Formation Of Breast

  • At Birth, Breast tissue is the same in men and women.
    • Estrogen stimulates breast tissue
    • Androgen antagonizes these effects
  • In Puberty, In boy
    • Temporarily, proliferation of ducts & stroma
    • Soon, Laticiferous tube are degraded finally

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, adolescence, or mid to late life.

The condition often goes away on its own, but treatments are available for severe or persistent cases.

When gynecomastia is the result of 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 by far the predominant hormone, but small amounts of estrogen are also present.
Gynecomastia can happen when the balance shifts, with an increase in estrogen or 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.

Because of this, It is dangerous idea of dividing men and women like a black & white. People are in continuous line like a rainbow in sex, race, character, and  health. Therefore, it is the most foolish idea to conclude a person with blood type or oriental 4 constitutional idea

Dr. Jeon, Evita Clinic

Estrogen During Puberty

Persistent Pubertal Gynecomastia

about 38%

Usually occurs age 10-16 (Tanner 3)

    • Initial estradiol surge at puberty
    • Followed by testosterone surge
    • usually regression within 6 months
    • Persists up to two years in 25%

Medication

First Choice - Stop the Drugs !

10 ~ 25%

Spirolatone

Anti-Ulcer Medication

(Omeprazole, Cimetidine, Ranitidine)

Anti-Androgen Medication : Finasteride

Drugs :
ETOH, Marijuana, Tree oils and lotions, HAART

Decreases testosterone

Idiopathic / Obesity / Normal Aging

10 ~ 25%

Androgen Insensitivity

Aromatase excess

  • Due to excess adipose tissue
  • Hereditary aromatase excess

Diagnosis Algorithm

Most important thing is get a detailed history – onset, how long, other symptom..

Carful examination by  inspection, palpation.

And more,

Blood test for Hormone, 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.

antiestrogens

  • tamoxifen (20 mg/d) reduces  pain  and  breast   size   ( in two-thirds).

Aromatase inhibitors in early proliferative phase.

  • testolactone, anastrazole, letrozole, or fromestane

Always, Evita Clinic get a confirm from the pathologist in any patient’s gynecomastia surgery.
(Male Breast Cancer accounts for only 0.2% )

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2017-04-04T09:41:37+00:00