Materiały źródłowe

• #1 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  Gynecomastia is a relatively common disorder. Its causes range from benign physiological processes to rare neoplasms. To diagnose the etiology of the gynecomastia, the clinician must understand the hormonal factors involved in breast development. Parallel to female breast development, estrogen, growth hormone (GH), and IGF-1 are required for breast growth in males. Since a balance exists between estrogen and androgens in males, any disease state or medication that increases circulating estrogens or decreases circulating androgens, causing an elevation in the estrogen to androgen ratio, can induce gynecomastia. […] In a population-based study of healthy boys and adolescents, IGF-I levels were found to be elevated in boys with pubertal gynecomastia compared with boys without gynecomastia suggesting that the GH-IGF-I axis may be involved in the pathogenesis of pubertal gynecomastia.

• #2 Gynecomastia: Pathophysiology, Evaluation, and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2770912/

  Gynecomastia, defined as benign proliferation of male breast glandular tissue, is usually caused by increased estrogen activity, decreased testosterone activity, or the use of numerous medications. […] The imbalance between estrogen action relative to androgen action at the breast tissue level appears to be the main etiology of gynecomastia. Elevated serum estrogen levels may be a result of estrogen-secreting neoplasms or their precursors (eg, Leydig or Sertoli cell tumors, human chorionic gonadotropin [hCG]producing tumors, and adrenocortical tumors) but more commonly are caused by increased extragonadal conversion of androgens to estrogens by tissue aromatase (as occurs in obesity). […] The balance between free testosterone and estrogen is also affected by serum levels of sex hormone-binding globulin, which is the proposed mechanism of gynecomastia in certain conditions, such as hyperthyroidism, chronic liver disease, and the use of some medications such as spironolactone. […] Eventually, the exposure to the hormonal imbalance leads to proliferation of glandular tissues, ie, ductal hyperplasia.

• #3 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Gynecomastia results from an altered estrogen-androgen balance, in favor of estrogen, or from increased breast sensitivity to a normal circulating estrogen level. […] The imbalance is between the stimulatory effect of estrogen and the inhibitory effect of androgen. […] Estrogens induce ductal epithelial hyperplasia, ductal elongation and branching, proliferation of the periductal fibroblasts, and an increase in vascularity. […] The histologic picture is similar in male and female breast tissue after exposure to estrogen. […] Estrogen production in males results mainly from the peripheral conversion of androgens (testosterone and androstenedione) to estradiol and estrone, which occurs through the action of the enzyme aromatase (mainly in muscle, skin, and adipose tissue). […] Since this only comprises a small fraction of estrogens in circulation (ie, 15% of estradiol and 5% of estrone), the remainder of estrogen in males is derived from the extraglandular aromatization of testosterone and androstenedione to estradiol and estrone.

• #4 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  Gynecomastia is a relatively common disorder. Its causes range from benign physiological processes to rare neoplasms. To diagnose the etiology of the gynecomastia, the clinician must understand the hormonal factors involved in breast development. Parallel to female breast development, estrogen, growth hormone (GH), and IGF-1 are required for breast growth in males. Since a balance exists between estrogen and androgens in males, any disease state or medication that increases circulating estrogens or decreases circulating androgens, causing an elevation in the estrogen to androgen ratio, can induce gynecomastia. […] In a population-based study of healthy boys and adolescents, IGF-I levels were found to be elevated in boys with pubertal gynecomastia compared with boys without gynecomastia suggesting that the GH-IGF-I axis may be involved in the pathogenesis of pubertal gynecomastia.

• #5 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Gynecomastia results from an altered estrogen-androgen balance, in favor of estrogen, or from increased breast sensitivity to a normal circulating estrogen level. […] The imbalance is between the stimulatory effect of estrogen and the inhibitory effect of androgen. […] Estrogens induce ductal epithelial hyperplasia, ductal elongation and branching, proliferation of the periductal fibroblasts, and an increase in vascularity. […] The histologic picture is similar in male and female breast tissue after exposure to estrogen. […] Estrogen production in males results mainly from the peripheral conversion of androgens (testosterone and androstenedione) to estradiol and estrone, which occurs through the action of the enzyme aromatase (mainly in muscle, skin, and adipose tissue). […] Since this only comprises a small fraction of estrogens in circulation (ie, 15% of estradiol and 5% of estrone), the remainder of estrogen in males is derived from the extraglandular aromatization of testosterone and androstenedione to estradiol and estrone.

• #6 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Gynecomastia results from an altered estrogen-androgen balance, in favor of estrogen, or from increased breast sensitivity to a normal circulating estrogen level. […] The imbalance is between the stimulatory effect of estrogen and the inhibitory effect of androgen. […] Estrogens induce ductal epithelial hyperplasia, ductal elongation and branching, proliferation of the periductal fibroblasts, and an increase in vascularity. […] The histologic picture is similar in male and female breast tissue after exposure to estrogen. […] Estrogen production in males results mainly from the peripheral conversion of androgens (testosterone and androstenedione) to estradiol and estrone, which occurs through the action of the enzyme aromatase (mainly in muscle, skin, and adipose tissue). […] Since this only comprises a small fraction of estrogens in circulation (ie, 15% of estradiol and 5% of estrone), the remainder of estrogen in males is derived from the extraglandular aromatization of testosterone and androstenedione to estradiol and estrone.

• #7 Gynecomastia – Wikipedia

  https://en.wikipedia.org/wiki/Gynecomastia

  Gynecomastia is the non-cancerous enlargement of one or both breasts in men due to the growth of breast tissue as a result of a hormone imbalance between estrogens and androgens. […] Gynecomastia may be caused by abnormal hormone changes, any condition that leads to an increase in the ratio of estrogens/androgens such as liver disease, kidney failure, thyroid disease and some non-breast tumors. […] Gynecomastia is thought to be caused by an altered ratio of estrogens to androgens mediated by an increase in estrogen action, a decrease in androgen action, or a combination of these two factors. […] The causes of common gynecomastia remain uncertain, but are thought to result from an imbalance between the actions of estrogen, which stimulates breast tissue growth, and androgens, which inhibit breast tissue growth.

• #8 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development. […] Increased estrogen production and/or action can occur at the testicular level or at the periphery and is characterized as follows: […] From the testes – Can be due to testicular tumors or to ectopic production of human chorionic gonadotropin (hCG), as is reported with carcinoma of lung, kidney, gastrointestinal (GI) tract, and extragonadal germ cell tumors. […] From peripheral conversion – Can be due to increased substrate or increased activity of aromatase, as in chronic liver disease, malnutrition, hyperthyroidism, adrenal tumors, and familial gynecomastia. […] Gynecomastia can be physiologic or pathologic. […] Pathologic gynecomastia can be caused by an increase in the production and/or action of estrogen, by a decrease in the production and/or action of testosterone accompanied by increased aromatization and high estrogen, or by drug use.

• #9 Breast enlargement in males: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003165.htm

  When an abnormal amount of breast tissue develops in males, it is called gynecomastia. It is important to find out if the excess growth in the area of the breast is breast tissue and not excess fat tissue (lipomastia). […] Enlarged breasts in males are usually harmless, but may cause men to avoid wearing certain clothing or to not want to be seen without a shirt. This can cause significant distress, particularly in young men. […] Normal hormone changes are the most common cause of breast development in newborns, boys, and men. There are other causes as well. […] Breast enlargement is usually caused by an imbalance of estrogen (female hormone) and testosterone (male hormone). Males have both types of hormones in their body. Changes in the levels of these hormones, or in how the body uses or responds to these hormones, can cause enlarged breasts in males.

• #10 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development. […] Increased estrogen production and/or action can occur at the testicular level or at the periphery and is characterized as follows: […] From the testes – Can be due to testicular tumors or to ectopic production of human chorionic gonadotropin (hCG), as is reported with carcinoma of lung, kidney, gastrointestinal (GI) tract, and extragonadal germ cell tumors. […] From peripheral conversion – Can be due to increased substrate or increased activity of aromatase, as in chronic liver disease, malnutrition, hyperthyroidism, adrenal tumors, and familial gynecomastia. […] Gynecomastia can be physiologic or pathologic. […] Pathologic gynecomastia can be caused by an increase in the production and/or action of estrogen, by a decrease in the production and/or action of testosterone accompanied by increased aromatization and high estrogen, or by drug use.

• #11 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  However, gynecomastia can also be idiopathic. […] Decreased androgen action […] Increased aromatization of androgens to estrogens […] Increased androgenic precursors (dehydroepiandrosterone [DHEA] and androstenedione) […] Increased SHBG binds testosterone estrogen favoring greater peripheral estrogen action […] Estrogen receptor agonism. […] Conditions that result in primary or secondary hypogonadism can lead to gynecomastia in different mechanisms. […] The associated reduction in testosterone production leads to a decrease in the serum testosterone concentration and a compensatory rise in leuteinizing hormone (LH) release. […] The excess LH results in enhanced Leydig cell stimulation with inhibition of the 17,20-lyase and 17-hydroxylase activities and increased aromatization of testosterone to estradiol; the net effect is an increase in estradiol relative to testosterone secretion.

• #12 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  However, gynecomastia can also be idiopathic. […] Decreased androgen action […] Increased aromatization of androgens to estrogens […] Increased androgenic precursors (dehydroepiandrosterone [DHEA] and androstenedione) […] Increased SHBG binds testosterone estrogen favoring greater peripheral estrogen action […] Estrogen receptor agonism. […] Conditions that result in primary or secondary hypogonadism can lead to gynecomastia in different mechanisms. […] The associated reduction in testosterone production leads to a decrease in the serum testosterone concentration and a compensatory rise in leuteinizing hormone (LH) release. […] The excess LH results in enhanced Leydig cell stimulation with inhibition of the 17,20-lyase and 17-hydroxylase activities and increased aromatization of testosterone to estradiol; the net effect is an increase in estradiol relative to testosterone secretion.

• #13 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Gynecomastia results from an altered estrogen-androgen balance, in favor of estrogen, or from increased breast sensitivity to a normal circulating estrogen level. […] The imbalance is between the stimulatory effect of estrogen and the inhibitory effect of androgen. […] Estrogens induce ductal epithelial hyperplasia, ductal elongation and branching, proliferation of the periductal fibroblasts, and an increase in vascularity. […] The histologic picture is similar in male and female breast tissue after exposure to estrogen. […] Estrogen production in males results mainly from the peripheral conversion of androgens (testosterone and androstenedione) to estradiol and estrone, which occurs through the action of the enzyme aromatase (mainly in muscle, skin, and adipose tissue). […] Since this only comprises a small fraction of estrogens in circulation (ie, 15% of estradiol and 5% of estrone), the remainder of estrogen in males is derived from the extraglandular aromatization of testosterone and androstenedione to estradiol and estrone.

• #14 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Gynecomastia results from an altered estrogen-androgen balance, in favor of estrogen, or from increased breast sensitivity to a normal circulating estrogen level. […] The imbalance is between the stimulatory effect of estrogen and the inhibitory effect of androgen. […] Estrogens induce ductal epithelial hyperplasia, ductal elongation and branching, proliferation of the periductal fibroblasts, and an increase in vascularity. […] The histologic picture is similar in male and female breast tissue after exposure to estrogen. […] Estrogen production in males results mainly from the peripheral conversion of androgens (testosterone and androstenedione) to estradiol and estrone, which occurs through the action of the enzyme aromatase (mainly in muscle, skin, and adipose tissue). […] Since this only comprises a small fraction of estrogens in circulation (ie, 15% of estradiol and 5% of estrone), the remainder of estrogen in males is derived from the extraglandular aromatization of testosterone and androstenedione to estradiol and estrone.

• #15 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  Gynecomastia, breast development in males, can occur normally during three phases of life. The first occurs shortly after birth in both males and females. This is partly caused by the high fetal blood levels of estradiol and progesterone (produced by the mother) that stimulate breast tissue in the newborn. […] Puberty marks the second period when gynecomastia can occur physiologically. In fact, up to 60% of boys have clinically detectable gynecomastia by age 14. […] The third age range in which gynecomastia is frequently seen is during older age (60 years). […] Pathologic gynecomastia is due to an increase in the circulating and/or local breast tissue ratio of estrogen to androgen. […] Increased estrogen levels will increase glandular proliferation by several mechanisms. These include direct stimulation of glandular tissue and by suppressing LH, therefore decreasing testosterone secretion by the testes and exaggerating the already high estrogen to androgen ratio. […] Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development.

• #16 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  Gynecomastia, breast development in males, can occur normally during three phases of life. The first occurs shortly after birth in both males and females. This is partly caused by the high fetal blood levels of estradiol and progesterone (produced by the mother) that stimulate breast tissue in the newborn. […] Puberty marks the second period when gynecomastia can occur physiologically. In fact, up to 60% of boys have clinically detectable gynecomastia by age 14. […] The third age range in which gynecomastia is frequently seen is during older age (60 years). […] Pathologic gynecomastia is due to an increase in the circulating and/or local breast tissue ratio of estrogen to androgen. […] Increased estrogen levels will increase glandular proliferation by several mechanisms. These include direct stimulation of glandular tissue and by suppressing LH, therefore decreasing testosterone secretion by the testes and exaggerating the already high estrogen to androgen ratio. […] Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development.

• #17 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Gynecomastia.aspx

  Gynecomastia is defined as the benign proliferation of male breast glandular tissue with a size exceeding two centimeters. […] In simplistic terms, gynecomastia is an increase in the male breast volume and is traditionally associated with hormonal incidences such as birth, adolescence, and old age. This enlargement of the male breast volume is due to increased ductal tissue, stroma, or fat mass. […] Gynecomastia can appear transient at birth due to increased circulating maternal estrogens. Later in life, gynecomastia may appear due to hormonal changes during puberty, resulting in an imbalance between estradiol and testosterone. Further still, gynecomastia may arise in old age (65 years); this hypertrophic increase in breast volume is thought to be due to a decline in testosterone levels as well as a shift in the ratio of testosterone to estrogen.

• #18 Understanding Gynecomastia and Its Management

  https://www.uspharmacist.com/article/understanding-gynecomastia-and-its-management/preview/uspeditorial?utm_source=TrendMD&utm_medium=cpc&utm_campaign=US_Pharmacist_TrendMD_1

  Gynecomastia, a benign condition in which breast tissue in males is enlarged, can cause psychological distress and breast pain. Physiological gynecomastia, which occurs in neonates, adolescents, and older adults, is often self-limiting, involving an imbalance of estrogen and testosterone. Nonphysiological gynecomastia can be pathologic, pharmacologic, or idiopathic in nature. Management of this condition involves reversal of the underlying cause or causes; pharmacologic treatment, such as testosterone in hypogonadal men or the selective estrogen receptor modulator tamoxifen for partial reduction in size or pain; and surgery for gynecomastia that persists beyond 12 months. […] Gynecomastia is a benign condition involving the proliferation of breast glandular tissue in males. […] Physiological gynecomastia has a trimodal age distribution, with incidence peaking in the neonatal period, puberty, and older age. Nonphysiological gynecomastia, including pathologic (due to a medical condition), pharmacologic (caused by a medication), and idiopathic (no underlying cause identified) etiologies, can occur at any age and has a wide variety of causes.

• #19 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  Gynecomastia, breast development in males, can occur normally during three phases of life. The first occurs shortly after birth in both males and females. This is partly caused by the high fetal blood levels of estradiol and progesterone (produced by the mother) that stimulate breast tissue in the newborn. […] Puberty marks the second period when gynecomastia can occur physiologically. In fact, up to 60% of boys have clinically detectable gynecomastia by age 14. […] The third age range in which gynecomastia is frequently seen is during older age (60 years). […] Pathologic gynecomastia is due to an increase in the circulating and/or local breast tissue ratio of estrogen to androgen. […] Increased estrogen levels will increase glandular proliferation by several mechanisms. These include direct stimulation of glandular tissue and by suppressing LH, therefore decreasing testosterone secretion by the testes and exaggerating the already high estrogen to androgen ratio. […] Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development.

• #20 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Gynecomastia.aspx

  The hormone estrogen is responsible for the augmentation of glandular tissue alongside the suppression of testosterone secretion. The luteinizing hormone is suppressed by estrogen; this hormone mediates testosterone secretion from the testes. […] Gynecomastia that occurs during puberty is thought to be caused by an elevated or accelerated rise in estradiol relative to the rise of testosterone. This subsequently causes an imbalance that normally regresses over time as testosterone levels gradually increase. […] Medical conditions, including any tumors of the pituitary, adrenal gland, and testes, can alter the hormonal profile seen in males, including an increase in estrogen and a decrease in testosterone. These imbalances lead to overall hormonal imbalances, which can cause gynecomastia in some males.

• #21 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  Gynecomastia is a relatively common disorder. Its causes range from benign physiological processes to rare neoplasms. To diagnose the etiology of the gynecomastia, the clinician must understand the hormonal factors involved in breast development. Parallel to female breast development, estrogen, growth hormone (GH), and IGF-1 are required for breast growth in males. Since a balance exists between estrogen and androgens in males, any disease state or medication that increases circulating estrogens or decreases circulating androgens, causing an elevation in the estrogen to androgen ratio, can induce gynecomastia. […] In a population-based study of healthy boys and adolescents, IGF-I levels were found to be elevated in boys with pubertal gynecomastia compared with boys without gynecomastia suggesting that the GH-IGF-I axis may be involved in the pathogenesis of pubertal gynecomastia.

• #22 Gynecomastia: Etiology, Diagnosis, and Treatment – Endotext – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279105/

  Gynecomastia, breast development in males, can occur normally during three phases of life. The first occurs shortly after birth in both males and females. This is partly caused by the high fetal blood levels of estradiol and progesterone (produced by the mother) that stimulate breast tissue in the newborn. […] Puberty marks the second period when gynecomastia can occur physiologically. In fact, up to 60% of boys have clinically detectable gynecomastia by age 14. […] The third age range in which gynecomastia is frequently seen is during older age (60 years). […] Pathologic gynecomastia is due to an increase in the circulating and/or local breast tissue ratio of estrogen to androgen. […] Increased estrogen levels will increase glandular proliferation by several mechanisms. These include direct stimulation of glandular tissue and by suppressing LH, therefore decreasing testosterone secretion by the testes and exaggerating the already high estrogen to androgen ratio. […] Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development.

• #23 Patient education: Gynecomastia (breast enlargement in males) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gynecomastia-breast-enlargement-in-males-beyond-the-basics

  Males taking combination treatment for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), called highly active antiretroviral therapy (HAART), sometimes develop enlarged breasts. […] It is not always clear what causes gynecomastia during mid to late life. Still, as males age, blood testosterone levels tend to decline, and the hormone balance changes to a higher amount of estrogen-to-testosterone ratio. […] Gynecomastia should not be confused with pseudogynecomastia (also known as lipomastia), which occurs in overweight males whose breasts enlarge because of fat deposits. […] The best treatment for gynecomastia depends upon its cause, duration, and severity and whether it causes pain or discomfort. […] Gynecomastia is a common complication of hormonal treatment for prostate cancer (androgen deprivation therapy or antiandrogen monotherapy).

• #24 Understanding Gynecomastia and Its Management

  https://www.uspharmacist.com/article/understanding-gynecomastia-and-its-management/preview/uspeditorial?utm_source=TrendMD&utm_medium=cpc&utm_campaign=US_Pharmacist_TrendMD_1

  An estimated 36% to 57% of men older than age 60 years develop gynecomastia, with the wide range in reported prevalence attributed to variations in studies diagnostic criteria and selected populations. Gynecomastia in older men may result from decreased serum testosterone concentrations, increased aromatase activity related to increased body fat that leads to increased conversion of androgens to estrogen, and elevated luteinizing hormone (LH) concentrations. Increased serum sex hormone-binding globulin (SHBG) concentrations may also make estrogen more bioavailable than testosterone, further affecting the E2-to-testosterone ratio. Notably, gynecomastia is attributable to medications in 80% of cases in older men. […] Nonphysiological gynecomastia can have pathologic, pharmacologic, and idiopathic etiologies. Medical conditions that can cause gynecomastia include disorders resulting in testosterone deficiency, malnutrition associated with cirrhosis or chronic renal disease, and certain thyroid disorders, among others.

• #25 Understanding Gynecomastia and Its Management

  https://www.uspharmacist.com/article/understanding-gynecomastia-and-its-management/preview/uspeditorial?utm_source=TrendMD&utm_medium=cpc&utm_campaign=US_Pharmacist_TrendMD_1

  An estimated 36% to 57% of men older than age 60 years develop gynecomastia, with the wide range in reported prevalence attributed to variations in studies diagnostic criteria and selected populations. Gynecomastia in older men may result from decreased serum testosterone concentrations, increased aromatase activity related to increased body fat that leads to increased conversion of androgens to estrogen, and elevated luteinizing hormone (LH) concentrations. Increased serum sex hormone-binding globulin (SHBG) concentrations may also make estrogen more bioavailable than testosterone, further affecting the E2-to-testosterone ratio. Notably, gynecomastia is attributable to medications in 80% of cases in older men. […] Nonphysiological gynecomastia can have pathologic, pharmacologic, and idiopathic etiologies. Medical conditions that can cause gynecomastia include disorders resulting in testosterone deficiency, malnutrition associated with cirrhosis or chronic renal disease, and certain thyroid disorders, among others.

• #26 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development. […] Increased estrogen production and/or action can occur at the testicular level or at the periphery and is characterized as follows: […] From the testes – Can be due to testicular tumors or to ectopic production of human chorionic gonadotropin (hCG), as is reported with carcinoma of lung, kidney, gastrointestinal (GI) tract, and extragonadal germ cell tumors. […] From peripheral conversion – Can be due to increased substrate or increased activity of aromatase, as in chronic liver disease, malnutrition, hyperthyroidism, adrenal tumors, and familial gynecomastia. […] Gynecomastia can be physiologic or pathologic. […] Pathologic gynecomastia can be caused by an increase in the production and/or action of estrogen, by a decrease in the production and/or action of testosterone accompanied by increased aromatization and high estrogen, or by drug use.

• #27 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  However, gynecomastia can also be idiopathic. […] Decreased androgen action […] Increased aromatization of androgens to estrogens […] Increased androgenic precursors (dehydroepiandrosterone [DHEA] and androstenedione) […] Increased SHBG binds testosterone estrogen favoring greater peripheral estrogen action […] Estrogen receptor agonism. […] Conditions that result in primary or secondary hypogonadism can lead to gynecomastia in different mechanisms. […] The associated reduction in testosterone production leads to a decrease in the serum testosterone concentration and a compensatory rise in leuteinizing hormone (LH) release. […] The excess LH results in enhanced Leydig cell stimulation with inhibition of the 17,20-lyase and 17-hydroxylase activities and increased aromatization of testosterone to estradiol; the net effect is an increase in estradiol relative to testosterone secretion.

• #28 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  However, gynecomastia can also be idiopathic. […] Decreased androgen action […] Increased aromatization of androgens to estrogens […] Increased androgenic precursors (dehydroepiandrosterone [DHEA] and androstenedione) […] Increased SHBG binds testosterone estrogen favoring greater peripheral estrogen action […] Estrogen receptor agonism. […] Conditions that result in primary or secondary hypogonadism can lead to gynecomastia in different mechanisms. […] The associated reduction in testosterone production leads to a decrease in the serum testosterone concentration and a compensatory rise in leuteinizing hormone (LH) release. […] The excess LH results in enhanced Leydig cell stimulation with inhibition of the 17,20-lyase and 17-hydroxylase activities and increased aromatization of testosterone to estradiol; the net effect is an increase in estradiol relative to testosterone secretion.

• #29 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Secondary hypogonadism due to a hypothalamic or pituitary abnormality may also be associated with gynecomastia. […] In these patients, the production of LH is deficient, resulting in a low testosterone production rate and low estradiol production from the testes. […] However, the adrenal cortex continues to produce estrogen precursors that are aromatized in extraglandular tissue; the result is an estrogen/androgen imbalance.

• #30 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Gynecomastia is defined as benign proliferation of glandular breast tissue in men. […] Gynecomastia, which can be physiologic or nonphysiologic, occurs when the estrogen-to-testosterone ratio in men is disrupted, leading to proliferation of glandular breast tissue. […] Nonphysiologic gynecomastia can occur at any age as a result of a number of medical conditions, medication use, or substance use. […] Gynecomastia may be the only presenting symptom in men with primary hypogonadism. […] Although testicular tumors are rare, approximately 10 percent of persons with testicular tumors present with gynecomastia alone. […] Gynecomastia occurs in 10 to 40 percent of men with hyperthyroidism, although it is rarely the only symptom at presentation. […] Hormonal dysfunction is common in men with renal failure because of overall suppression of testosterone production and direct testicular damage secondary to uremia.

• #31 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Gynecomastia is defined as benign proliferation of glandular breast tissue in men. […] Gynecomastia, which can be physiologic or nonphysiologic, occurs when the estrogen-to-testosterone ratio in men is disrupted, leading to proliferation of glandular breast tissue. […] Nonphysiologic gynecomastia can occur at any age as a result of a number of medical conditions, medication use, or substance use. […] Gynecomastia may be the only presenting symptom in men with primary hypogonadism. […] Although testicular tumors are rare, approximately 10 percent of persons with testicular tumors present with gynecomastia alone. […] Gynecomastia occurs in 10 to 40 percent of men with hyperthyroidism, although it is rarely the only symptom at presentation. […] Hormonal dysfunction is common in men with renal failure because of overall suppression of testosterone production and direct testicular damage secondary to uremia.

• #32 SciELO Brazil – Gynecomastia: physiopathology, evaluation and treatment Gynecomastia: physiopathology, evaluation and treatment

  https://www.scielo.br/j/spmj/a/PFcc79gBghNMHmXs7RPs89g/

  GM is a multifactorial disease and many conditions may be associated with it. […] Relative excess of serum levels of estrogens compared with androgens is implicated in the pathogenesis, due to estradiol production rising sooner than testosterone production. […] Older men over the age of 65 years often present relative hypogonadism with a decline in plasma testosterone levels, elevation of SHBG and decrease in free testosterone. […] Benign testicular tumors (Sertoli or Leydig cell tumors) may secrete estradiol. […] Severe hyperthyroidism increases serum SHBG. […] Drug-induced GM merits deep consideration as it may account for as many as 25% of all cases of new-onset GM in adults. […] So far, at least 20 clinical conditions and 30 medications have been implicated in relation to causing GM. However, the etiology of GM is still only understood to a limited extent, and up to 50% of the cases may have no obvious cause.

• #33 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development. […] Increased estrogen production and/or action can occur at the testicular level or at the periphery and is characterized as follows: […] From the testes – Can be due to testicular tumors or to ectopic production of human chorionic gonadotropin (hCG), as is reported with carcinoma of lung, kidney, gastrointestinal (GI) tract, and extragonadal germ cell tumors. […] From peripheral conversion – Can be due to increased substrate or increased activity of aromatase, as in chronic liver disease, malnutrition, hyperthyroidism, adrenal tumors, and familial gynecomastia. […] Gynecomastia can be physiologic or pathologic. […] Pathologic gynecomastia can be caused by an increase in the production and/or action of estrogen, by a decrease in the production and/or action of testosterone accompanied by increased aromatization and high estrogen, or by drug use.

• #34 Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment

  https://e-apem.org/journal/view.php?number=1034

  GM without testicular swelling is the main symptom in 7%-11% of subjects with testicular tumors, and it may be the only clinical finding on physical examination at the time of diagnosis. […] Feminizing adrenocortical tumors (FATs) are extremely rare and have a median age at diagnosis of 6 years. […] Breast cancer in adolescents accounts for 0.1% of all breast cancer cases and less than 1% of all pediatric cancer cases. […] The management of GM necessitates the consideration of secondary etiologies. […] In cases of drug-induced GM, cessation of the offending agent or substitution with alternative medication is recommended. […] Pharmacological intervention may be considered for cases of pubertal GM that do not resolve spontaneously within a period of 2 years or for those associated with significant tenderness or psychosocial morbidity.

• #35 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Gynecomastia is defined as benign proliferation of glandular breast tissue in men. […] Gynecomastia, which can be physiologic or nonphysiologic, occurs when the estrogen-to-testosterone ratio in men is disrupted, leading to proliferation of glandular breast tissue. […] Nonphysiologic gynecomastia can occur at any age as a result of a number of medical conditions, medication use, or substance use. […] Gynecomastia may be the only presenting symptom in men with primary hypogonadism. […] Although testicular tumors are rare, approximately 10 percent of persons with testicular tumors present with gynecomastia alone. […] Gynecomastia occurs in 10 to 40 percent of men with hyperthyroidism, although it is rarely the only symptom at presentation. […] Hormonal dysfunction is common in men with renal failure because of overall suppression of testosterone production and direct testicular damage secondary to uremia.

• #36 SciELO Brazil – Gynecomastia: physiopathology, evaluation and treatment Gynecomastia: physiopathology, evaluation and treatment

  https://www.scielo.br/j/spmj/a/PFcc79gBghNMHmXs7RPs89g/

  GM is a multifactorial disease and many conditions may be associated with it. […] Relative excess of serum levels of estrogens compared with androgens is implicated in the pathogenesis, due to estradiol production rising sooner than testosterone production. […] Older men over the age of 65 years often present relative hypogonadism with a decline in plasma testosterone levels, elevation of SHBG and decrease in free testosterone. […] Benign testicular tumors (Sertoli or Leydig cell tumors) may secrete estradiol. […] Severe hyperthyroidism increases serum SHBG. […] Drug-induced GM merits deep consideration as it may account for as many as 25% of all cases of new-onset GM in adults. […] So far, at least 20 clinical conditions and 30 medications have been implicated in relation to causing GM. However, the etiology of GM is still only understood to a limited extent, and up to 50% of the cases may have no obvious cause.

• #37 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Gynecomastia is defined as benign proliferation of glandular breast tissue in men. […] Gynecomastia, which can be physiologic or nonphysiologic, occurs when the estrogen-to-testosterone ratio in men is disrupted, leading to proliferation of glandular breast tissue. […] Nonphysiologic gynecomastia can occur at any age as a result of a number of medical conditions, medication use, or substance use. […] Gynecomastia may be the only presenting symptom in men with primary hypogonadism. […] Although testicular tumors are rare, approximately 10 percent of persons with testicular tumors present with gynecomastia alone. […] Gynecomastia occurs in 10 to 40 percent of men with hyperthyroidism, although it is rarely the only symptom at presentation. […] Hormonal dysfunction is common in men with renal failure because of overall suppression of testosterone production and direct testicular damage secondary to uremia.

• #38 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Conditions that impair absorption, such as ulcerative colitis and cystic fibrosis, may result in gynecomastia. […] Although obesity causes pseudogynecomastia (a proliferation of adipose rather than glandular tissue), elevated weight is also associated with true gynecomastia. […] Gynecomastia is a common adverse effect of bicalutamide (Casodex) therapy that may prompt some men to discontinue prostate cancer treatment. […] Tamoxifen has been recommended as a preventive agent for gynecomastia in these patients. […] Surgery can be performed at any time to reduce breast tissue, and a number of techniques have been used.

• #39 Gynecomastia

  https://www.uspharmacist.com/article/gynecomastia

  Chronic liver disease and kidney failure can both produce gynecomastia by affecting the body’s hormonal balance. A patient with liver disease may experience an increased conversion of testosterone to estrogen as well as an elevation in serum SHBG. In renal disease, gynecomastia occurs in 50% of patients on hemodialysis, primarily due to Leydig’s cell dysfunction; luteinizing hormone (LH) levels are elevated in these patients. […] Although drugs are responsible for less than 20% of all cases of gynecomastia, there is a long list of medications that have been identified as potential causes of this condition. Gynecomastia occurs because of a variety of actions depending on the drug and its chemical structure. […] Treatment of gynecomastia is very different from the treatment of most other conditions because it is often the result of other problems (i.e., neoplasms, hormonal imbalance, systemic diseases). The approach to gynecomastia is based on identification and treatment of the primary cause. […] When the primary cause is adequately treated, the breasts should shrink in size after several months of treatment, although they may not completely return to normal.

• #40 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Conditions that impair absorption, such as ulcerative colitis and cystic fibrosis, may result in gynecomastia. […] Although obesity causes pseudogynecomastia (a proliferation of adipose rather than glandular tissue), elevated weight is also associated with true gynecomastia. […] Gynecomastia is a common adverse effect of bicalutamide (Casodex) therapy that may prompt some men to discontinue prostate cancer treatment. […] Tamoxifen has been recommended as a preventive agent for gynecomastia in these patients. […] Surgery can be performed at any time to reduce breast tissue, and a number of techniques have been used.

• #41 Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment

  https://e-apem.org/journal/view.php?number=1034

  However, some studies have indicated that a significant number of adolescents with pubertal GM had normal estrogen level, and they linked GM to increased susceptibility of the breast tissue to normal level of circulating estrogen. […] These studies also claimed that the presence of local tissue factors in the breast increased the aromatization of androgens to estrogen in the breast tissue itself, which was corroborated by the presence of elevated aromatase activity in the fibroblasts in the pubic skin of GM patients. […] A study reported that men with a body mass index (BMI) of 25 kg/m2 or higher are far more likely to develop GM or pseudogynecomastia, with a reported prevalence as high as 80%. […] Individuals who are obese are prone to GM due to their higher concentration of adipose tissue in the breast region.

• #42 Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment

  https://e-apem.org/journal/view.php?number=1034

  This adipose tissue is known to contain the aromatase enzyme complex, which facilitates the conversion of testosterone to estradiol. […] AES is a rare genetic disease characterized by pre- or peripubertal onset of GM and is transmitted as an X-linked recessive or autosomal dominant trait. […] GM can develop as a result of exposure to medications that lower the level of androgens, increase estradiol levels, or displace androgens from breast androgen receptors. […] The development of GM may theoretically be induced by ongoing environmental exposure to chemicals that have a mild estrogen-agonist effect. […] GM has been linked to chronic illnesses such cystic fibrosis, ulcerative colitis, liver disease, chronic renal failure, and human immunodeficiency virus (HIV). […] According to reports, more than 50% of KS patients have GM as a result of both increased aromatase activity and decreased androgen production.

• #43 SciELO Brazil – Gynecomastia: physiopathology, evaluation and treatment Gynecomastia: physiopathology, evaluation and treatment

  https://www.scielo.br/j/spmj/a/PFcc79gBghNMHmXs7RPs89g/

  GM is a multifactorial disease and many conditions may be associated with it. […] Relative excess of serum levels of estrogens compared with androgens is implicated in the pathogenesis, due to estradiol production rising sooner than testosterone production. […] Older men over the age of 65 years often present relative hypogonadism with a decline in plasma testosterone levels, elevation of SHBG and decrease in free testosterone. […] Benign testicular tumors (Sertoli or Leydig cell tumors) may secrete estradiol. […] Severe hyperthyroidism increases serum SHBG. […] Drug-induced GM merits deep consideration as it may account for as many as 25% of all cases of new-onset GM in adults. […] So far, at least 20 clinical conditions and 30 medications have been implicated in relation to causing GM. However, the etiology of GM is still only understood to a limited extent, and up to 50% of the cases may have no obvious cause.

• #44 Causes and Treatment of Male Breast Enlargement – Gynecomastia | Kyle Song MD – Irvine Plastic Surgery

  https://www.socoplasticsurgery.com/blog/causes-and-treatment-of-male-breast-enlargement-gynecomastia/

  Male breast enlargement, otherwise known as gynecomastia, is a surprisingly common condition, as it occurs in almost 30% to 50% of healthy pubescent males and adult men. […] Male breast enlargement is caused by an imbalance between testosterone and estrogen levels. In some men, the testosterone is unable to inhibit the estrogen, which is why male breasts are formed. Gynecomastia is often a misunderstood health condition, as the medical community is still not sure what triggers the hormonal imbalance. […] It’s thought that drug-induced gynecomastia accounts for about 25% of all cases; however, the other 25% of cases are still a mystery.

• #45 Understanding Gynecomastia and Its Management

  https://www.uspharmacist.com/article/understanding-gynecomastia-and-its-management/preview/uspeditorial?utm_source=TrendMD&utm_medium=cpc&utm_campaign=US_Pharmacist_TrendMD_1

  An estimated 36% to 57% of men older than age 60 years develop gynecomastia, with the wide range in reported prevalence attributed to variations in studies diagnostic criteria and selected populations. Gynecomastia in older men may result from decreased serum testosterone concentrations, increased aromatase activity related to increased body fat that leads to increased conversion of androgens to estrogen, and elevated luteinizing hormone (LH) concentrations. Increased serum sex hormone-binding globulin (SHBG) concentrations may also make estrogen more bioavailable than testosterone, further affecting the E2-to-testosterone ratio. Notably, gynecomastia is attributable to medications in 80% of cases in older men. […] Nonphysiological gynecomastia can have pathologic, pharmacologic, and idiopathic etiologies. Medical conditions that can cause gynecomastia include disorders resulting in testosterone deficiency, malnutrition associated with cirrhosis or chronic renal disease, and certain thyroid disorders, among others.

• #46 Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment

  https://e-apem.org/journal/view.php?number=1034

  This adipose tissue is known to contain the aromatase enzyme complex, which facilitates the conversion of testosterone to estradiol. […] AES is a rare genetic disease characterized by pre- or peripubertal onset of GM and is transmitted as an X-linked recessive or autosomal dominant trait. […] GM can develop as a result of exposure to medications that lower the level of androgens, increase estradiol levels, or displace androgens from breast androgen receptors. […] The development of GM may theoretically be induced by ongoing environmental exposure to chemicals that have a mild estrogen-agonist effect. […] GM has been linked to chronic illnesses such cystic fibrosis, ulcerative colitis, liver disease, chronic renal failure, and human immunodeficiency virus (HIV). […] According to reports, more than 50% of KS patients have GM as a result of both increased aromatase activity and decreased androgen production.

• #47 Gynecomastia: What It Is, Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/symptoms/16227-enlarged-male-breast-tissue-gynecomastia

  Gynecomastia may be a side effect of certain medications, including: Cimetidine (for heartburn and acid reflux). Digoxin (for certain heart issues). Finasteride (for enlarged prostate or alopecia). Ketoconazole (for fungal or yeast infections). Spironolactone (for high blood pressure and heart failure). Thiazides (a class of diuretics). Phenothiazines (a class of first-generation antipsychotic medications). Theophylline (for asthma and COPD). Methotrexate (for rheumatoid arthritis and cancer). Imatinib (chemotherapy drug). […] If you have gynecomastia due to a hormonal imbalance, exercise likely won’t make a difference. This is because an imbalance of estrogen and testosterone is responsible for an increase in your breast tissue, and exercise can’t override that.

• #48 Gynecomastia: What It Is, Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/symptoms/16227-enlarged-male-breast-tissue-gynecomastia

  Gynecomastia may be a side effect of certain medications, including: Cimetidine (for heartburn and acid reflux). Digoxin (for certain heart issues). Finasteride (for enlarged prostate or alopecia). Ketoconazole (for fungal or yeast infections). Spironolactone (for high blood pressure and heart failure). Thiazides (a class of diuretics). Phenothiazines (a class of first-generation antipsychotic medications). Theophylline (for asthma and COPD). Methotrexate (for rheumatoid arthritis and cancer). Imatinib (chemotherapy drug). […] If you have gynecomastia due to a hormonal imbalance, exercise likely won’t make a difference. This is because an imbalance of estrogen and testosterone is responsible for an increase in your breast tissue, and exercise can’t override that.

• #49 Patient education: Gynecomastia (breast enlargement in males) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gynecomastia-breast-enlargement-in-males-beyond-the-basics/print

  Gynecomastia is a condition in which the glandular tissue in the breasts becomes enlarged in males, 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. […] 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. […] The most common causes of gynecomastia in adult males that seek a medical evaluation for gynecomastia include: Pubertal gynecomastia that does not resolve – 25 percent; Drugs – 10 to 25 percent; Unknown causes (idiopathic) – 25 percent. […] Gynecomastia occurs in up to 75 percent of males who take drugs called antiandrogens to treat prostate cancer.

• #50 Patient education: Gynecomastia (breast enlargement in males) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gynecomastia-breast-enlargement-in-males-beyond-the-basics/print

  It is not always clear what causes gynecomastia during mid to late life. Still, as males age, blood testosterone levels tend to decline, and the hormone balance changes to a higher amount of estrogen-to-testosterone ratio. […] Gynecomastia should not be confused with pseudogynecomastia (also known as lipomastia), which occurs in overweight males whose breasts enlarge because of fat deposits. […] The best treatment for gynecomastia depends upon its cause, duration, and severity and whether it causes pain or discomfort. […] Gynecomastia is a common complication of hormonal treatment for prostate cancer (androgen deprivation therapy or antiandrogen monotherapy). However, there are treatment options available to prevent the development of gynecomastia, including tamoxifen and radiation therapy. […] Men with prostate cancer who undergo antiandrogen therapy are at risk for developing gynecomastia. Pretreatment with radiation or taking a medication (tamoxifen) along with the antiandrogen are two options for preventing breast growth.

• #51 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Conditions that impair absorption, such as ulcerative colitis and cystic fibrosis, may result in gynecomastia. […] Although obesity causes pseudogynecomastia (a proliferation of adipose rather than glandular tissue), elevated weight is also associated with true gynecomastia. […] Gynecomastia is a common adverse effect of bicalutamide (Casodex) therapy that may prompt some men to discontinue prostate cancer treatment. […] Tamoxifen has been recommended as a preventive agent for gynecomastia in these patients. […] Surgery can be performed at any time to reduce breast tissue, and a number of techniques have been used.

• #52 Gynecomastia | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html

  Conditions that impair absorption, such as ulcerative colitis and cystic fibrosis, may result in gynecomastia. […] Although obesity causes pseudogynecomastia (a proliferation of adipose rather than glandular tissue), elevated weight is also associated with true gynecomastia. […] Gynecomastia is a common adverse effect of bicalutamide (Casodex) therapy that may prompt some men to discontinue prostate cancer treatment. […] Tamoxifen has been recommended as a preventive agent for gynecomastia in these patients. […] Surgery can be performed at any time to reduce breast tissue, and a number of techniques have been used.

• #53 Patient education: Gynecomastia (breast enlargement in males) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gynecomastia-breast-enlargement-in-males-beyond-the-basics

  Males taking combination treatment for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), called highly active antiretroviral therapy (HAART), sometimes develop enlarged breasts. […] It is not always clear what causes gynecomastia during mid to late life. Still, as males age, blood testosterone levels tend to decline, and the hormone balance changes to a higher amount of estrogen-to-testosterone ratio. […] Gynecomastia should not be confused with pseudogynecomastia (also known as lipomastia), which occurs in overweight males whose breasts enlarge because of fat deposits. […] The best treatment for gynecomastia depends upon its cause, duration, and severity and whether it causes pain or discomfort. […] Gynecomastia is a common complication of hormonal treatment for prostate cancer (androgen deprivation therapy or antiandrogen monotherapy).

• #54 What’s Gynecomastia? How Supportive Therapy May Help

  https://www.verywellhealth.com/gynecomastia-prominent-male-breasts-430620

  Gynecomastia may be caused by chronic conditions such as: Cirrhosis of the liver (chronic liver damage causing scarring and liver failure), Hypogonadism (sex glands produce little if any hormones), Hyperthyroidism (overactive thyroid), Poor kidney function, Testicular or adrenal tumors (rare), Klinefelter’s syndrome (genetic condition resulting from an extra copy of the X chromosome). […] The use of certain drugs may also lead to enlarged breasts in men. […] Anabolic steroid use often causes irreversible gynecomastia as well. The injection of external testosterone inhibits the natural production of testosterone, which cannot recover quickly enough between steroid-injecting cycles to prevent estrogen predominance. […] Gynecomastia is usually benign (non-cancerous) and not a life-threatening issue.

• #55 SciELO Brazil – Gynecomastia: physiopathology, evaluation and treatment Gynecomastia: physiopathology, evaluation and treatment

  https://www.scielo.br/j/spmj/a/PFcc79gBghNMHmXs7RPs89g/

  Gynecomastia (GM) is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. […] A hormonal imbalance between estrogens and androgens is the key hallmark of GM generation. […] The etiology of GM is attributable to physiological factors, endocrine tumors or dysfunctions, non-endocrine diseases, drug use or idiopathic causes. […] Continuous environmental exposure to substances with weak estrogen-agonist action, probably due to epigenetic mechanisms, theoretically can induce the development of GM. […] There is evidence that enlarged male breast glands contain luteinizing hormone (LH) and human chorionic gonadotropin (hCG) receptors. […] Another hormonal action that stimulates breast tissue in men is observed secondary to hyperprolactinemia.

• #56 Enlarged breasts in men (gynecomastia) | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/enlarged-breasts-in-men-gynecomastia?content_id=CON-20164022

  Learn how an imbalance of the hormones estrogen and testosterone can cause breast tissue swelling in boys or men. […] Gynecomastia (guy-nuh-koh-MAS-tee-uh) is an increase in the amount of breast gland tissue in boys or men. An imbalance of the hormones estrogen and testosterone causes it. […] Estrogen levels that are too high or are out of balance with testosterone levels can cause gynecomastia. […] Gynecomastia can happen when the amount of testosterone in the body drops compared with estrogen. The decrease can be caused by conditions that lower testosterone or block its effects. Or it can be caused by conditions that raise the estrogen level. […] Certain health conditions that affect the balance of hormones can either cause or be linked with gynecomastia. […] Some plant oils used in shampoos, soaps or lotions have been associated with gynecomastia. These include tea tree or lavender oil. This likely is due to compounds in the oil that may mimic estrogen or affect testosterone.

• #57 Breast enlargement in males: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003165.htm

  In men, hormone changes due to aging can cause breast growth. This may occur more often in overweight or obese men and in men age 50 and older. […] Certain health problems can cause breast growth in adult men, including chronic liver disease, kidney failure and dialysis, low testosterone level, and obesity. […] Gynecomastia has also been linked to exposure to endocrine disrupters. These are common chemicals often found in plastics. […] Men who have enlarged breasts may have an increased risk for breast cancer. Breast cancer in men is rare. Signs that may suggest breast cancer include one-sided breast growth, firm or hard breast lump that feels like it is attached to the tissue, skin sore over the breast, and bloody discharge from the nipple. […] Breast growth that is large, uneven, or does not go away may cause a decrease in quality of life. Treatments that may be used in this situation are hormone treatment that blocks the effects of estrogens and breast reduction surgery to remove the breast tissue. […] Gynecomastia that has been present for a long time is less likely to resolve even if the right treatment is started.

• #58 Plastic Surgery for Gynecomastia: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/1273437-overview

  Gynecomastia is derived from the Greek terms gynec (feminine) and mastos (breast). The literal translation, male breasts, relates to any condition that results in excessive development of breast tissue in males. Males may rarely develop breast cancer, but this is often associated with testicular atrophy. […] Male breast volume is composed of a combination of ductal and stromal tissue, commonly referred to as glandular tissue, and an increase in adipocytes, typically referred to as fatty tissue. Excess skin resulting in significant ptosis of the breast may be present in patients with severe gynecomastia. […] Histologically, gynecomastia has three recognized pathologic patterns, as follows: Florid type – Characterized by an increase in the number and length of ducts, proliferation of ductal epithelium, periductal edema, a highly cellular fibroblastic stroma and hypervascularity, and the formation of pseudolobules. Fibrous type – Characterized by dilated ducts with minimal proliferation of epithelium, an absence of periductal edema, and an almost acellular fibrous stroma without adipose tissue. Intermediate type – An overlapping pattern of the florid and fibrous types.

• #59 Plastic Surgery for Gynecomastia: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/1273437-overview

  Gynecomastia is derived from the Greek terms gynec (feminine) and mastos (breast). The literal translation, male breasts, relates to any condition that results in excessive development of breast tissue in males. Males may rarely develop breast cancer, but this is often associated with testicular atrophy. […] Male breast volume is composed of a combination of ductal and stromal tissue, commonly referred to as glandular tissue, and an increase in adipocytes, typically referred to as fatty tissue. Excess skin resulting in significant ptosis of the breast may be present in patients with severe gynecomastia. […] Histologically, gynecomastia has three recognized pathologic patterns, as follows: Florid type – Characterized by an increase in the number and length of ducts, proliferation of ductal epithelium, periductal edema, a highly cellular fibroblastic stroma and hypervascularity, and the formation of pseudolobules. Fibrous type – Characterized by dilated ducts with minimal proliferation of epithelium, an absence of periductal edema, and an almost acellular fibrous stroma without adipose tissue. Intermediate type – An overlapping pattern of the florid and fibrous types.

• #60 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Gynecomastia.aspx

  Three types of gynecomastia have been identified. These include florid, fibrous, and intermediate. Florid gynecomastia is characterized by an increased volume of ductal tissue and vascularity. It is most commonly seen in the early stages of the condition. […] Fibrous gynecomastia is observed following a year of suffering from the condition and is characterized by the presence of stroma fibrosis with fewer ducts. […] In most cases, if gynecomastia persists longer than a year, the fibrous type is more prevalent and irreversible, which may subsequently reduce the likelihood of success of medical treatment. […] Medical treatment for gynecomastia aims to correct the imbalance between estrogen and androgens. […] The efficacy of pharmacological treatment of gynecomastia is restricted to small case series and case reports.

• #61 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Gynecomastia.aspx

  Three types of gynecomastia have been identified. These include florid, fibrous, and intermediate. Florid gynecomastia is characterized by an increased volume of ductal tissue and vascularity. It is most commonly seen in the early stages of the condition. […] Fibrous gynecomastia is observed following a year of suffering from the condition and is characterized by the presence of stroma fibrosis with fewer ducts. […] In most cases, if gynecomastia persists longer than a year, the fibrous type is more prevalent and irreversible, which may subsequently reduce the likelihood of success of medical treatment. […] Medical treatment for gynecomastia aims to correct the imbalance between estrogen and androgens. […] The efficacy of pharmacological treatment of gynecomastia is restricted to small case series and case reports.

• #62 Plastic Surgery for Gynecomastia: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/1273437-overview

  Gynecomastia is derived from the Greek terms gynec (feminine) and mastos (breast). The literal translation, male breasts, relates to any condition that results in excessive development of breast tissue in males. Males may rarely develop breast cancer, but this is often associated with testicular atrophy. […] Male breast volume is composed of a combination of ductal and stromal tissue, commonly referred to as glandular tissue, and an increase in adipocytes, typically referred to as fatty tissue. Excess skin resulting in significant ptosis of the breast may be present in patients with severe gynecomastia. […] Histologically, gynecomastia has three recognized pathologic patterns, as follows: Florid type – Characterized by an increase in the number and length of ducts, proliferation of ductal epithelium, periductal edema, a highly cellular fibroblastic stroma and hypervascularity, and the formation of pseudolobules. Fibrous type – Characterized by dilated ducts with minimal proliferation of epithelium, an absence of periductal edema, and an almost acellular fibrous stroma without adipose tissue. Intermediate type – An overlapping pattern of the florid and fibrous types.

• #63 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Gynecomastia.aspx

  Three types of gynecomastia have been identified. These include florid, fibrous, and intermediate. Florid gynecomastia is characterized by an increased volume of ductal tissue and vascularity. It is most commonly seen in the early stages of the condition. […] Fibrous gynecomastia is observed following a year of suffering from the condition and is characterized by the presence of stroma fibrosis with fewer ducts. […] In most cases, if gynecomastia persists longer than a year, the fibrous type is more prevalent and irreversible, which may subsequently reduce the likelihood of success of medical treatment. […] Medical treatment for gynecomastia aims to correct the imbalance between estrogen and androgens. […] The efficacy of pharmacological treatment of gynecomastia is restricted to small case series and case reports.

• #64 SciELO Brazil – Gynecomastia: physiopathology, evaluation and treatment Gynecomastia: physiopathology, evaluation and treatment

  https://www.scielo.br/j/spmj/a/PFcc79gBghNMHmXs7RPs89g/

  Gynecomastia (GM) is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. […] A hormonal imbalance between estrogens and androgens is the key hallmark of GM generation. […] The etiology of GM is attributable to physiological factors, endocrine tumors or dysfunctions, non-endocrine diseases, drug use or idiopathic causes. […] Continuous environmental exposure to substances with weak estrogen-agonist action, probably due to epigenetic mechanisms, theoretically can induce the development of GM. […] There is evidence that enlarged male breast glands contain luteinizing hormone (LH) and human chorionic gonadotropin (hCG) receptors. […] Another hormonal action that stimulates breast tissue in men is observed secondary to hyperprolactinemia.

• #65 Plastic Surgery for Gynecomastia: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/1273437-overview

  The presence of elevated estrogen and progesterone receptors in patients with Klinefelter syndrome provides a potential mechanism by which these patients may develop breast neoplasms. By contrast, patients with idiopathic gynecomastia did not demonstrate an increased number of estrogen or progesterone receptors. Also, the binding affinity of the receptors in both groups were not affected. The absence of elevated progesterone or estrogen receptors in patients with idiopathic gynecomastia helps to explain why these patients rarely manifest breast malignancy.

• #66 Gynecomastia in adolescent males: current understanding of its etiology, pathophysiology, diagnosis, and treatment

  https://e-apem.org/journal/view.php?number=1034

  However, some studies have indicated that a significant number of adolescents with pubertal GM had normal estrogen level, and they linked GM to increased susceptibility of the breast tissue to normal level of circulating estrogen. […] These studies also claimed that the presence of local tissue factors in the breast increased the aromatization of androgens to estrogen in the breast tissue itself, which was corroborated by the presence of elevated aromatase activity in the fibroblasts in the pubic skin of GM patients. […] A study reported that men with a body mass index (BMI) of 25 kg/m2 or higher are far more likely to develop GM or pseudogynecomastia, with a reported prevalence as high as 80%. […] Individuals who are obese are prone to GM due to their higher concentration of adipose tissue in the breast region.

• #67 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Gynecomastia.aspx

  Gynecomastia is not considered life-threatening, but it can cause significant emotional distress. […] Young people in particular with gynecomastia have been shown to become depressed, isolated, and withdrawn; these young adolescents may also suffer from low self-esteem. […] In addition, there is a very small risk of breast cancer.

• #68 Breast enlargement in males: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003165.htm

  When an abnormal amount of breast tissue develops in males, it is called gynecomastia. It is important to find out if the excess growth in the area of the breast is breast tissue and not excess fat tissue (lipomastia). […] Enlarged breasts in males are usually harmless, but may cause men to avoid wearing certain clothing or to not want to be seen without a shirt. This can cause significant distress, particularly in young men. […] Normal hormone changes are the most common cause of breast development in newborns, boys, and men. There are other causes as well. […] Breast enlargement is usually caused by an imbalance of estrogen (female hormone) and testosterone (male hormone). Males have both types of hormones in their body. Changes in the levels of these hormones, or in how the body uses or responds to these hormones, can cause enlarged breasts in males.

• #69 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Gynecomastia.aspx

  Gynecomastia is not considered life-threatening, but it can cause significant emotional distress. […] Young people in particular with gynecomastia have been shown to become depressed, isolated, and withdrawn; these young adolescents may also suffer from low self-esteem. […] In addition, there is a very small risk of breast cancer.

• #70 Breast enlargement in males: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003165.htm

  In men, hormone changes due to aging can cause breast growth. This may occur more often in overweight or obese men and in men age 50 and older. […] Certain health problems can cause breast growth in adult men, including chronic liver disease, kidney failure and dialysis, low testosterone level, and obesity. […] Gynecomastia has also been linked to exposure to endocrine disrupters. These are common chemicals often found in plastics. […] Men who have enlarged breasts may have an increased risk for breast cancer. Breast cancer in men is rare. Signs that may suggest breast cancer include one-sided breast growth, firm or hard breast lump that feels like it is attached to the tissue, skin sore over the breast, and bloody discharge from the nipple. […] Breast growth that is large, uneven, or does not go away may cause a decrease in quality of life. Treatments that may be used in this situation are hormone treatment that blocks the effects of estrogens and breast reduction surgery to remove the breast tissue. […] Gynecomastia that has been present for a long time is less likely to resolve even if the right treatment is started.

• #71 Gynecomastia: Causes, Symptoms, Treatment, Surgery, & Self Care

  https://www.medicinenet.com/gynecomastia/article.htm

  A number of medical conditions may also result in gynecomastia: Malnutrition and re-feeding (recovery from malnutrition) have both been shown to create a hormonal environment that may lead to gynecomastia. Similarly, cirrhosis of the liver alters normal hormone metabolism and may lead to the condition. […] Gynecomastia can be a side effect of many medications, for example: Spironolactone, a diuretic that has anti-androgenic activity. […] Gynecomastia, especially in pubertal males, often goes away on its own within about six months, so observation is preferred over specific treatment in many cases. Stopping medications and treatment of existing medical problems or health conditions that cause enlarged breasts in men also are mainstays of gynecomastia treatment. […] Men with gynecomastia have about a fivefold greater risk of developing male breast cancer when compared with the general population. It is believed that gynecomastia itself is not a precancerous condition, but the hormonal changes (relative increase in estrogens, lower levels of androgens) that produce gynecomastia in adult men also increase their risk of developing breast cancer. […] Gynecomastia that occurs because of hormonal fluctuations with growth or aging cannot be prevented. Gynecomastia related to medical conditions can only be prevented to the extent that the underlying or responsible condition can be prevented.

• #72 SciELO Brazil – Gynecomastia: physiopathology, evaluation and treatment Gynecomastia: physiopathology, evaluation and treatment

  https://www.scielo.br/j/spmj/a/PFcc79gBghNMHmXs7RPs89g/

  If GM either persists or becomes more severe and is associated with pain, psychological distress or embarrassment caused by avoidance of activities in which the chest is exposed, pharmacological and surgical therapeutic options should be considered, especially when the patient wishes to pursue treatment. […] GM of long duration is unlikely to regress spontaneously and may often progress to dense fibrosis and hyalinization. […] The aims of surgical treatment of GM are to restore normal chest contours, eliminate the inframammary fold, correct the NAC position, remove redundant skin, create symmetry between the two halves of the chest and minimize scarring.

• #73 SciELO Brazil – Gynecomastia: physiopathology, evaluation and treatment Gynecomastia: physiopathology, evaluation and treatment

  https://www.scielo.br/j/spmj/a/PFcc79gBghNMHmXs7RPs89g/

  If GM either persists or becomes more severe and is associated with pain, psychological distress or embarrassment caused by avoidance of activities in which the chest is exposed, pharmacological and surgical therapeutic options should be considered, especially when the patient wishes to pursue treatment. […] GM of long duration is unlikely to regress spontaneously and may often progress to dense fibrosis and hyalinization. […] The aims of surgical treatment of GM are to restore normal chest contours, eliminate the inframammary fold, correct the NAC position, remove redundant skin, create symmetry between the two halves of the chest and minimize scarring.

• #74 Understanding Gynecomastia and Its Management

  https://www.uspharmacist.com/article/understanding-gynecomastia-and-its-management/preview/uspeditorial?utm_source=TrendMD&utm_medium=cpc&utm_campaign=US_Pharmacist_TrendMD_1

  Up to 25% of gynecomastia cases can be attributed to medications, with one cohort study suggesting that medications are a contributing factor in 80% of older adults with gynecomastia. […] Pharmacologic management may be considered in patients with severe gynecomastia of recent onset (less than 6 months), those with persistent gynecomastia after discontinuation of offending medications or substances, and those in whom an underlying cause has not been identified. Gynecomastia that persists beyond 6 months is unlikely to regress, owing to the presence of fibrotic tissue. […] Three pharmacologic classes are available for the management of gynecomastia: androgens (testosterone, dihydrotestosterone, danazol), selective estrogen receptor modulators (SERMs; e.g., tamoxifen, clomiphene citrate, raloxifene), and aromatase inhibitors (letrozole, anastrozole).

• #75 Understanding Gynecomastia and Its Management

  https://www.uspharmacist.com/article/understanding-gynecomastia-and-its-management/preview/uspeditorial?utm_source=TrendMD&utm_medium=cpc&utm_campaign=US_Pharmacist_TrendMD_1

  Up to 25% of gynecomastia cases can be attributed to medications, with one cohort study suggesting that medications are a contributing factor in 80% of older adults with gynecomastia. […] Pharmacologic management may be considered in patients with severe gynecomastia of recent onset (less than 6 months), those with persistent gynecomastia after discontinuation of offending medications or substances, and those in whom an underlying cause has not been identified. Gynecomastia that persists beyond 6 months is unlikely to regress, owing to the presence of fibrotic tissue. […] Three pharmacologic classes are available for the management of gynecomastia: androgens (testosterone, dihydrotestosterone, danazol), selective estrogen receptor modulators (SERMs; e.g., tamoxifen, clomiphene citrate, raloxifene), and aromatase inhibitors (letrozole, anastrozole).

• #76 Understanding Gynecomastia and Its Management

  https://www.uspharmacist.com/article/understanding-gynecomastia-and-its-management/preview/uspeditorial?utm_source=TrendMD&utm_medium=cpc&utm_campaign=US_Pharmacist_TrendMD_1

  Testosterone treatment may be considered for hypogonadal men with proven testosterone deficiency; it is not recommended for all patients with gynecomastia, however. This treatment should be avoided in eugonadal men, as testosterone can have negative effects, including aggravating or inducing gynecomastia through aromatization or catalyzing the conversion of testosterone to E2. […] The most-studied SERM is tamoxifen, with a partial response expected for pubertal gynecomastia. […] It has been theorized that aromatase inhibitors such as anastrozole and letrozole decrease the estrogen-to-androgen ratio by blocking estrogen synthesis; however, they are typically not recommended owing to a lack of efficacy data from clinical trials. […] Gynecomastia that does not resolve spontaneously or with medical treatment may persist into the fibrotic stage after 12 months. In late adolescence or older age, surgical intervention may be indicated. […] The focus of surgical procedures is to remove hypertrophic fibrotic glandular tissue and reestablish the shape of the male breast.

• #77 SciELO Brazil – Gynecomastia: physiopathology, evaluation and treatment Gynecomastia: physiopathology, evaluation and treatment

  https://www.scielo.br/j/spmj/a/PFcc79gBghNMHmXs7RPs89g/

  If GM either persists or becomes more severe and is associated with pain, psychological distress or embarrassment caused by avoidance of activities in which the chest is exposed, pharmacological and surgical therapeutic options should be considered, especially when the patient wishes to pursue treatment. […] GM of long duration is unlikely to regress spontaneously and may often progress to dense fibrosis and hyalinization. […] The aims of surgical treatment of GM are to restore normal chest contours, eliminate the inframammary fold, correct the NAC position, remove redundant skin, create symmetry between the two halves of the chest and minimize scarring.

• #78

  https://cajmns.centralasianstudies.org/index.php/CAJMNS/article/view/2758

  Gynecomastia, a common benign enlargement of male breast tissue, results from an imbalance between estrogen and androgen levels. […] The pathophysiological mechanisms involve hormonal fluctuations due to puberty, aging, medication use, liver or kidney dysfunction, and endocrine disorders. […] Understanding the clinical, morphological, and microscopic features of gynecomastia enhances diagnostic accuracy and guides appropriate management strategies, ensuring better patient care.

• #79 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  Thus, any cause of estrogen excess from overproduction to peripheral aromatization of androgens can initiate the cascade to breast development. […] Increased estrogen production and/or action can occur at the testicular level or at the periphery and is characterized as follows: […] From the testes – Can be due to testicular tumors or to ectopic production of human chorionic gonadotropin (hCG), as is reported with carcinoma of lung, kidney, gastrointestinal (GI) tract, and extragonadal germ cell tumors. […] From peripheral conversion – Can be due to increased substrate or increased activity of aromatase, as in chronic liver disease, malnutrition, hyperthyroidism, adrenal tumors, and familial gynecomastia. […] Gynecomastia can be physiologic or pathologic. […] Pathologic gynecomastia can be caused by an increase in the production and/or action of estrogen, by a decrease in the production and/or action of testosterone accompanied by increased aromatization and high estrogen, or by drug use.

• #80 Gynecomastia: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/120858-overview

  However, gynecomastia can also be idiopathic. […] Decreased androgen action […] Increased aromatization of androgens to estrogens […] Increased androgenic precursors (dehydroepiandrosterone [DHEA] and androstenedione) […] Increased SHBG binds testosterone estrogen favoring greater peripheral estrogen action […] Estrogen receptor agonism. […] Conditions that result in primary or secondary hypogonadism can lead to gynecomastia in different mechanisms. […] The associated reduction in testosterone production leads to a decrease in the serum testosterone concentration and a compensatory rise in leuteinizing hormone (LH) release. […] The excess LH results in enhanced Leydig cell stimulation with inhibition of the 17,20-lyase and 17-hydroxylase activities and increased aromatization of testosterone to estradiol; the net effect is an increase in estradiol relative to testosterone secretion.

• #81 Gynecomastia – pathogenesis, diagnosis and treatment | Czajka | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/25863

  Gynecomastia is a benign, unilateral or bilateral enlargement of the male breast due to the imbalance between the androgens and estrogens at the breast tissue level. […] This clinical condition is particularly common in boys during puberty and in aging men. […] The breast enlargement, especially with accompanying pain can cause serious psychological problem. […] At the present time there are no generally accepted procedures for the evaluation and treatment of patients with gynecomastia. […] There are many studies conducted to find the safe and efficient medical therapy that could ameliorate the quality of life of the patients with gynecomastia.

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