Who should a man with gynecomastia go to? Treatment of gynecomastia Gynecomastia in men, doctor

Gynecomastia is more common than we might think at first glance. Even in the ancient world, men were familiar with this problem. According to Greek mythology, gynecomastia developed in those males who led an inappropriate lifestyle.

Agree, a man with female breasts is strange. That is why this condition causes a lot of psychological problems to its owners.

Gynecomastia cannot be spoken of as a 100% disease. Enlargement of the mammary glands in a man is not always a disease. True, only a doctor can determine the most likely variant of the problem.

The first most important question that a doctor decides when a patient comes to him is what type of gynecomastia is there? Namely, true or false.

False gynecomastia is said to occur when the mammary gland becomes enlarged due to adipose tissue. In this case, a man will be helped to get rid of “breasts” by general weight loss and physical activity.

The situation with true gynecomastia is much more complicated. Still, there is no need to panic right away. Why? For one simple reason - true gynecomastia is also not always a disease. Yes, gynecomastia is normal during three periods of a man’s life. This is the so-called physiological gynecomastia.

Physiological gynecomastia is a condition that is caused by the influence of female sex hormones. It is absolutely normal and is just another stage in the development of the male body.

When can a man experience such gynecomastia?

1. Gynecomastia of the newborn. Female sex hormones that enter the boy’s body from the placenta before birth cause swelling of the mammary glands. Happens quite often, but not always. After a few weeks, the mammary glands return to normal.
2. Adolescent (juvenile, pubertal) gynecomastia. This type of physiological gynecomastia develops in young men and often becomes the cause of psychological problems, especially if the symptoms do not go away for a longer period of time. Swelling of the mammary glands in a man occurs when the male part of the hormonal system is still imperfect, and the female part is active (about 13-14 years). The size of the glands (fortunately, very rarely) is comparable to the size of the female breast. According to statistics, among all young people, 70% are familiar with the symptoms of gynecomastia. Treatment is necessary when the mammary glands have not completely returned to normal. In these cases, surgeons come to the rescue.
3. The third stage of physiological gynecomastia is gynecomastia of advanced age. The cause is a decrease in the synthesis of male sex hormones (testosterone), as a result of which estrogens predominate. During this period of a man’s life, there are enough reasons for the development of pathological gynecomastia, which must be remembered. But more on that later.

Pathological gynecomastia

According to the classification accepted throughout the world (according to Frantz F.G., Wilson J.D. Endocrine disorders of the breast. Williams textbook of endocrinology 1998; pp. 877-900), depending on the reasons that caused the pathology, gynecomastia is divided into:

1. Pathological gynecomastia

• Testosterone deficiency
• Birth defects
• Congenital anorchia (absence of testicles and underdevelopment of genital organs)
• Klinefelter syndrome
• Androgen resistance (Morris syndrome - testicular feminization - and Reifenstein syndrome)
• Defects in testosterone synthesis
• Secondary testicular failure (viral orchitis, trauma, castration, neurological and granulomatous diseases, renal failure).

• Increased production of estrogen
• Increased testicular production of estrogen
• Testicular tumors
• Bronchogenic cancer and other tumors that produce human chorionic gonadotropin hormone (CG)
• True hermaphroditism
• Increased substrate for extraglandular aromatase
• Adrenal diseases
• Liver diseases
• Starvation
• Thyrotoxicosis
• Increased extraglandular aromatase

• Estrogens and drugs that act like estrogen (diethylstilbestrol, estrogen-containing cosmetics, contraceptives, estrogen-containing foods, phytoestrogens).
• Drugs that enhance the endogenous formation of estrogen (chorionic gonadotropin, clomiphene).
• Drugs that inhibit testosterone synthesis or its effect (ketoconazole, metronidazole, cimetidine, etomidate, alkylating drugs, flutamide, spironolactone).
• Drugs with an unknown mechanism of action for gynecomastia (isoniazid, methyldopa, calcium channel blockers, captopril, tricyclic antidepressants, penicillamine, diazepam, as well as marijuana, heroin, etc.).

Simply put, the reason for the development of gynecomastia is the predominance of estrogens (female sex hormones). However, such a predominance can be true (overproduction of estrogen) or relative, when the synthesis of male hormones is reduced.

Many conditions lead to a relative deficiency of testosterone (reduced production). Klinefelter's syndrome, testicular feminization, Reifenstein syndrome, secondary testicular failure (the result of diseases such as viral orchitis, trauma, castration, neurological and granulomatous diseases, renal failure) and defects in testosterone synthesis deserve special attention.

Klinefelter syndrome is a genetic disorder. Men have a certain set of chromosomes that determines external characteristics: tall stature, long limbs, eunuchoidism, gynecomastia, increased secretion of female sex hormones, a tendency to obesity, as well as mental disorders. Unfortunately, its prevalence is not as low as we would like. Treatment is carried out with male sex hormones to correct secondary sexual characteristics.

Testicular feminization and Reifenstein syndrome are combined into one group. Both conditions are caused by cell insensitivity (resistance) to testosterone. As a result, there is an obstacle to the path of testosterone to the cells. That is, it is there, but cannot act on tissue.

Testicular feminization syndrome develops when the cells have an inferior structure and cannot accept testosterone (no receptors). In this case, the set of chromosomes is characteristic of men, and the appearance is feminine, therefore the syndrome is also called pseudohermaphrodism. There is underdevelopment of the genital organs and the testicles are almost always present. There is no treatment for this syndrome.

Reifenstein syndrome is a genetic disease, the essence of which also consists in impaired tissue sensitivity to androgens. Reifenstein syndrome is similar in appearance to Klinefelter syndrome: hypospadias (an abnormal development of the penis, in which there is an incorrect location of the opening of the urethra), gynecomastia, eunuchoidism, atrophy of the seminiferous tubules and often azoospermia (lack of sperm in the seminal fluid - infertility).

Treatment in this case comes down to androgen replacement therapy.

Secondary testicular failure

There are conditions in which gynecomastia is one of the side conditions or complications. For example, renal failure, hyperthyroidism, liver cirrhosis, viral orchitis, traumatic lesions and others. In this case, treatment of the underlying disease and, if possible, correction of gyneocmastia come to the fore.

Gynecomastia caused by hyperproduction (excess production) of estrogens.

The second most important group of reasons for the appearance of enlarged mammary glands in men is the hyperproduction of estrogen. This group includes fewer but much more dangerous conditions. For example, testicular tumors, bronchogenic cancer, adrenal tumors, true hermaphroditism, liver disease, fasting, thyrotoxicosis, increased extraglandular aromatase. Patients require an integrated approach, sometimes long-term treatment and gynecomastia becomes less important compared to the underlying disease.

Medicines In the classification, you, of course, paid attention to medicines. Let's talk about them. Studies have shown that more than 50% of patients with gynecomastia took 1 or more medications. Some of them have hormonal effects, and some disrupt the function of the genital organs. Help in this case is to discontinue the drug that caused gynecomastia. However, it happens that it is not possible to cancel the drug. Then, after assessing the benefit and risk, the doctor will decide to discontinue the drug.

How to understand that gynecomastia has appeared? Normally, in a man we see only the nipple. When palpating the mammary gland, there should be no lumps or formations. An increase in the size of the mammary glands (symmetrical or unilateral), their pain, increased sensitivity and thickening of the tissue around one or both nipples are the first signs of gynecomastia. The patient may also complain of a feeling of heaviness, bloating and discomfort in the breast area.

Attention! Lumps, formations outside the areola, discharge from the nipple (including bloody ones), enlarged regional lymph nodes, skin changes in the mammary glands are signs that are not related to gynecomastia. In this case, you need to urgently consult a doctor in order to rule out malignancy. Let us note that malignant processes of the mammary glands in men occur extremely rarely, about 100 times less often than in women, but it is necessary to protect yourself.

Where to run?

Very often a man is faced with the question: which specialist should he contact? An appeal to both a surgeon and a mammologist or endocrinologist is correct. The problem is very versatile and it is better to get advice from all specialists.

How will the doctor make a diagnosis?

First, the doctor will question the prospective patient in detail. Therefore, before going to the doctor, try to remember how long ago the mammary glands began to enlarge, whether this was accompanied by painful sensations, whether there were changes in sexual desire, pain or discomfort in the testicles, as well as weight fluctuations over this period of time.

Important! What medications the patient is taking or has taken, diet, chronic diseases and genetic characteristics of the family, what diseases the patient has suffered.

A mandatory stage of diagnosis will be a laboratory test to determine the patient’s hormonal status. Depending on the data obtained, instrumental methods may also be indicated: mammography, ultrasound of the breast, ultrasound and biopsy of the testicles, examination of the adrenal glands, ultrasound, X-ray examination of the skull, chest, liver function testing.

If breast cancer is suspected, breast tissue is examined.

How to treat?

Treatment of gynecomastia directly depends on its type.

If physiological gynecomastia occurs, it goes away on its own. The only recommendation for gynecomastia during puberty is to increase physical activity.

If we are dealing with false gynecomastia, a diet and general weight loss measures are prescribed.

True pathological gynecomastia is treated differently depending on the stage of its development. There are 3 stages:

• Developing (proliferating) gynecomastia. Duration - 4 months.
• The intermediate stage lasts from 4 months to 1 year
• The fibrous stage is characterized by the appearance of mature connective tissue in the mammary gland and the deposition of adipose tissue around the glandular tissue.

At the initial stage, gynecomastia can be combated using conservative methods, namely, prescribing medications to correct the testosterone/estrogen ratio. With properly selected therapy, the mammary gland completely returns to its original size. In cases where there is a lack of testosterone, its drugs are prescribed, and in cases where there is an excess of estrogen, drugs are prescribed that block the effect of estrogen on the mammary gland.

Already from the second stage, it is not possible to achieve a complete solution to the problem with the help of drugs. Here you will need the help of a surgeon if conservative therapy is still powerless.

And at the last stage, only a surgeon can solve the problem. Surgical treatment is always indicated when conservative therapy is ineffective. Even if gynecomastia does not pose a danger, but the patient’s psychological state suffers, surgical treatment is also indicated.

The key point in treating gynecomastia is to eliminate the cause of the problem. However, it is not always possible to influence the cause of gynecomastia (for example, medications). When choosing treatment, it is necessary to carefully weigh the pros and cons, especially when it comes to chronic diseases and oncological processes.

Ermilova Nadezhda

Gynecomastia in men is manifested by pathological but benign enlargement of the mammary glands due to the proliferation of stromal or adipose tissue. In the first case, we are talking about true gynecomastia; the defect usually occurs in newborns, adolescents, the elderly, or due to hormonal imbalance. Lipomastia is associated with excess body weight and does not pose a threat to men's health, but if gynecomastia is not treated, over time the diagnosis can result in serious psychological trauma.

A specialist will help

Gynecomastia is one of those diseases that are very reluctant to discuss among friends or relatives, so not all men know which doctor to contact with a delicate problem. First of all, you should make an appointment with your local doctor, he will conduct an initial examination of the breast and refer the patient to a specialist.

Diagnosis and further treatment of the disease are the responsibility of a mammologist and endocrinologist.

Diagnosis and further treatment of the disease are the responsibility of a mammologist and endocrinologist. If there is a disturbance in reproductive function, the man is additionally recommended to visit a urologist or andrologist; if there is mechanical damage to the pectoral muscles in the gym, the surgeon will assess the condition of the glandular tissue and draw up a preliminary conclusion. With advanced gynecomastia, you cannot do without consulting an oncologist.

Conservative therapy

If the form of the disease allows you to treat gynecomastia at home, then the man should be patient. Depending on the cause of proliferation of glandular structures, the therapeutic course can last from 1-2 months to several years. Thus, hormonal drugs to normalize the level of androgens and female sex hormones are used for six months.

For uncomplicated gynecomastia, doctors prescribe:

Testosterone. Indicated exclusively for deficiency of the steroid or its derivatives. The drug allows you to return the normal size and shape of the mammary gland and optimize overall hormonal levels. It is necessary to remove the aesthetic defect by observing the exact dosage; uncontrolled use of testosterone leads to severe gynecomastia, which is difficult to treat.

Clomiphene. The action of an anti-estrogen is to suppress the synthesis of female hormones in the body of the stronger sex. Activates the natural production of androgen and also reduces the amount of fat deposits.

Danazol. Men with gynecomastia should monitor their hormonal testosterone-estrogen ratio. With the help of a synthetic drug, the production of estrogen slows down and the hormonal balance is normalized. In high doses, Danazol has weak androgenic activity.

Nolvadex. Initially, the medication was used to treat breast cancer; it is effective even in the later stages of gynecomastia. Nolvadex is a selective estrogen receptor antagonist, therefore it affects only the affected areas of the body.

You can artificially restore your hormonal profile at home using capsules or intramuscular injections. It is worth noting that androgen deficiency in mature men is often accompanied by gynecomastia of varying severity. In this case, doctors advise treatment with testosterone with the addition of esters; organic substances maintain the required concentration of the sex hormone over a long period of time. Testosterone propionate, Testosterone cypionate and others are popular in medical practice.

A large amount of prolactin in the blood stimulates the growth of male breasts, for example, after a steroid course. Due to hyperprolactinemia, libido decreases, oligospermia occurs, and the mammary gland may secrete serous or milky secretions (galactorrhea). The drug Cabergoline has a strictly selective effect and effectively fights gynecomastia in men.

Natural solution to the problem

Conservative treatment gives good results in the first 4 months from the onset of gynecomastia symptoms, while alternative medicine methods are appropriate throughout the course of the disease. Herbal medicine, naturopathy, correction of hormonal levels using a specially selected diet and exercises that strengthen the pectoral muscles are aimed at getting rid of physiological gynecomastia and generally strengthening the body.

• Diet food.

Normally, the body of an adult male contains approximately 2 g of zinc, most of which is found in the liver, muscle tissue and pancreas. Against the background of a decrease in microelement reserves, gynecomastia occurs, so doctors recommend enriching the daily diet with zinc.

When treating gynecomastia, it is important to follow a diet with zinc-containing foods, for example seafood.

1. Beef liver.
2. Pumpkin and sunflower seeds, sesame, almonds.
3. Wheat, oatmeal and rice porridge.
4. Seafood (oysters, anchovies, fish roe).
5. Fresh vegetables and fruits (green peas, broccoli, boiled or canned corn, black currants, citrus fruits).
6. Green tea, mineral water.

Men with excess weight and bad habits are at risk. Hops contain powerful phytoestrogens; excessive consumption of beer inevitably leads to endocrine disorders and obesity. To organize a proper and balanced diet, you should consult a nutritionist. Nicotine also has an inhibitory effect on testosterone concentrations, so heavy smokers are at risk of breast enlargement.

Complex treatment of gynecomastia in men involves the use of various exercises that can be performed at home, on the street, or in the gym. Physical exercise promotes weight loss, relieves emotional stress, irritability, and improves sleep quality.

Physical exercise promotes weight loss, relieves emotional stress, irritability, and improves sleep quality.

You can prevent or get rid of gynecomastia by:

1. Pushups. A man should do push-ups in the morning and evening, increasing the number of approaches daily.
2. Jogging at various distances. It is advisable to run in the fresh air in the morning.
3. Cycling. Fights extra pounds, thereby eliminating false gynecomastia.
4. Swimming. Doctors advise men to visit the pool at least 3 times a week.

The listed options are excellent for self-training, however, returning to normal breast size with fatty or mixed type of gynecomastia is a long and labor-intensive process. It is important that the initial level of physical activity is selected by the attending physician.

• Traditional medicine advice.

As an auxiliary treatment of gynecomastia, a combination of traditional methods with drug therapy is suitable. Sometimes the disease is accompanied by aching pain in the sternum. Bee products have a healing effect on the glandular tissue of men.

The honey compress is applied as follows: a thin layer of honey is applied to the mammary glands, covered with plastic wrap on top and tightly fixed with a towel. The duration of the procedure should not exceed 8 hours.

Enlarged breasts can be removed by increasing the concentration of steroids in a man’s body using:

• Ginseng root. Homemade or pharmacy tinctures are designed to enhance testosterone production. To prepare a medicine for gynecomastia, you need to mix 50 g of ginseng root, ginkgo biloba leaves, yohimbe bark, oatmeal and pour in a liter of ethyl alcohol. Place the tincture in a dark place for half a month; after the specified period, strain the liquid. Drink 30 drops per day. The duration of treatment is determined by the doctor, usually the course does not exceed 2 months.
• Dill and valerian seeds. Take a glass of dill seed and 2 tbsp. l. valerian, fill them with 1.25 liters of boiling water. Mix the ingredients and leave in a cool place for a day, then add 200 ml of water. Men with gynecomastia are treated three times a day, using 1 tbsp. l. tinctures 30 minutes before meals.
• Thyme. Drinking a decoction of the medicinal plant for a month will relieve a man of gynecomastia. To prepare the drink, add 2 tbsp. l. herbs with a liter of water and boil over low heat for about 5-10 minutes. It is useful to add honey to the cooled broth to taste.

As you can see, gynecomastia can be avoided by radically changing your lifestyle: giving up bad habits, following the principles of a healthy diet, and regularly training your pectoral muscles. A timely visit to a doctor greatly increases a man’s chances of recovery and allows him to avoid serious consequences. Take care of yourself!

Beautiful, large breasts for women are the standard of beauty and pride, but if such breasts appear on a man, it causes embarrassment, discomfort and shame. Such unjustified growth of the mammary glands makes you worry about how to treat gynecomastia in men, especially if breast enlargement is accompanied by unpleasant sensations in the nipple area, fluid discharge from them, or even pain. Enlargement of the mammary glands in men is called gynecomastia. This disease is accompanied by hyperplasia of muscle and fat tissue. The appearance of symptoms such as swelling of the mammary glands and darkening of the nipple areola may indicate a serious malfunction in the body, including oncological processes. The causes of the occurrence are various hormonal changes when the female hormone estrogen increases in the male body. A decrease in testosterone levels also leads to the development of this disease. And the manifestation of the disease against the background of various diseases (obesity, genital infections, liver cirrhosis, kidney failure, tumors of internal organs, use of certain medications and drugs) is called pathological gynecomastia.

Diagnosis of gynecomastia

Breast enlargement itself does not pose a significant threat to men's health. This is not considered a disease as such, but is a symptom that indicates a malfunction in a man’s body. Very often, representatives of the stronger sex hope that this manifestation will go away on its own, without the intervention of a doctor, and sometimes they don’t even know which doctor to contact with such a problem. In order for the treatment of gynecomastia in men to be selected correctly, you need to immediately contact your family doctor or therapist. After confirming the diagnosis, the patient will be redirected to a doctor who controls the endocrine system. He, in turn, will order the following studies:

• General blood test and hormone levels.
• Liver tests (if liver cirrhosis is suspected).
• Ultrasound examination of the mammary glands, lymph nodes, mammography.
• Biopsy or puncture of the gland (in an advanced stage).

To understand how to get rid of gynecomastia, you first need to identify its type. During the examination, both true and false gynecomastia can be diagnosed. In the first case, there is an increase and formation of glandular and connective tissues, which lead to the growth of the mammary glands. In the second, the disease occurs due to weight gain, in which fat deposits accumulate in the male mammary glands. If false, this disease does not pose a threat to the patient, but only leads to psychological discomfort (embarrassment for people when changing clothes). When palpating the mammary glands, no lumps are observed, unlike true gynecomastia.

Methods of treating the disease

When determining the cause of breast enlargement in a man, the attending physician prescribes appropriate therapy. If the disease is not in an advanced form, but only at the initial stage, the patient only needs to correct and remove bad habits in order to bring the imbalance of hormones back to normal. To do this you need:

• To give up smoking. Nicotine and harmful tars reduce the production of testosterone in a man’s body.
• Drinking beer should also be avoided. It contains female hormones, the increase of which leads to breast growth, and the man’s body itself begins to resemble a woman’s.
• The use of steroid drugs changes hormonal levels for the worse.
• Refusal of semi-finished products. They have a detrimental effect on hormone production.
• Establish proper nutrition (fiber, lean meat, vegetables and fruits, add more greens and grains), remove flour, fat, and sweets from the diet. Such food will normalize the functioning of the body, and consuming fish oil will increase the level of testosterone in the body.

Drug treatment

Therapy is prescribed with the help of medications if true gynecomastia is at the initial stage of development and the mammary gland is not significantly enlarged. This treatment is aimed at normalizing sex hormones in the body. If the cause is a decrease in the production of the hormone testosterone, then treatment of gynecomastia in men will include taking the following medications:

• The drug Testosterone – increases the level of male sex hormone to the desired level. This will allow you not to resort to surgical treatment.
• Injectable drugs containing male sex hormones – Sustamone, Omnadrene. They are good for those who do not like to take medications and do daily injections. These drugs are administered intramuscularly and their effect lasts for a long time.
• Proviron. Compensates for the lack of testosterone, thanks to the active component mesterolone. It is able to reduce such negative manifestations that are caused by androgen deficiency, such as decreased performance, fatigue, irritability, sleep disturbance, depression, and psycho-vegetative disorders.
• Thiamine bromide. It slows down and prevents the production of the aromatase enzyme, which converts male testosterone into female estrogen.

If the cause of gynecomastia lies in an increase in female sex hormones - estrogens, then the therapeutic focus is to suppress its activity and reduce the production of the hormone by the body. When treated with medications, the disease can be cured no earlier than after 5–6 months. Many patients are not satisfied with this and agree to surgery. Positive dynamics after taking the tablets begin to be seen after 2 months of regular use. When prescribing drugs that reduce estrogen synthesis, they also prescribe medications that will, on the contrary, stimulate the production of testosterone in the body. The most effective of them:

• Tamoxifen is a well-reviewed drug that is aimed at blocking estrogen in men. It also has a positive effect on the mammary glands.
• Clomiphene is an effective remedy that monitors the amount of active female sex hormones. It should be borne in mind that when taking these medications you should adhere to a certain diet. What to limit yourself to, check with your doctor. It is strictly forbidden to consume alcohol, fatty and salty foods.
• Nolvadex - this drug is prescribed in the later stages of the disease, but in which surgery is impossible for various reasons (fear of surgery, contraindications).
• Danazol is aimed at reducing the production of female hormones in the testicles, but it is not particularly popular; doctors prescribe it the least often.

You can also use gels and ointments for external use. The patient will receive a significant positive effect by using Androgel ointment by rubbing it into the chest area every day; it helps in 90% of cases.

If the cause of gynecomastia in men is the use of anabolic steroids, then their use should be stopped immediately. But refusal from them is carried out only under the supervision of a doctor. There are cases when stopping steroids is impossible for various reasons; such patients are prescribed the drug Anastrozole, it will help stop the growth of the mammary glands and avoid surgery.

Traditional methods of treating gynecomastia

It is very good to combine drug treatment with the use of traditional recipes for gynecomastia in men, which together give an even greater positive result and can cure the disease without resorting to surgery. All therapy with such prescriptions is aimed at increasing the male hormone testosterone. The most effective stimulant in testosterone production is Ginseng root. It is recommended to consume a small piece of it every day, chewing it thoroughly in the mouth, although it does not taste very pleasant, it helps to get rid of the disease. You can try a drink made from Turmeric. Just dilute a teaspoon in a glass of water and mix well until completely dissolved. Turmeric also increases male hormones in the body and also helps burn fat deposits. To relieve swelling and pain, it is recommended to use cold compresses. To do this, ice wrapped in a towel is applied to the enlarged breast for 2-3 minutes. Salt baths are useful for gynecomastia; sea salt improves blood circulation and relieves swelling around the nipple. Such procedures should be carried out several times a week, for 20 minutes. And yet it should be remembered that it is impossible to cure gynecomastia using traditional methods, especially at a late stage. In this case, gynecomastia is treated by a doctor with a different focus - a surgeon, using surgery.

Surgical method of treatment

For gynecomastia in men, surgical treatment is aimed at getting rid of hypertrophied mammary glands through surgery. It is indicated for the following factors:

• When the mammary gland is enlarged to a very large size.
• If the therapeutic method of treatment does not give a positive result.
• A malignant neoplasm appeared in the mammary glands.
• The patient experiences psychological discomfort.
• The course of the disease is too long.

For gynecomastia, surgery is performed in two ways:

Mastectomy is the surgical removal of the breast. The surgery is performed in a hospital and in most cases is well tolerated by patients. This procedure lasts about an hour and does not require a long hospital stay. It is carried out either under local anesthesia, after which you can immediately leave the clinic, or under general anesthesia, after which you will have to stay for 2-3 days. The excised breast tissue is necessarily sent for histological examination to check the presence or absence of cancer cells. The stitches are removed after 4–6 days. This intervention, although quite serious in approach, is not overly complicated. The most important thing is that after the operation there is no relapse of the disease. In certain cases, patients are advised to undergo drainage. It is imperative to wear a compression bandage - this is the main condition. The scar after such an operation is almost invisible.

Laser liposuction

Laser liposuction - this method is indicated for patients with false gynecomastia (increase in body fat due to excess weight). During this operation, a small puncture is made, about 2-4 mm, and a thin laser is inserted into it. It makes the fat layer less dense. This makes it possible to suck it out through a vacuum device. This method leaves almost no noticeable marks on the patient’s body. It is carried out under local anesthesia, recovery occurs as soon as possible.

After any operation, the patient continues to experience swelling and pain - this is normal. In such cases, ultrasound with hydrocortisone, magnetic laser and microcurrent therapy are prescribed. After the operation, the next day, it is recommended to apply special ointments; they promote rapid scarring of the suture. Compression garments should be worn for at least a month. After surgery, the patient is often interested in the question of which doctor to contact if a relapse of the disease or similar symptoms occurs. A relapse is possible if the operation was performed poorly or the patient did not follow the recommendations for recovery.

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There are true and false variants of the disease. True gynecomastia is breast enlargement. False is a consequence of excess body weight, that is, adipose tissue grows excessively. The cause of gynecomastia is an increase in estrogen and progesterone (female sex hormones). This may be due to congenital genetic defects or be a consequence of taking anabolic drugs.

In order to distinguish the disease from ordinary obesity, you need to pay attention to some features of the mammary gland. In men, the symptoms of gynecomastia depend on the stage of development of the pathology:

The development of the disease in men poses a great danger, as cancerous degeneration often occurs. In addition, such men are most often infertile and have many other concomitant pathologies.

Which doctor treats

To get rid of the disease, a man should consult a doctor as soon as he notices changes. Delay reduces the chances of successful treatment, and also increases the risk of developing an oncological process. In case of gynecomastia, there is no doubt which doctor to contact. The main treating specialist is endocrinologist.

The doctor understands hormonal problems, so he can help such a patient. To confirm the diagnosis, he will prescribe a biochemical blood test to identify estrogen and testosterone, as well as their ratio. The main methods are Ultrasound of the breast and scrotal organs. To exclude cancer, a CT scan of the lungs, adrenal glands, brain or other target organs is performed. Therefore, with gynecomastia, men need to go to an endocrinologist.

Principles of therapy

In the first stage of the disease, and sometimes in the second, it is possible conservative treatment. It involves the use of hormone replacement therapy. They also prescribe medications that suppress the effect of estrogen in the male body. The doctor treats gynecomastia in men in this way and monitors the dynamics. If improvement is noted, therapy is continued. If there is no reverse development of the process, then the doctor prescribes a consultation with a surgeon, since surgery is required.

Surgical intervention consists of removing the enlarged organ and restoring the physiological contour of the male breast. The type of operation depends on the patient’s condition, signs of cancerous degeneration and some other individual characteristics. With gynecomastia, the doctor must carefully examine the patient to rule out cancer. Otherwise, the operation may provoke metastases. After the gland is removed, the man remains under medical supervision for some time.

Enlargement of the mammary glands in males, which is determined by palpation and is often noticeable to the naked eye. The disease is benign in nature, usually does not threaten the patient’s life, but can be a consequence or a harbinger of serious disorders in the body. Gynecomastia is caused by the proliferation of inactive glandular tissue of the mammary gland and hyperplasia of adipose tissue under the influence of estrogens, the amount of which is usually minimal in a man’s body.

Breast enlargement in men is most common during certain periods of life, namely:

• in the neonatal period- under the influence of maternal estrogens that penetrate the baby’s body transplacentally; usually regression of this form of gynecomastia is observed several weeks after birth;
• during puberty- develops in boys aged 11-14 years against the background of a physiological decrease in the level of free testosterone and an increase in estradiol and sex hormone binding globulin; with a favorable outcome, it regresses a year after its onset;
• aged 50-80 years develops most often, usually due to hormonal disorders.

Gynecomastia is classified as follows:

• depending on the predominance of adipose and glandular tissue in the mammary gland - false and true, respectively;
• depending on the location of the defect - symmetrical and asymmetrical.

Breast enlargement in men usually involves an imbalance of the hormones testosterone and estrogen. Among causes of gynecomastia Usually hormonal disorders, however, they also have certain prerequisites:

• side effects of medications, including some antiandrogens, antibiotics, antiulcer and cardiovascular drugs, psychoactive and antitumor substances, drugs for the treatment of hyperprolactinemia;
• a decrease in the level of the male sex hormone testosterone, which can be triggered by various functional disorders, from congenital absence of testicles to chronic renal failure, from dysfunction of the endocrine glands to cancer;
• an increase in the level of the female sex hormone estrogen, which is also provoked by various factors of external and internal origin, from the use of cosmetics to oncological processes.

Idiopathic gynecomastia deserves special attention, that is, one for which no clear cause has been identified. It is diagnosed after a comprehensive examination and review of the pathological history, if the symptoms of gynecomastia in a particular case do not coincide with those generally accepted for physiological gynecomastia.

Gynecomastia is characterized by the following set clinical symptoms:

• inverted nipple syndrome;
• fixation of the skin over the tumor;
• ulceration of the skin over the tumor;
• fixation of the tumor to the pectoralis major muscle;
• proliferation of regional lymph nodes.

Gynecomastia usually develops in three stages:

• initial stage or proliferating gynecomastia- illness lasting a maximum of 4 months, conservative methods are sufficient for treatment;
• intermediate stage- the disease has been developing for more than 4 months, but less than one year; during this period, the mammary gland matures to a state the reverse development of which is very difficult to achieve;
• final or fibrous stage- in the mammary gland there is a predominance of connective tissue, often surrounded by fatty tissue; the changes are irreversible and can be corrected surgically.

How to treat gynecomastia?

Treatment of gynecomastia determined by its origin. Therefore, treatment strategies must be considered in accordance with the factors that awaken the disease.

• Iatrogenic gynecomastia(provoked by inadequate medications) can be overcome after drug withdrawal, which must be done with the participation of the attending physician, and not independently.
• Pubertal gynecomastia usually goes away on its own 2-3 years after the onset of puberty.
• Gynecomastia due to neoplasms various localizations usually requires treatment of this neoplasm, often with surgery.
• Gynecomastia due to thyrotoxicosis or hypothyroidism also involves treating its underlying cause.
• If the basis of gynecomastia is hypogonadism, then the doctor may prescribe therapy with testosterone or human chorionic gonadotropin.
• At idiopathic gynecomastia treatment may not be prescribed at all, hardly in the case when the patient experiences psychological or physical discomfort, pain, which happens infrequently.

From drug therapy for treatment of gynecomastia Tamoxifen, Danazol, Mesterolone are used; regression is also observed when taking aromatase inhibitors. With drug treatment, the first control examination is advisably carried out 2 months after the start of treatment. It is aimed at assessing the effectiveness and safety of the selected dose of drugs. Conclusions are made after palpation and ultrasound of the mammary glands, biochemical blood test (to assess liver function). To assess the effectiveness and safety of treatment with testosterone drugs, the concentration of total testosterone in the blood serum, the content of hemoglobin and hematocrit, and the determination of prostate-specific antigen are determined. It is recommended to repeat all of the above examinations every six months, and if drug therapy is ineffective, resort to surgical methods.

Surgical interventions are becoming increasingly popular today. The indications are:

• lack of effect from conservative therapy after two years of its implementation;
• persistent pubertal gynecomastia (more than 5 cm, 3 years after development).

During surgery, the normal anatomical structure of the male breast is restored by removing additional tissue. Removal is performed through a semicircular paraareolar incision. Complications in this case may include necrosis, flattening of the nipple, and loss of sensitivity in the areolar area.

What diseases can it be associated with?

• - the mechanism of development of gynecomastia is not fully understood, but in this case it occurs against the background of the resulting hyperprolactinemia.
• , as a result of which there is a decrease in the secretion of testosterone by the testicles, and the level of total and free estradiol remains within physiological values ​​or increases.
• - a significant increase in the level of prolactin in the blood naturally causes the proliferation of epithelial cells of the mammary gland and suppresses the synthesis of gonadotropins, which develops into secondary hypogonadism, and then into gynecomastia.
• - gynecomastia develops against the background of increased levels of SHBG and increased conversion of androgens into estrogens.
• Hypogonadotropic - usually accompanied by a decrease in testosterone synthesis, while the production of estrogen by the adrenal glands remains, and this already leads to relative hyperestrogenemia.
• Benign - neoplasms begin to produce estrogens or their precursors.
• Tumors that produce hCG are usually germ cell tumors of the testicles and carcinomas of various localizations - an increase in the level of hCG provokes the production of testosterone by the testicles, the excess of which is converted into estrogens through metabolism in adipose tissue.
• - usually in patients with renal failure, the level of luteinizing hormone, estradiol, and to some extent prolactin increases, and the concentration of testosterone is reduced to reduced values.
• Chronic - accompanied by a decrease in the metabolism of androgens in the liver, they are aromatized into estrogens, the level of SHBG increases and the concentration of free testosterone decreases.

Treatment of gynecomastia at home

Treatment of gynecomastia at home is possible if preference is given to conservative methods, which involves the prescription of medications aimed at regulating the testosterone/estrogens balance. The prescription of drugs should occur after professional diagnosis, and the treatment itself should be carried out under the supervision of specialized specialists. At a certain stage of treatment, you may need to consult an endocrinologist, mammologist, oncologist, surgeon, and even a urologist, whose opinion should not be neglected.

What medications are used to treat gynecomastia?

• - apply to skin once a day
• - 400 mg once daily
• - regardless of food intake, 25-75 mg/day in 1-3 divided doses; Duration of taking the drug is 3 months
• - intramuscularly, 1 ampoule every 3 months
• - intramuscularly 1 ml every 3 weeks
• - 20 mg once daily
• Drugs - 1000-3000 units intramuscularly every 3-5 days as prescribed by a doctor

Treatment of gynecomastia with traditional methods

Treatment of gynecomastia folk remedies do not have the desired effect, since they do not affect the mechanism of the disease, which is often caused solely by hormonal imbalance.

Which doctors should you contact if you have gynecomastia?

Diagnosis of the disease begins with taking an anamnesis, which is the responsibility of a mammologist or endocrinologist. The doctor will ask about the following nuances:

• duration of existence of an enlarged mammary gland;
• the presence of pain or thickening of the gland;
• taking medications;
• sexual function;
• changes in body weight;
• symptoms of thyrotoxicosis.

Laboratory tests that a specialist can prescribe include a biochemical blood test (with determination of creatinine and liver enzymes), a study of hormone levels (total testosterone, SHBG, estradiol, LH, FSH, prolactin, TSH, free T4, β-hCG). At the same time, instrumental examinations are prescribed - mammography, ultrasound of the mammary glands, scrotum, MRI of the adrenal glands, brain (if indicated). The attending physician will inform you about the preparation for each test or examination, if necessary. You may need a consultation later or a.

Treatment of other diseases starting with the letter - g