Cordova and Moschella proposed a morphological classification of gynecomastia based on the evaluation of the relationship between the nipple-areola complex and the inframammary fold, which makes it possible to establish an algorithm for the most suitable intervention. Medical treatment can therefore be beneficial if implemented during the early proliferative phase, before the glandular structure has been replaced by stromal hyalinization and fibrosis. In the later stages (after 12m), there is marked stromal fibrosis, a slight increase in the number of ducts, but little to no epithelial proliferation and no inflammatory response. Men over the age of 50 are at higher risk of male breast and prostate cancer, due to declining testosterone levels. These steroids increase testosterone levels, which can convert to estrogen in excess, causing breast tissue to develop. When estrogen levels increase or androgen levels decrease, men may experience breast tissue growth. Men with gynecomastia have about a fivefold greater risk of developing male breast cancer when compared with the general population. Gynaecomastia, or the enlargement of male breast tissue, is a condition that can occur at any age due to various factors. It was also successfully used to reduce the estrogen excess and breast enlargement in a patient with familial aromatase excess, a patient with Sertoli cell tumor, and two hypogonadal males with gynecomastia that had been induced by testosterone therapy. They block the effects of estrogen on breast tissue which can reverse the growth. Drugs like tamoxifen shrink breast tissue in men with gynecomastia. Exercise and weight management are important for overall health but in the case of true gynecomastia the breast tissue won’t decrease much with weight loss alone. This procedure involves the surgical removal of the glandular breast tissue that causes gynecomastia. Importantly, there is also a growing body of evidence supporting the utility of this class of drugs in gynecomastia, particularly Tmx.21,22,23,24 Tmx is an estrogen antagonist, and is a well-tolerated, reliable and non-toxic agent. Although clinical data are limited, more studies have determined the efficacy of anti-estrogens compared with other gynecomastia therapies. Several agents regulate the hormonal imbalance that is thought to cause the gynecomastia. The duration of gynecomastia is a major factor affecting the initial approach to treatment. If gynecomastia is drug induced, symptoms may regress when the causative medication is stopped or changed.5,6,11 Systemic illness-related gynecomastia regresses with the treatment of these disorders (for example the treatment of hyperthyroidism, or surgical removal of testicular, adrenal, or other causative tumors may lead to regression). Before beginning treatment, the patient must be informed that these cases are usually benign and self-limiting and that over time fibrotic tissue replaces the symptomatic proliferation of glandular tissue, meaning that the pain and tenderness will resolve. Many bodybuilders seek treatment to remove the excess tissue, often opting for surgery. In this blog post, we will explore the surgical treatment of gynecomastia, its symptoms, causes, and the various treatment options available. MedicineNet does not provide medical advice, diagnosis or treatment. Gynecomastia related to medical conditions can only be prevented to the extent that the underlying or responsible condition can be prevented. Psychological consequences can occur if the breast enlargement is pronounced or is a source of embarrassment. Gynecomastia that has been present for 12 months or more (long term) may undergo scarring (fibrosis), which makes treatment with medications much more difficult, if not impossible to achieve a response. Table 3 lists differences in the presentation of gynaecomastia and malignancy. Germ cell tumours produce intratesticular human chorionic gonadotrophin, which can cause dysfunction of Leydig cells and reduced testosterone production. Renal failure has many effects on hormone and drug metabolism. The mechanisms are thought to be similar to those governing gynaecomastia during puberty. Cosmetics, creams, and lotions may contain oestrogens or compounds with oestrogen effects. Oestradiol and oestrone can be interconverted in peripheral tissues (fig 1). Medications are more effective in reducing gynecomastia in the early stages since scarring often occurs after about 12 months. Further tests may be recommended to help establish the cause of gynecomastia in certain cases. If there is a suspicion of cancer, a mammogram may be ordered. A careful medical history is also important, including medication and drug use. Up to 70% of teenage boys experience some degree of gynecomastia. Studies show that up to 70% of men over the age of 50 experience some form of gynecomastia. Many cases of pubertal gynecomastia resolve naturally, but some may persist into adulthood. Yes, gynecomastia is normal at 21, especially if it started during puberty.
