Formation Of Breast
- At Birth, Breast tissue is the same in men and women.
- Estrogen stimulates breast tissue
- Androgen antagonizes these effects
- In Puberty, for boys
- There is a temporary proliferation of ducts & stroma
- Eventually, the Laticiferous tube disappears
Gynecomastia is a condition in which the glandular tissue in the breasts becomes enlarged in boys or men, sometimes causing discomfort or nipple tenderness.
It is usually the result of a hormonal imbalance and typically occurs during infancy or puberty.
The condition often goes away on its own, but treatments are available for severe or persistent cases.
When gynecomastia is caused by an underlying health problem, treatment of that problem usually improves the gynecomastia as well.
Although people tend to think of androgens as “male hormones” and estrogens as “female hormones,” people of both sexes produce both types of hormones.
In males, androgens are the predominant hormone, but small amounts of estrogen are also present.
Gynecomastia can happen when the balance shifts – with an increase in estrogen and a decrease in androgens.
This can occur because of expected hormonal changes during puberty or aging; or because of the use of certain drugs or herbal products.
Men and women are alike. We should not be divided based on the color of our skin. We should be one no matter our sex, race, character, and health. Like a rainbow – it consists of different colors but works beautifully together.
Estrogen during PubertyPersistent Pubertal Gynecomastia
Usually occurs age 10-16 (Tanner 3)
- Initial estradiol surge at puberty
- Followed by testosterone surge
- Usually, regresses within 6 months
- Persists up to two years in 25% of boys
MedicationFirst Choice - Stop Drugs!
10 ~ 25%
(Omeprazole, Cimetidine, Ranitidine)
Anti-Androgen Medication : Finasteride
ETOH, Marijuana, Tree oils and lotions, HAART
Decreases testosteroneIdiopathic / Obesity / Normal Aging
10 ~ 25%
- Due to excess adipose tissue
- Hereditary aromatase excess
Most important thing is to get a detailed history – onset, how long, other symptoms.
Careful examination by Inspection and palpation.
Blood test for Hormone Imbalance, Examination by Ultasonography, Mammography.
Correction of Primary Cause, Improve within months.
Surgery is the most effective therapy in long duration
Indications for surgery
- severe psychologic or cosmetic problems
- continued growth or tenderness
- suspected malignancy.
- tamoxifen (20 mg/d) reduces pain and breast size ( in two-thirds).
Aromatase inhibitors in early proliferative phase.
- testolactone, anastrazole, letrozole, or fromestane