Gynecomastia

What's this

The term gynecomastia indicates the abnormal development of breast size in humans. The resulting swelling of the chest gives the chest a typically feminine appearance.

This similarity creates in most cases important psychological repercussions. Generally, the difficult cohabitation with this pathology results in disorders of the social and sexual sphere. The problem is so strongly felt that the number of males who have undergone surgery in recent years has considerably increased.

Symptoms

Gynecomastia can be unilateral or bilateral, it initially manifests itself with an increase in sensitivity and with the appearance of painful bumps under the nipple area. Later on, there is an additional swelling associated with the deposition of adipose tissue and the increase in glandular tissue.

Causes

The causes that lead to the onset of gynecomastia are numerous, among the main ones we recall those of genetic, hormonal, pharmacological nature and those dependent on other pathologies.

Drugs such as anabolic steroids, drugs used to treat HIV, anti-androgen drugs or antidepressant drugs are just a few examples of medicines that can promote the onset of the disorder.

Similarly, pathological conditions such as hypogonadism or certain types of cancer can cause hormonal imbalances that lead to the development of gynecomastia.

In light of what has been said so far, it is therefore clear that the main cause of the appearance of this condition is to be found in the alteration of hormonal balance. In particular, an imbalance in the metabolism of testosterone and estrogen is created in favor of the latter. The increase in estrogen and / or the body's sensitivity to them may occur

Excess testosterone : occurs naturally in pubertal age (puberal gynecomastia), or "artificially" following the intake of anabolic steroids. The body tries to protect itself from the excess of androgens by converting a portion into estrogens, typically female hormones, responsible among other things for breast development.
Excess estrogen : occurs naturally (genetic predisposition) or due to promoter substances, such as drugs, pesticides and other pollutants.

Classification

Based on its origin, gynecomastia is classified as:

Pubertal gynecomastia : it is a physiological process that takes place in puberty (12-17 years) when the intense hormonal production causes an excessive development of the mammary glands. This phenomenon generally regresses within a couple of years.
Congenital gynecomastia : the primary cause is the altered hormonal balance that can have a family connotation (heredity).
Induced gynecomastia : in these cases the causes must be sought in the assumption of certain drugs able to compromise the natural hormonal function.

Depending on the distinctive features, gynecomastia can be classified into:

True gynecomastia : the increase in breast volume is caused by the increase in the glandular component.
False gynecomastia (or pseudo-gynecomastia ): the increase in breast volume is caused by the increase in adipose tissue in the mammary area.
Mixed gynecomastia : the increase in breast volume is caused by the interaction of the two factors described above.

Today gynecomastia is a rather widespread phenomenon, especially if we consider the so-called "false gynecomastia". The significant increase in cases encountered over the last decade presupposes that in the future there will be a further spread of the problem (especially in industrialized countries).

Diagnosis

The diagnosis is made by simple palpation; in any case, with an ultrasound of the chest, it is possible to resolve any doubt about the false origin of the mammary swelling (false gynecomastia).

Treatment

The treatment of gynecomastia can vary depending on various factors, such as the cause, the type of gynecomastia that has affected the patient (true, false, mixed) and the degree of severity with which the disorder occurs.

Fortunately, in the case of puberal gynecomastia, in many situations no type of treatment is necessary, since the disorder tends to regress spontaneously.

In other cases of gynecomastia, on the other hand, it may be necessary to intervene with pharmacological therapies and / or surgery.

Naturally, in the case in which the gynecomastia is caused by basic pathologies, the primary treatment must be directed towards the triggering disease.

Pharmacological treatment

Unfortunately, there are few pharmacological therapies currently available for the treatment of gynecomastia not dependent on other pathologies.

The main pharmacological treatment of gynecomastia, in fact, provides for the sole administration of drugs with anti-estrogenic activity, such as tamoxifen and anastrozole.

Notes on surgical treatment

In the case of "true gynecomastia" the regression of the disease can only occur in puberty, after this period the chances of spontaneous regression are very low. This type of pathology requires surgery.

On the contrary, if gynecomastia is due only to localized fat and muscle relaxation, the chances of recovery are higher. Surgery is not always necessary, since the pathology can simply be cured with a food program aimed at reducing body fat and muscle toning.

Surgery strategies differ depending on the nature of the problem.

If for the excess of adipose tissue it is generally sufficient to perform a "simple" liposuction under local anesthesia, for the excess of glandular tissue it is necessary to perform the surgical removal of the mammary gland.

In the latter case the intervention lasts about an hour and is performed in a day-hospital. A small incision is made in the lower half of the areola to allow the glandular tissue to be removed. After a few days the patient can resume normal daily activities.

Prevention

Nutrition and physical activity

For some years now, there has been much talk of so-called "estrogenic-like foods". This term identifies those foods contaminated with substances that have a particular affinity for estrogen receptors.

Currently, more than one hundred chemical components are known which possess these harmful characteristics, the main ones being: pesticides, livestock growth promoters, drugs for human and veterinary use. Even plastic containers can contain estrogenic chemicals that are harmful to health.

Pre-pubertal children are particularly sensitive to the effects that these substances have on growth and sexual development (since before pubertal release extremely low levels of endogenous hormones are produced).

To reassure parents and consumers there are numerous laws that strictly prohibit the use of these substances but which cannot prevent the natural contamination of food.

The contribution of nutrition to the appearance of gynecomastia, usually marginal, can therefore become significant in the case of particularly unregulated food habits combined with reduced physical activity.

Some advices

To prevent gynecomastia it is good to respect the following rules:

Do not overdo the consumption of meat and make sure in any case of its origin (in some non-EU countries, quality controls may be lower).
Eliminate visible fat: as toxic substances accumulate mainly in the adipose tissue of the animal.
Maintain high fiber intake (consume a lot of fruit and vegetables), as inedible plant residues are able to reduce excess estrogen in the body.
Following a regular program of physical activity, in many cases (see false gynecomastia) this disorder is caused by the simple increase in localized fat in the mammary area and by the simultaneous relaxation of the pectoral muscle.
Keep body weight in check: testosterone levels are significantly reduced in obese individuals, whereas estrogen levels increase.