Gynecomastia is a benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast.Gynecomastia results from an altered estrogen-androgen balance, in favor of estrogen, or increased breast sensitivity to a normal plasma concentrations of circulating estrogen level.
The predominant androgen, testosterone, is synthesized in males mainly by the Leydig cells of the testes (95%) and, to a much lesser extent, by zona reticularis cells of the adrenal cortex (5%). Two thirds of the circulating testosterone is bound to sex hormone–binding globulin (SHBG). Testosterone is converted to dihydrotestosterone (DHT) in the target tissues (5-alpha reductase). DHT is often considered the active form of testosterone. Testosterone is under feedback regulation of luteinizing hormone (LH), secreted by the pituitary gland in the brain. Estrogen production in males is mainly from the peripheral conversion of androgens (ie, testosterone, androstenedione) through the action of the enzyme aromatase, mainly in muscle, skin, and adipose tissue.
The normal production ratio of testosterone to estrogen is approximately 100:1. The normal ratio of testosterone to estrogen in the circulation is approximately 300:1.
Generally, gynecomastia is a benign condition. Upon examination and medical evaluation, most patients are usually satisfied with a simple explanation of the condition and reassurance that the condition is benign, particularly if the enlargement is minimal. Surgical intervention is typically reserved for diagnostic purposes or for patients who request treatment. Most patients who visit a plastic surgeon request treatment for psychological reasons. These patients seek treatment because they find the condition embarrassing. They wear loose clothes and avoid exposure in showers and swimming pools, which greatly inhibits their activities of daily living.
Frequency: In the US: Gynecomastia is the most common cause for male breast evaluation. The frequency is highly variable based on the criteria used for defining the condition. In one study, a figure of 38% was reported in boys aged 10-16 years using a definition of breast tissue greater than 5 cm in diameter. In another series, gynecomastia was noted in approximately 10% of boys aged 12-17 years. In yet another report, gynecomastia was noted in 36% of young military recruits and in approximately 57% of men older than 50 years. Autopsy studies indicate a prevalence ranging from 4-40%.
Gynecomastia can be classified based on etiology. Idiopathic gynecomastia accounts for approximately 75% of cases. Physiologic gynecomastia occurs primarily in newborns and in adolescents at puberty. In the newborn, the neonatal breast results from the action of maternal estrogens, placental estrogens, or both in concert. The increased breast tissue usually disappears in a few weeks. Adolescent gynecomastia is common during puberty. The median age of onset is 14 years. Breast tissue growth is often asymmetrical, and the breasts are frequently tender. Adolescent gynecomastia usually regresses by age 20 years. However, residual gynecomastia may be present in one or both breasts.
Pathologic gynecomastia is due to testosterone deficiency, increased estrogen production, or increased conversion of androgens to estrogens. The pathological conditions associated with gynecomastia include congenital anorchia, Klinefelter syndrome, testicular feminization, hermaphroditism, adrenal carcinoma, liver disorders, and malnutrition.
Many pharmacological agents can cause gynecomastia. These drugs can be categorized by their mechanisms of action. The first type is drugs that act exactly like estrogens, such as diethylstilbestrol, birth control pills, digitalis, and estrogen-containing cosmetics. The second type is drugs that enhance endogenous estrogen formation, such as gonadotropins and clomiphene. The third type is drugs that inhibit testosterone synthesis and action, such as ketoconazole, metronidazole, and cimetidine. The final type is drugs that act by unknown mechanisms, such as isoniazid, methyldopa, captopril, tricyclic antidepressants, diazepam, and heroin.
From Wikipedia: Causes
Physiologic gynecomastia occurs in neonates, at puberty and with aging.
Potential pathologic causes of gynecomastia are: medications including hormones, increased serum estrogen, decreased testosterone production, androgen receptor defects, chronic kidney disease, chronic liver disease, HIV, and other chronic illness. Gynecomastia as a result of spinal cord injury and refeeding after starvation has been reported. In 25% of cases, the cause of the gynecomastia is not known.
Medications cause 10-20% of cases of gynecomastia. These include cimetidine, omeprazole, spironolactone, finasteride and certain antipsychotics. Some act directly on the breast tissue, while other lead to increased secretion of prolactin from the pituitary by blocking the actions of dopamine (prolactin-inhibiting factor/PIF) on the lactotrope cell groups in that organ. Androstenedione, used as a performance enhancing food supplement, can lead to breast enlargement by excess estrogen activity. Marijuana use is also thought by some to be a possible cause, but this is controversial.
Increased estrogen levels can also occur in certain testicular tumors, and in hyperthyroidism. Certain adrenal tumors cause elevated levels of androstenedione which is converted by the enzyme aromatase into estrone, a form of estrogen. Other tumors that secrete hCG can increase estrogen. A decrease in estrogen clearance can occur in liver disease, and this may be the mechanism of gynecomastia in liver cirrhosis. Obesity tends to increase estrogen levels.
Decreased testosterone production can occur in congenital or acquired testicular failure, for example in genetic disorders such as Klinefelter Syndrome. Diseases of the hypothalamus or pituitary can also lead to low testosterone. Abuse of anabolic steroids has a similar effect.
Although stopping these medications can lead to regression of the gynecomastia, surgery is sometimes necessary to eliminate the condition.
The condition usually can be diagnosed by examination by a physician. Occasionally, imaging by X-rays or ultrasound is needed to confirm the diagnosis. Blood tests are required to see if there is any underlying disease causing the gynecomastia.
Gynecomastia is not physically harmful, but in some cases can be an indicator of other more dangerous underlying conditions. Furthermore, it can frequently present social and psychological difficulties for the sufferer. Weight loss can alter the condition in cases where it is triggered by obesity, but for many it will not eliminate it as the breast tissue remains.
* Generally, no treatment is required for physiologic gynecomastia.
* In approximately 90% of patients, pubertal gynecomastia resolves spontaneously within several weeks to 3 years. Breasts greater than 4 cm in diameter may not completely regress.
* Identifying and managing an underlying primary disorder often alleviates breast enlargement.
* If hypogonadism (primary or secondary) is the cause, parenteral or transdermal testosterone replacement therapy is instituted.
* For patients with idiopathic gynecomastia or residual gynecomastia after treatment of the primary cause, medical or surgical treatment may be considered.
* Clomiphene, an antiestrogen, can be administered on a trial basis at a dose of 50-100 mg/d orally for up to 6 months. Approximately 50% of patients achieve partial reduction in breast size, and approximately 20% of patients note complete resolution. Outcomes vary with the type and duration of gynecomastia. Adverse effects are rare and include visual problems, rash, and nausea.
* Tamoxifen (Novladex), an estrogen antagonist, is effective for recent-onset and tender gynecomastia when used in doses of 10-20 mg orally twice daily. Up to 80% of patients report partial-to-complete resolution of gynecomastia within 3 months. Nausea and epigastric discomfort are the main adverse effects.
* Other drugs used less frequently include danazol and testolactone.
o Danazol, a synthetic derivative of testosterone, inhibits pituitary secretion of LH and FSH, which decreases estrogen synthesis from the testicles. The dose used for gynecomastia is 200 mg orally twice daily. Complete resolution of breast enlargement has been reported in 23% of cases. Adverse effects include weight gain, acne, muscle cramps, fluid retention, nausea, and abnormal liver function tests.
o Testolactone, a peripheral aromatase inhibitor, has been used with varying success rates (<40% decrease in size) in doses of 150 mg orally 3 times/d for 6 months. Nausea, vomiting, edema, and worsening of hypertension have been reported with its use.
Surgical Care: if the gyno doesn't resolve itself (adolescent gyno) naturally, nor later respond to *physican-ordered* pharmacological treatment.
* Reduction mammoplasty is considered for patients with macromastia or long-standing gynecomastia or in those in whom medical therapy failed. It is also considered for cosmetic reasons (and accompanying psychosocial reasons).
* If surgery is necessary for patients with lipomastia (ie, pseudogynecomastia), liposuction may suffice.
I found quite a bit of anecdotal evidence that turmeric (curcumin) extract is an effective herbal treatment for many men. I would do a google search and read up on this option.
It is beyond the ability of this forum to provide medical advice - that's the provence of medical professionals. See your doctor for examination, evaluation and technical advice or treatment for this condition.
I think the surgery for it is relatively easy and simple. You could also try medications. What do you mean by saying medicines don't go well with you, do you get a sort of nervous reaction from taking meds?
Bud...if I can call you Bud; I saw the pic and I don't think you really have a problem. Oh you HAVE one; but here's my take on it. You're just a kid, compared to many on this board. AND you're carrying a bunch of excess -- "love (less) handles," belly fat, chubby arms. I looked pretty close to you at your age; but I got it together. You will too, probably. I'm no doctor...and don't play one on TV (which, by the way, you probably watch too much of) but I think losing weight would take care of any "gyno" you think you have. Good luck! But, mainly, you're going to have to think the whole thing out and decide if you want to look like that or look a lot better (and BE a lot healthier when you are 40 years older). By cousin and I both looked like the junk-food eating, lack of regular and meaningful exercise fatties we were...at your age; I changed because I had a role model (a teacher) whose wife was into Yoga and health foods, while he was into Iron and protein. My cousin continued with the dark side, because it seemed easier at the time, so it CONTINUED to seem easier, and he is NOW very round, arthritic, no love of life. Write down WHAT you want to be and read it with your imagination several time a day, until it becomes a part of you; KEEP plugging along, slowly adding more and more of what YOU KNOW IS RIGHT FOR YOU, and doing away with more and more of what you deep down KNOW is wrong for you or anyone else.
FUFU do not gete to excited there buddy LOL
Proper diet and exercise should help to correct majority of the problem. Stay away from soy and also might want to increase zinc intake to may be 40-50 mgs a day to help with lowering the aromatse. Dropping body fat will be the biggest help as trouble already mentioned. Then if it is still bothering you consult your dr and maybe a plastic surgeon
agreed. I have a friend who is convinced he has gynecomastasia, but he is chubby and he just looks the same as every other chubby guy ive seen. i think he needs to lose some fat first, same as you, to really see if there is a problem or not. 1yr of good eating + working out + cardio would see a major difference in your appearance and how you feel about yourself. I havent seen any lean/athletic guys reporting this problem (just from what ive seen)
If you have hormonal imbalances which ur dr should have checked for already for Estrodial, sbhg,testosterone, testosterone free. That would give indication there. Estrodial should be kept betweem 15-30 ng/dl according to homone replacement specialist for optimal performance. You may want to check your estrogen to testosterone levels to see if testerone is much higher then the estrogen. What was your testosterone level. If it was less then 50-60% the higest range then you may want to seek second opinon. Has your dr check thyroid thoroughly. Even they say its normal that does not mean that is is right for your body.
How are you sleeping?
what time you goto bed? Get up?
Do you wake up feeling refreshed
you waking up with a boner
how many days you trainn
what is deit like
are you under alot of stress or feel over whelmed
Do you feel depressed and isolated
How long you out in sunlight for daily
Do you snore alot?
These and many other factors affect your biochemistry and well being
I havent seen any lean/athletic guys reporting this problem (just from what ive seen)
More bodyfat = more aromatase action = more estrogen.
Those nipples look a little puffy, that happens to me from time to time when hormonally enhanced, so yes I'd say its the start of gyno. For me it is always the left side. I agree with you though that trimming up is step 1, not surgery.
Thanks for all of the replies guys. I am now 18 (will be 19 within 4 months) and it isnt going away, but neither is my bodyfat (i got lazy and stopped caring for a year)...but now I am back in full force, and apretiate all of the responses ive gotten while I was away.
"chems=strength"'s statement really gave me hope, and I DO realize that I have a fat problem. Coincidentially, when I first came to the states, I was really skinny. Then when I turned about 11 or 12, i started gaining weight, and the size of them started to increase. They turn normal when its cold out or w.e, but otherwise, I gotta wear some undershirts to help reduce their size and appearance.
BTW I duno if this is weird, but when they started getting bigger, the outsides were the first to get big, and the inside (very inside) stayed in, and eventually came out. Thanks for all input
If there are anymore people than can shed light on my situation, I am more than happy to answer ANY AND ALL questions...maybe there are certain symptoms, sensitive areas, etc that are associated with gyno, becasue if I know that its not gyno but just excess body fat, its going to give me lots of motivation in the gym to lose weight and get in shape knowing it WILL go away
Ive just looked at many pictures of gyno surgery patients before and after, and most were in their older years, but I can safely say that I am nowhere close to them when it comes to the size. All I have is just "swolen" nipples, and a VERY SMALL area around them...I can take pictures at different angles if anyone would need. The nipple itself is softer than the rest of my chest, so I dont know what that means.
Will check back in the morning
Last edited by BuddyClubNeon; 04-10-2007 at 10:20 PM.
17, testosterone surging!!!!! That is it in a nutshell. It converts to estrogen. Does so in the fat cells too. Shed some fat, mostly by moving big weights. Most Endocrinologists will insist you do nothing for years. SERMS may be what you need, but get your levels checked for free test/estrogen, if you have not. Do not consider steroids as an out.
I had gyno at 13, 14. It took about a year, and subsided.