment of malignant tumors in the prostate gland;
drugs for antiretroviral therapy for human immunodeficiency virus.

Pubertal gynecomastia (adolescent) can appear in boys aged 12-14 years, which is explained by temporary changes in hormone levels. As a rule, in this case, both mammary glands will enlarge, and sometimes discharge from the nipples is observed. Usually, within a maximum of 2 years, the adolescent’s hormonal status stabilizes, and gynecomastia disappears on its own. There are cases when pubertal gynecomastia persists for more than 2 years - doctors will classify it as persistent.

In old age (50-80 years), gynecomastia is also physiological in nature, and its appearance is due to the fact that due to age-related changes in a man, the level of estrogen (female sex hormones) increases.

Symptoms and stages of gynecomastia

Based on the complaints of men, doctors identify a group of characteristic signs of gynecomastia (see photo):

There are episodes when men notice slight discharge from the nipples, similar to breast milk.
In men, libido decreases, sexual activity fades, and the first signs of erectile dysfunction appear.
The timbre of the vocal cords changes.
Hair growth, characteristic of male hair growth, decreases.
A man becomes susceptible to depression and mood swings.
An increasing feeling of discomfort and heaviness in the area of the mammary glands, accompanied by occasional mild itching and swelling in the chest.
No pain. Pain syndrome, as a rule, is not noted.
A man may notice swollen and hardened areas in his mammary glands. On both sides at once or only on one.
A sharp increase in breast size. Rapid growth of up to 5–15 cm is possible, but gynecomastia with the growth of glands no more than 3–4 cm is more common.
In parallel with the growth of hypertrophy, an expansion of the area of the nipples may occur. At the same time, they acquire a dark shade and become more pronounced.

During gynecomastia there are three stages:

Developing (proliferating) – initial changes, the first 4 months, when reverse development of gynecomastia is possible with appropriate drug treatment;
Intermediate – characterized by the maturation of glandular tissue; lasts from 4 months to a year;
Fibrous – the appearance of connective and adipose tissue in the mammary gland is noted; regression of the pathological process is practically impossible.

The appearance of bloody discharge from the nipple, lumps in the gland, changes in the skin of the gland, ulcerations, and enlarged axillary lymph nodes makes one suspect breast cancer.

Diagnostics

During a face-to-face appointment, the patient's breast tissue and axillary lymph nodes are palpated. Based on palpation, the doctor can make a preliminary diagnosis, and to confirm it, prescribe additional diagnostic procedures to the patient:

Mammography
Breast biopsy
Computed tomography of the adrenal glands

It is mandatory to take blood for a laboratory test, which will determine the level of:

Testosterone
Estradiol
Luteinizing hormone
Thyroid-stimulating hormone
Prolactin
Human chorionic gonadotropin

Patients can seek help from a physician, surgeon, urologist and endocrinologist. Consultation with highly specialized specialists will allow you to develop a competent treatment strategy.

What does gynecomastia look like in men: photo

The photo clearly shows how gynecomastia manifests itself in men:

Complications

Gynecomastia that exists for more than 12 months may undergo scarring (fibrosis), which makes drug treatment extremely difficult.

Another complication of gynecomastia is psychological consequences; they most often occur in adolescents if breast enlargement is the cause of inferiority complexes.

How to treat gynecomastia?

Physiological types of gynecomastia usually disappear spontaneously and do not require drug correction. Sometimes hormonal drugs may be prescribed to suppress high concentrations of estrogen in physiological gynecomastia in adolescents. Treatment of pathological gynecomastia is determined by the underlying disease that caused the enlargement of the mammary glands.

Surgical treatment for gynecomastia is carried out in cases where conservative therapy is ineffective or it is clear that drug treatment will not give the desired result (for tumor lesions).

Treatment of gynecomastia without surgery

Only a doctor can prescribe drug treatment for gynecomastia without surgery. It is prohibited to prescribe hormone replacement therapy yourself due to the possible worsening of symptoms or side effects.

The treatment uses medications that can be taken at home:

Testosterone or dihydrotestosterone - is prescribed to patients with low levels of this male hormone (elderly men, adolescents).
Clomiphene is an anti-estrogen and normalizes hormonal levels.
Tamoxifen (Nolvadex) is a selective estrogen receptor modulator. It is prescribed for severe and painful forms of gynecomastia.
Danazol is a synthetic derivative of testosterone that reduces the production of estrogen by the testicles. It is used extremely rarely in therapy.
Testolactone is a drug with an antiestrogenic effect.
Tamoxifen – used to treat breast cancer.

You can also try folk remedies. The basic principle of traditional medicine in the treatment of male gynecomastia is the use of plants that reduce the production of female hormones and stimulate the production of male ones.

Products used in herbal medicine at home:

Ginseng root is a natural stimulator of testosterone synthesis. Eat a piece of the root every day, chewing it thoroughly and mixing it with saliva. The product does not have the most pleasant taste, but it helps effectively. Additionally, it stimulates potency.
Tincture for men's health - designed to regulate hormonal levels and improve potency. Mix 50 g of ginkgo biloba leaves, yohimbe bark, fresh oat straw with a liter of alcohol. Leave for 2 weeks in a dark place, strain, store in the refrigerator. Take 30 drops 3-4 times a day for 2 months.
Lovage – strengthens the body, improves digestion and treats hormonal disorders. The root of the plant contains phytosterol, which normalizes prostate function. Grind 100 g of lovage root, pour in a bottle of red wine, heat until foam appears, leave for 3 days. Strain, take 50 ml every evening an hour after dinner.
Herbal mixture for gynecomastia, weak potency, infertility. Combine 100 g of ginseng root, 50 g of licorice root and raspberry leaves. Pour a tablespoon of the mixture into two glasses of boiling water, let cool, strain. Drink in a day. The course of treatment will be 2-3 months.

If a malignant process is diagnosed, urgent surgery is necessary.

Breast removal surgery

If conservative therapy does not bring the desired results, or in the case when, after the diagnosis has been established, it is clear that drug treatment will not lead to success, surgical intervention is performed. It consists of excision of the mammary gland and subsequent restoration of its physiological contour.

The operation is indicated in the following cases:

significant increase in glandular tissue;
the pathology does not disappear for more than a year;
too obvious cosmetic flaw.

For gynecomastia, the following types of mastectomies are performed:

Endoscopic, in which an incision is made in the armpit area. Most often it is performed for minor breast enlargement.
Subcutaneous. A periareolar incision is made to preserve the areola.
Subcutaneous with liposuction procedure.

All types of operations are well tolerated by patients. As a rule, rehabilitation does not require a lot of time. True, in the first few days, men experience swelling and hematomas; some patients feel slight discomfort in the chest.

The rehabilitation period is individual for each patient, but the final result can be observed 3 months after the operation.

After surgery, wearing special shapewear is recommended for 1.5–3 weeks - it promotes skin contraction and helps the correct formation of the muscle contour. For a month it is necessary to exclude even minimal physical activity.

Forecast

Gynecomastia in newborns and adolescents is characterized by a favorable course. In the post-pubertal period, gynecomastia disappears within 2 years in 75% of young men, and in another 15% over the next 3 years.

The outcome of pathological forms of gynecomastia depends on the possibility of eliminating the cause of the disease. Prognostically, drug-induced gynecomastia is more favorable, while gynecomastia caused by chronic diseases is less favorable.

Long-term gynecomastia increases the likelihood of breast cancer in men.

Enlargement of the mammary glands in men is formed as a result of the growth of adipose or glandular tissue. The disease can be either unilateral or bilateral. Breast thickening often develops during puberty and then goes away on its own. Often, the disorder occurs in athletes, for example, those practicing bodybuilding, due to lack of exercise and use of anabolic steroids. To ensure that the hormonal balance does not shift towards female hormones, you need to carefully select the training program during the course.

The mammary gland can increase from 1 to 10 cm. Symptoms of the disease are expressed in breast hardening, painful sensations when palpating and a feeling of heaviness. If there is no result from conservative treatment, surgical intervention is indicated, since advanced gynecomastia can develop into breast cancer. The ICD-10 disease is numbered N62. The army and gynecomastia are quite compatible, so there is no delay with such a diagnosis.

Classification of the disease

Exists false And true form of the disease. In some cases, they can be combined, for example, with dyspituitarism in adolescents. The first form includes pseudogynecomastia, that is, breast enlargement due to fat deposits in boys or men, when there are no alveolar formations in the tissues.

True gynecomastia It happens physiological And pathological. The first form includes newborn, adolescent and senile gynecomastia. The pathological appearance develops with genetic and iatrogenic pathology, hormonal and somatic diseases, genetic disorders and paraneoplastic dysfunction (testicular, breast, kidney cancer, etc.).

Stands out diffuse(extensive) and nodal(partial) prevalence of the disease.

One-sided male gynecomastia usually develops with increased local sensitivity of the breast to blood estrogens. The mammary gland on the left is most often affected. Double sided the form of the disease means that both breasts are affected at the same time, although the intensity of the disorders is usually different.

There are 3 stages of development:

1. Developing– the first period, lasting about 4 months. The changes are reversible and conservative therapy is sufficient.
2. Intermediate the form can last up to 1 year. Breast tissue changes.
3. Fibrous– fat cells are deposited in the mammary gland, and mature connective tissue is formed; reverse development is impossible.

Clinically, there are 4 degrees of gynecomastia:

I degree- least subareolar nodularity;
II degree- the seal is smaller than the size of the areola;
III degree- the node has the volume of the areola;
IV degree- the lump is larger than the pigmented area around the nipples.

By size they are conventionally distinguished moderate(up to 6 cm), average(up to 10 cm) and expressed(more than 10 cm) education. It is calculated using a formula taking into account the height and circumference of the gland.

Symptoms and signs

Due to fetoplacental blood and a large volume of maternal estrogens, children, including girls, may develop transient gynecomastia after birth. This phenomenon is typical for a large part of newborns; over time, the pathology goes away on its own.

The pubertal transient form of the disease as a natural phenomenon is observed in 35-85% of boys during puberty. At this age, guys usually experience minimal, slightly noticeable breast enlargement. Usually there is a bilateral increase; in the case of unilateral formation, the asymmetry can be quite strong.

The causes of this form of gynecomastia are not fully understood. It has been established that during puberty, the production of estrogen is higher than testosterone, which contributes to hormonal imbalance. There is an opinion that the ratio of gonadotropins and PRL is to blame. Since the secretion of FSH increases when the secretion of FSH increases, the number of testicular cells increases, and the secretion of LH reaches the “male” level only after 2 years. In this case, a slight proliferation of the milk ducts occurs. Of course, this causes mental discomfort and anxiety in the young man: instead of the desired maturity, feminization occurs. The young man tries to hide his gynecomastia, avoids playing sports, and is embarrassed to undress in front of his peers. As a rule, after 6-18 months all symptoms disappear spontaneously.

The juvenile form of the disease can be hereditary, but fathers often forget about the presence of such disorders in their past, which complicates the collection of anamnesis. There is usually no need for treatment during puberty, you just need to wait a little longer.

At this age, only with persistent gynecomastia does enlargement of the mammary glands persist. Moreover, this form practically does not respond to conservative therapy and often requires surgery. According to statistics, approximately 1/3 of adult representatives of the stronger sex have gynecomastia, manifested by proliferation of the mammary gland ducts and stroma. This is due to the influence of environmental, pathopharmacological and other factors.

Brief interesting data
- Lenehin first described gynecomastia in 1771.
- The disease got its name from two Latin words gyne - woman and mastos - breast.
- During puberty, gynecomastia occurs in 50–70% of adolescents and up to 70% of older men.

Often doctors do not pay due attention to the problem of the disease, which leads to late treatment and the formation of large nodules. This causes great discomfort for young men and can even lead to suicide attempts. The operation does not help eliminate the defect and does not help mask the anomaly. Since postoperative scars often provoke increased interest among women in the future. Against this background, depression may develop. Often, the clinical picture of gynecomastia is supplemented by disorders of sexual development - testosterone is produced inappropriately for age, delayed or, conversely, premature development of the penis and testicles, obesity, the formation of a eunuchoid phenotype or feminization.

Severe complications are expressed in female-type development, unnatural distribution of subcutaneous adipose tissue and supination of the forearms. This occurs due to damage to the central part of the regulation of the reproductive system.

Complications

Gynecomastia left untreated for more than a year may undergo fibrosis (scarring), which makes drug therapy difficult. The disease can also leave serious psychological consequences and contribute to the emergence of an inferiority complex.

The most dangerous complication is the degeneration of gynecomastia into cancer. According to statistics, 20-60% of cases of malignant breast tumors in men are formed due to the disease.

After surgery, signs such as skin tears, breast asymmetry, infectious complications, scarring or scarring may occur. Serious disorders requiring reoperation are extremely rare.

In mature men with excess weight, after removal of a large volume of tissue, insufficient blood supply may develop, which leads to necrosis of the nipple. Its sensitivity, when changing its usual position, sometimes decreases or completely disappears.

Causes of the disease

The formation and functioning of the mammary glands are influenced by estrogens, androgens, prolactin, growth hormone, and pituitary gonadotropic hormones. They consist of two sections: secretory and interstitial.

Highlight interstitial transformation with deposition of fat cells, proliferation of connective tissue and parenchymal with proliferation of milk ducts. The first type is associated with the influence of testosterone, estrogens and progesterone. The second form is prolactin, since there is excessive production of prolactin.

Studies have shown that the condition of the mammary glands in women is influenced by the same hormones as in men. Gynecomastia is accompanied by increased accumulation of estradiol in the body. A long-term disease leads to fibrosis and hyalinization of the gland tissue.

Gynecomastia is a pronounced symptomatic manifestation of absolute or relative hyperestrogenemia. Estrogens are produced in the body of any healthy man, but increased secretion or exogenous administration is a pathology. The role of the hormone prolactin in the development of gynecomastia is not completely clear, but nevertheless, we must not forget that it increases the sensitivity of target organs (kidneys, liver, etc.).

During pregnancy, how the fetus develops mammary glands is determined by the set of sex chromosomes, which can be a consequence of sensitivity to hormonal influences.

From all that has been said, we can conclude that the causes of gynecomastia may be an increase in the production of estrogens and PRL, impaired metabolism of estrogens, androgens in the liver, increased sensitivity of tissues to them, functional hyperprolactinemia, regular contact with drugs containing estrogens or blocking androgens.

Some diseases of organs and systems can contribute to the development of gynecomastia: liver cirrhosis, hyperthyroidism, chest injuries or damage to the chest by herpes infection, adrenal tumors, diabetes mellitus, pulmonary tuberculosis, renal and liver failure, HIV infection.

Diagnostics

Breast lumps and nodules can be detected by palpation, which can be very painful. At the same time, their consistency, symmetry, and size are assessed. Also, by palpation, enlarged lymph nodes, the condition of the nipples, their displacement and mobility, and adhesion to other tissues are diagnosed. Gynecomastia is often accompanied by the separation of secretions from the nipple; this is usually serous colostrum; profuse galactorrhea rarely develops.

First of all, the doctor tries to determine whether gynecomastia is false or true, pathological or physiological. He will definitely clarify how long ago the breasts began to enlarge and whether the process is progressing. Detects the development of symptoms of erectile function, hypogonadism, fertility and sexual desire. Diagnostics includes determining the location of subcutaneous fat, the nature of hair growth and timbre of voice, and examination of the genitals.

It is necessary to take tests for the level of hormones in the blood: PRL, LH, testosterone, FSH, TSH, estradiol, hCG. It is also necessary to examine creatinine, liver enzymes and evaluate the results of a chest and breast x-ray (mammography), in some cases an ultrasound of the testicles is indicated. Patients with incomplete puberty undergo CT or MRI of the adrenal glands.

Treatment

Treatment of gynecomastia should be carried out by an endocrinologist or mammologist.

First of all, the cause of the disease should be identified and eliminated. For example, if gynecomastia is a consequence of taking a drug, it is enough to discontinue it or replace it with another.

Usually, the disease is simply observed for up to 6 months and expected to resolve on its own. If it does not occur, then they try to get rid of breast enlargement with the help of hormonal treatment: clomiphene, testosterone, tamoxifen and danazol. Gynecomastia in adolescents can usually be treated with bromocriptine. Aevit and vitamin B1 are also indicated.

Surgical removal (mastectomy) is performed only if there is a pronounced cosmetic defect, if there is a suspicion of cancer development, or if there is no result from conservative treatment. Mammoplasty helps remove breast tissue to form a bed under the nipple to prevent its retraction.

Prevention

Prevention of the disease involves careful selection of medications, avoidance of anabolic steroids, leading a healthy lifestyle without drugs, alcohol and overeating, and eliminating causes that can provoke gynecomastia. Treatment should begin as early as possible, since the longer the course, the higher the likelihood of degeneration into cancer.. A man's diet should consist of healthy and plant-based foods.

Traditional methods of treatment

At home, the patient must follow all doctor's recommendations. Unfortunately, folk remedies are powerless in the treatment of gynecomastia. In order to normalize the psychological background, you can brew sedative herbs or use them in tincture (motherwort, peony, valerian).