Jinekomasti

Gynecomastia

Gynecomastia is the enlargement of breast tissue in children and men, a condition caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly. Newborn babies, children who are going through puberty and older men may develop gynecomastia as a result of normal changes in hormone levels, although there are other causes as well.

Usually, gynecomastia is not a serious problem, but it can be difficult to cope with the condition. Men and boys with gynecomastia sometimes feel pain in their breasts and may feel embarrassed.

Gynecomastia can disappear on its own. If it persists, medications or surgery can help.




Symptoms

Signs and symptoms of gynecomastia include:

  • Tissue of the swollen mammary glands
  • Pain with palpation in the breast

When to consult with the doctor

Visit a doctor if you have:

  • Swelling
  • Pain
  • Pain with palpation
  • Discharge from the nipple in one or both breasts



Causes

Gynecomastia is caused by a decrease in the amount of testosterone compared to the amount of estrogen. The cause of this decrease can be a condition that blocks or reduces the effects of testosterone or a condition that increases the level of estrogen. There are several factors that can alter the hormonal balance, including the following.




Natural hormonal changes

Testosterone and estrogen control the development and maintenance of sexual characteristics in both men and women. Testosterone controls male traits, such as muscle mass and body hair. Estrogen controls female traits, such as breast growth.

Most people think that estrogen is an exclusively female hormone, but men also produce it, although usually in small amounts. However, male estrogen levels that are too high or not in balance with testosterone levels produce gynecomastia.

Gynecomastia in infants. More than half of male infants are born with enlarged breasts due to the effects of the mother’s estrogen. Usually, the inflamed tissues of the breast disappear in two or three weeks after birth.

Gynecomastia during puberty. Gynecomastia caused by hormonal changes during puberty is relatively frequent. In most cases, the inflamed breast tissue disappears without treatment in six months or two years.

Gynecomastia in men. The prevalence of gynecomastia reappears between 50 and 69 years. It affects at least 1 in 4 men of that age group.

Medicines

There are different medications that can cause gynecomastia. These include:

  • Antiandrogens that are used to treat prostate enlargement, prostate cancer, and some other conditions. For example: flutamide, finasteride (Proscar, Propecia) and spironolactone (Aldactone).
  • Anabolic steroids and androgens.
  • Medications for AIDS. Gynecomastia can develop HIV positive in men who receive a treatment regimen called high-activity antiretroviral therapy (HAART, for its acronym in English). Efavirenz (Sustiva) is more commonly associated with gynecomastia than with other HIV medications.
  • Anxiolytics, such as diazepam (Valium).
  • Tricyclic antidepressants.
  • Antibiotics
  • Medications for ulcers, such as cimetidine (Tagamet HB).
  • Oncological treatment (chemotherapy).
  • Medications for the heart, such as digoxin (Lanoxin) and calcium channel blockers.
  • Medications for gastric motility, such as metoclopramide (Reglan).



Drugs and alcohol

Substances that can cause gynecomastia include:

  • Alcohol
  • Amphetamines
  • Marijuana
  • Heroin
  • Methadone

Affections

There are several conditions that can cause gynecomastia by affecting the normal balance of hormones. These include:

  • Hypogonadism. Any of the conditions that interfere with normal testosterone production, such as Klinefelter syndrome or pituitary insufficiency, may be related to gynecomastia.
  • Aging. The hormonal changes that occur with normal aging can cause gynecomastia, especially in overweight men.
  • Tumors Some tumors, such as those that affect the testicles, the adrenal glands or the pituitary gland, can produce hormones that alter the female hormonal balance.
  • Hyperthyroidism. With this condition, the thyroid gland produces too much thyroxine.
  • Renal insufficiency. Approximately half of the people who are treated on a regular basis with hemodialysis experience gynecomastia due to hormonal changes.
  • Hepatic insufficiency and cirrhosis. Hormone fluctuations related to liver problems as well as medications that are taken for cirrhosis are associated with gynecomastia.
  • Malnutrition and starvation. When the body is deprived of adequate nutrition, the levels of testosterone decline but those of estrogen remain constant, which causes a hormonal imbalance. Gynecomastia can also occur when you return to normal nutrition.



Herbal products

Vegetable oils, such as tea tree or lavender, which is used in shampoos, soaps or lotions, have been related to gynecomastia. This is probably due to its weak estrogenic activity.

Risk factor’s

Risk factors for gynecomastia include:

  • Adolescence
  • Advanced adulthood
  • Use of androgens or anabolic steroids to improve athletic performance
  • Certain conditions, including kidney or liver disease, thyroid diseases, hormonally active tumors and Klinefelter syndrome
  • Complications
  • Gynecomastia has some physical complications, but it can also cause psychological or emotional problems by appearance.

Prevention

There are some factors you can control to reduce the risk of gynecomastia:

Do not use illegal drugs. Some examples include steroids and androgens, amphetamines, heroin and marijuana.
Avoid alcohol. Do not drink alcohol or, if you drink, do it in moderation.

Check the medications you take. If you take medications that can cause gynecomastia, ask the doctor if there are other options.






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