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Q: What can be done about gynecomastia, which is large breasts in males?
A: Gynecomastia, as also mentioned in the question, consists in an enlargement of the male breast. This may occur in only one breast, in both breasts, be symmetrical, or be asymmetrical. Such an enlargement of the male breast may occur as a normally occurring physiologic condition at various stages of life or as a pathologic condition. There are at least three causes of physiologic gynecomastia. First, it may occur in the newborn because of the estrogens coming from the mother or placenta. In this case, gynecomastia usually persists for a few weeks and then disappears. Second, gynecomastia frequently occurs in puberty, and lasts for about a year. In this case, the condition is probably a consequence of a change in the ratio of male hormones(androgens)to that of female hormones(estrogens). Finally, gynecomastia also is frequently seen among elderly men, most likely due an increase in the quantity of estrogens in the body, as men age. There are many possible pathologic causes of gynecomastia. Examples include: chronic liver disease, starvation, testicular tumor, cancer of the lung, liver cancer, and adrenal tumors. In all of these cases, there is an increased production of female hormones(estrogens). On the other hand, there may be an increase in production of male hormones(androgens). Examples of such conditions include: certain chromosomal abnormalities, resistance of the organism to the action of male hormones(androgens), increased function of the thyroid, and chronic kidney disease. Finally, many drugs can cause gynecomastia. Examples include: drugs which prevent the formation of male hormones, such as aldactone and cimetidine; drugs which act like female hormone compounds, such as diethylstilbestrol, birth control pills, digitalis, marihuana, heroin; a type of hormones referred to as gonadotropins, which are produced in the brain(in the so called anterior pituitary), and which work on the ovaries and testicles; and drugs which produce this condition by unknown mechanisms, such as certain drugs used against depression, INH, and methyldopa.
Evaluation of a patient with gynecomastia requires a careful drug history, careful examination of the testicles, assesment of liver function, an endocrine evaluation to assess hormonal status, and, if necessary, a chromosomal analysis. Furthermore, frequently it is also necessary to obtain a chest x-ray. Occasionally, it is also necessary to do a needle biopsy of the breast, in cases one needs to distinguish gynecomastia from a tumor of the breast, as would particularly be necessary when the breast enlargement only occurs on one breast or is not symmetric.
Treatment of gynecomastia consists in treating the condition which is producing it. Of course, in cases pf physiologic gynecomastia, the disease resolves spontaneously. Furthermore, in cases in which the gynecomastia is drug induced, stopping the drug which causes the condition makes the breasts go back to normal size. In cases of appreciable and persistent gynecomastia, in which the actual cause cannot be found and/or corrected, treatment consists in surgical correction.
Updated: 07/13/99
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