The causes of gynecomastia are diverse, but for simplification, there could be three main causes, each causing a hormonal disorder: persistent physiological gynecomastia pubertal (in adolescents), gynecomastia related to pathology and drugs causing gynecomastia.
Idiopathic gynecomastia, so called when no medical cause is found, remains by far the most common. Adipomastia should be distinguished from gynecomastia: it is an excess of fat in the breast or breasts, often accompanied by overweight. Adipomastia (or pseudogynecomastia ) is often associated with gynecomastia but is not defined by breast hypertrophy, i.e. a glandular excess. His surgical treatment is liposuction, while the surgical treatment of true gynecomastia is total (removal) of the mammary gland.
Medicines can cause a shift in the balance between estrogens and androgens through different ways, directly and indirectly, and thereby cause gynecomastia. Contrary to popular belief, an increase in prolactin does not in itself cause gynecomastia. 3 However, under the influence of prolactin, a decrease in the production of gonadotrophic hormones in the pituitary gland, with the resultant reduced testosterone production, can cause gynecomastia. This may be the explanation for the fact that gynecomastia is often mentioned in the literature in connection with substances that can cause prolactin levels due to an anti-dopaminergic action.
Galactorrhea in women and gynecomastia in men are disorders that are often mentioned in the same breath, although their pathophysiology is different. Galactorrhea and gynecomastia are important to the practitioner because they:
– fairly frequent occurrence as a physiological and harmless phenomenon;
– can have very different causes, including the use of a large number of medicines;
– can be a symptom of serious and sometimes malignant diseases, the prognosis of which can be favorably influenced by rapid diagnosis and therapy.
Diagnosis of Drugs That Can Cause Gynecomastia
As with galactorrhea, gynecomastia also has a relatively frequent cause of drugs. In addition, especially when there is no other explanation (such as puberty, adiposity or climacterium virile), the possibility of a liver disease or an estrogen-producing tumor must always be considered. 6-8 If the assay methods used do not make a sufficient distinction between LH and human chorionic gonadotropin (HCG), an HCG-producing carcinoma can be concealed behind an increased ‘LH’ level with normal FSH values. 5 Figure 2 shows a diagram derived from Carson that can be used for the formulation of the policy in a patient with gynecomastia. Detailed advice for specialist policy in patients with abnormal biochemical results can be found in an Braunstein article.
Drugs Causing Gynecomastia In Puberty
This pubertal gynecomastia present in many adolescents is usually transient. If she does not regress, her surgical excision may be considered. Breast hypertrophy is due to an excess of estrogen and therefore an unbalanced estrogen/testosterone ratio. The mammary gland has an increased susceptibility to estrogen and hypertrophies accordingly.
Glandular Hypertrophy Drugs Causing Gynecomastia
These causes require appropriate medical and sometimes surgical treatment. Often, the diagnosis is made after the hormonal assessment in an endocrinologist. Pathological causes of gynecomastia include endocrine disorders, that is to say hormonal disorders (hyperthyroidism, acromegaly, prolactin adenoma, Addison’s disease), paraneoplastic syndromes accompanying certain cancers (tumor of the testis, tumor of the adrenal gland and other feminizing tumors), but also in kidney diseases, liver cirrhosis and testicular atrophy (hypogonadism).
A thorough clinical examination will exclude breast cancer in men (which represents 1% of breast cancers). In favor of this diagnosis, the single side, the progressive increase of the volume, the possible deformation or retraction of the nipple which can be the seat of blood flow. At the slightest doubt, morphological examinations will be performed: mammography and ultrasound or MRI.
Note that some causes of mammary hypertrophy may be genetic such as feminizing testis syndrome and Klinefelter syndrome (existence of one, two or three extra X chromosomes).
Iatrogenic Drugs Causing Gynecomastia
The iatrogenic causes of gynecomastia are the causes of medication (and narcotics). Among the drugs, there may be mentioned estrogens (resulting in the body by hyperestrogenism), antacids such as cimetidine (Tagamet®), certain diuretics such as spironolactone treating heart disease (Aldactone®, Aldactazine®), tricyclic antidepressants, antiandrogens, certain neuroleptics, AIDS medications (Efavirenz®), some anxiolytics (diazepam®), antifungals (ketoconazole®), antibiotics (metonizadole®). Among the drugs, we can mention cannabis, heroin, methadone (drug substitute), amphetamines. Taking alcohol with or without cirrhosis would also be the cause of gynecomastia.
Idiopathic Drugs Causing Gynecomastia
Idiopathic or physiological gynecomastia is considered a diagnosis of elimination. Often present in men after a certain age, it is due to the natural and progressive decrease in testosterone production and is often linked to excess weight. Excess weight promotes the aromatization of testosterone into estrogen in the adipose tissue. As in adolescents, there is increased sensitivity of the mammary gland to estrogen. After the failure of drug treatments in pathological cases, or when gynecomastia has been present for a long time, and it induces psychological embarrassment, an operation for definitive surgical treatment is the most effective solution to find a male breast with almost invisible healing. There are some powerful herbal supplements like Crazy Bulk’s Gynectrol that can help you in fight against gynecomastia causes due to drugs.
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