The Role of Steroids and Hormones in Gynecomastia-Factors and Treatments (original) (raw)
Related papers
Endocrine, 2016
Gynecomastia-the enlargement of male breast tissue in men-is a common finding, frequently observed in newborns, adolescents, and old men. Physiological gynecomastia, occurring in almost 25 % of cases, is benign and self-limited; on the other hand, several conditions and drugs may induce proliferation of male breast tissue. True gynecomastia is a common feature often related to estrogen excess and/or androgen deficiency as a consequence of different endocrine disorders. Biochemical evaluation should be performed once physiological or iatrogenic gynecomastia has been ruled out. Non-endocrine illnesses, including liver failure and chronic kidney disease, are another cause of gynecomastia which should be considered. Treating the underlying disease or discontinuing medications might resolve gynecomastia, although the psychosocial burden of this condition might require different and careful consideration.
Gynecomastia: pathophysiology, evaluation, and management
Mayo Clinic Proceedings, 2009
Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications. Although a fairly common presentation in the primary care setting and ...
A clinical approach to gynecomastia
Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2015
Gynecomastia is the commonest breast condition in male, which can cause significant psychological distress and anxiety to the patient. It refers to the benign enlargement of the male breast caused by proliferation of glandular breast tissue due to an imbalance between the inhibitory effect of androgen and stimulatory effect of estrogen. Gynecomastia can be physiological during neonatal period, puberty or old age. Various drugs, systemic disorders, benign or malignant tumours and hypogonadism can also lead to gynecomastia, while about 25% of cases are idiopathic. Gynecomastia should be differentiated from pseudogynecomastia (adipomastia), which is characterized by excessive accumulation of adipose tissue without glandular proliferation. A detailed history and examination helps to exclude differential diagnosis, identify the underlying etiology and to assess the severity of the disease and the concerns of the patient. The management of gynecomastia depends on the underlying etiology and the concerns of the patient. This may include interventions for relief of pain or discomfort, restoration of normal appearance and reassurance regarding cancer. Treatment options include watchful waiting, pharmacotherapy and surgery.
Gynecomastia: Clinical Review and Endocrinology Perspectives
Indian Journal of Endocrine Surgery and Research
Gynecomastia is the term used to describe the benign growth of glandular breast tissue in men. The most common causes are pubertal gynecomastia, hypogonadism, and drugs. An imbalance in the actions of free estrogen and androgens in the breast tissue is the root cause of gynecomastia. Physiologic or pubertal gynecomastia is a common finding in mid-puberty, with pubic hair present in Tanner stage III-IV. Gynecomastia is commonly bilateral, however, 20% of pubertal boys have unilateral disease. In gynecomastia, evaluation needs history-onset, progression, associated pain, medication history, and symptoms of hypogonadism. True gynecomastia and pseudogynecomastia should be distinguished by the feel of glandular or fat tissue. The testis and abdomen examination is an essential part of the examination. It is reasonable to measure the levels of serum testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), prolactin, thyroid stimulating hormone (TSH), serum estradiol, serum human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP), liver function test, and renal function test in peripubertal boys with macromastia (Tanner stage III or greater) and adult males with newly developing gynecomastia, fast growth, and eccentric or hard, irregular masses or gynecomastia larger than 4 cm inch. Physiologic gynecomastia usually resolves on its own. In 75-90% of adolescents, pubertal gynecomastia resolves independently after 1-2 years. Aromatase inhibitors, e.g., letrozole and estrogen receptor modulators, e.g., tamoxifen (10-20 mg daily), are recommended for painful pubertal gynecomastia or macromastia (Tanner staging III or more). If the gynecomastia is persevering (>2 years) and very disturbing to the boy, surgical reduction, mammoplasty by an experienced surgeon can be pursued.
The Burden of Anabolic Androgenic Steroid-Induced Gynecomastia
Indian Journal of Plastic Surgery
Introduction Gynecomastia is benign proliferation of male breast tissue that can be idiopathic or secondary to hormonal imbalance. Consumption of steroids plays a major role in the development of gynecomastia. The increased consumption of anabolic androgenic steroid (AAS) in youngsters to boost the physical strength and improve appearance is associated with increased prevalence of gynecomastia. True estimation of AAS-associated gynecomastia is difficult to calculate and prone to underestimation because of low social acceptance. Accurate estimation is required to assess future healthcare, for prevention and to give appropriate treatment. Aims and Objectives The aim of this study was to calculate the steroid consumption in gynecomastia patients accurately so that appropriate treatment can be given and their response to treatment could be analysed. Methods This is a prospective study done in a tertiary care hospital from June 2019 to June 2022. All the gynecomastia patients treated dur...
Clinical and Etiological Aspects of Gynecomastia in Adult Males: A Multicenter Study
BioMed research international, 2018
To evaluate the characteristics of presentation, biochemical profile, and etiology of gynecomastia in adults. Medical records of 237 men aged 18-85 years with gynecomastia were evaluated. Highest prevalence of gynecomastia was observed between 21 and 30 years (n = 74; 31.2%). The most common presenting complaints were aesthetic concerns (62.8%) and breast pain (51.2%). 25.3% of the subjects had a history of pubertal gynecomastia. 56.5% had bilateral gynecomastia. 39.9% were overweight and 22.8% were obese. The etiology could not be identified in 45.1% of the cases; the most frequent identified causes were anabolic steroids consumption (13.9%), hypogonadism (11.1%), and use of pharmaceutical drugs (7.8%). Patients with bilateral gynecomastia had a longer history of disease, higher BMI, and lower testosterone levels. Patients with gynecomastia presented more often with aesthetic concerns and secondarily with breast pain. The most frequent final diagnosis was idiopathic gynecomastia, w...
Clinical and Biochemical Phenotype of Adolescent Males with Gynecomastia
Journal of Clinical Research in Pediatric Endocrinology, 2019
Objective: Gynecomastia is defined as benign proliferation of male breast glandular tissue. Its prevalence during puberty stands at 50-60% and this condition is common also in neonatal and elderly males. It develops mainly due to the disequilibrium between estrogen and androgen activity in breast tissue, where estradiol binds to estrogen receptor and stimulates ductal and glandular cells. The aim of this work was to find a relationship between the sex hormones alterations and the natural history (evolution) of gynecomastia. Furthermore, the work tries to indicate the importance of checking the E2/TTE ratio. Materials and Methods: Participants in this study were 93 male patients aged 9 to 18 (mean age 13.8 ± 2.6) referred to an outpatient clinic between January 2011 and February 2016 with breast enlargement. Results: In 63 of 93 boys the gynecomastia was confirmed and 28 of them were follow-up (median of 3 months). None of all observed boys have reduced the size of breast during the observation and there was no correlation between BMI Z-Score and size of breast (p>0.05). Breast enlargement progressed in 9 boys (32.1%). We have observed a positive correlation between E2/TTE Ratio and Tanner B stage (r=0.47; p=0.034). Conclusions: The E2/TTE ratio may be a helpful tool in diagnosing gynecomastia. Altered E2/TTE ratio might be responsible for part of cases described previously as idiopathic. Additionally, weight loss does not imply reduction of breast size in boys, nonetheless it should be the first step before further treatment of prolonged gynecomastia.
Gynecomastia: A clinical review
Aesthetic Surgery Journal, 2000
Background: Male breast enlargement can occur transiently in up to three fourths of adolescent boys and is persistent in 7% of cases. The development of lipoplasty techniques has enabled treatment of this condition with only inconspicuous scarring. Objective: This article reviews the causes, diagnosis, and treatment of gynecomastia in the light of the authors' clinical experience. Methods: The causes and
Role of Testosterone and Dihydrotestosterone in Spontaneous Gynecomastia of Adolescents
Systems Biology in Reproductive Medicine, 1992
To test a possible hormonal mechanism of gynecomastia at puberty, a group of pubertal spontaneous gynecomastia (PSG) and healthy young volunteers (HYV), Tanner's stage 11-V, were studied. Peripheral blood samples were obtained for measuring follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), testosterone (T), dihydrotestosterone (DHT), estradiol (E-2) and estrone (E-I). No difference was established in steroids in pituitary hormonal concentration when both groups were compared on a sexual stage-matched control basis, except for T 2 SD in 519 subjects of PSG and DHT 2 SD in all of PSG. The T:DHT ratio varied from 5.0 to 15.4 in PSG and from 0.42 to 2.224 in HYV. Whether spontaneous gynecomastia might exist in an enzimatic blockade of Sa-reductase and whether a decrease in the T:DHT ratio might favor the estrogen action for the progression of breast enlargement deserve further analysis.
Medicinski podmladak
Introduction: Gynecomastia is an abnormal growth of the male breast due to excessive proliferation of ductal epithelial cells. It usually occurs during puberty, so the influence of hormones on the stimulation of ductal cells is indicative. Androgen, estrogen and progesterone are steroid hormones that exert their influence by binding to intracellular receptors and thus activating transcriptional mechanisms, i.e. act as trophic factors. Material and methods: A retrospective study for the period 01.01.2021-31.12.2021 was performed and 6 patients were found, of which in two cases left and right breast gynecomastia surgeries were performed. Hematoxylin-eosin (HE) stained slides and corresponding paraffin blocks were taken from the archive, and a tissue microarray was constructed, with 4 tissue cylinders for each tissue sample. Immunohistochemical staining was performed for androgen, estrogen, and progesterone receptors. The obtained slides were scanned on a Leica Biosystems Aperio AT2 sl...