Hey, I thought I'd drop in with everyone's favorite topic for discussion: Gynecomastia!
A quick definition from Wikipedia:
QUOTE (http://en.wikipedia.org/wiki/Gynecomastia)
Gynecomastia, or gynaecomastia, pronounced [...] is the development of abnormally large mammary glands in males resulting in breast enlargement, which can sometimes cause secretion of milk.[1] The term comes from the Greek gyne meaning "woman" and mastos meaning "breast". The condition can occur physiologically in neonates, in adolescents, and in the elderly. In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubertal gynecomastia is not due to obesity, the breast development shrinks or disappears within a couple of years [2]. The causes of common gynecomastia remain uncertain, although it has generally been attributed to an imbalance of sex hormones or the tissue responsiveness to them; a root cause is rarely determined for individual cases. Breast prominence can result from hypertrophy of breast tissue, chest adipose tissue and skin, and is typically a combination. Breast prominence due solely to excessive adipose is often termed pseudogynecomastia[3] or sometimes lipomastia[4].
Causes
Physiologic gynecomastia occurs in neonates, at or before puberty and with aging. Many cases of gynecomastia are idiopathic, meaning they have no clear cause. Potential pathologic causes of gynecomastia are: medications including hormones, increased serum estrogen, decreased testosterone production, androgen receptor defects, chronic kidney disease, chronic liver disease, HIV,[5] and other chronic illness. Gynecomastia as a result of spinal cord injury and refeeding after starvation has been reported.[6] In 25% of cases, the cause of the gynecomastia is not known.
Medications cause 10-20% of cases of gynecomastia in post-adolescent adults. These include cimetidine, omeprazole, spironolactone, Imatinib Mesylate, finasteride and certain antipsychotics. Some act directly on the breast tissue, while others lead to increased secretion of prolactin from the pituitary by blocking the actions of dopamine (prolactin-inhibiting factor/PIF) on the lactotrope cell groups in the anterior pituitary. Androstenedione, used as a performance enhancing food supplement, can lead to breast enlargement by excess estrogen activity. Medications used in the treatment of prostate cancer, such as antiandrogens and GnRH analogs can also cause gynecomastia. Marijuana use is also thought by some to be a possible cause; however, published data is contradictory.[7]
Increased estrogen levels can also occur in certain testicular tumors, and in hyperthyroidism. Certain adrenal tumors cause elevated levels of androstenedione which is converted by the enzyme aromatase into estrone, a form of estrogen. Other tumors that secrete hCG can increase estrogen. A decrease in estrogen clearance can occur in liver disease, and this may be the mechanism of gynecomastia in liver cirrhosis. Obesity tends to increase estrogen levels.[8][9]
Decreased testosterone production can occur in congenital or acquired testicular failure, for example in genetic disorders such as Klinefelter Syndrome. Diseases of the hypothalamus or pituitary can also lead to low testosterone. Abuse of anabolic androgenic steroids (AAS) has a similar effect. Mutations to androgen receptors, such as those found in Kennedy disease can also cause gynecomastia.
Although stopping these medications can lead to regression of the gynecomastia, surgery is sometimes necessary to eliminate the condition.
Repeated topical application of products containing lavender and tea tree oils among other unidentified ingredients to three prepubescent males coincided with gynecomastia; it has been theorised that this could be due to their estrogenic and antiandrogenic activity. However, other circumstances around the study are not clear, and the sample size was insignificant so serious scientific conclusions cannot be drawn.[10]
Diagnosis
The condition usually can be diagnosed by examination by a physician. Occasionally, imaging by X-rays or ultrasound is needed to confirm the diagnosis. Blood tests are required to see if there is any underlying disease causing the gynecomastia.
Prognosis
Gynecomastia is not physically harmful, but in some cases can be an indicator of other more dangerous underlying conditions. Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful. Furthermore, it can frequently present social and psychological difficulties for the sufferer.[11] Weight loss can alter the condition in cases where it is triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging tissues about the chest, chest ptosis, or drooping chest.
Treatment
Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Patients should talk with their doctor about revising any medications that are found to be causing gynecomastia; often, an alternative medication can be found that avoids gynecomastia side-effects, while still treating the primary condition for which the original medication was found not to be suitable due to causing gynecomastia side-effects (e.g., in place of taking spironolactone the alternative eplerenone can be used.) Selective estrogen receptor modulator medications, such as tamoxifen and clomiphene, or androgens or aromatase inhibitors such as Letrozole are medical treatment options, although they are not universally approved for the treatment of gynecomastia. Endocrinological attention may help during the first 2-3 years. After that window, however, the breast tissue tends to remain and harden, leaving surgery (either liposuction, gland excision, skin sculpture, reduction mammoplasty, or a combination of these surgical techniques) the only treatment option. Many American insurance companies deny coverage for surgery for gynecomastia treatment on the grounds that it is a cosmetic procedure. Radiation therapy is sometimes used to prevent gynecomastia in patients with prostate cancer prior to estrogen therapy. Compression garments can camouflage chest deformity and stabilize bouncing tissue bringing emotional relief to some. There are also those who choose to live with the condition.
The New England Journal of Medicine published a report in the September 20, 2007 edition of their publication, the article is appropriately entitled: "Gynecomastia" by Glenn D. Braunstein, M.D.
Some background info on NEJM:
QUOTE (http://en.wikipedia.org/wiki/New_England_Journal_of_Medicine)
The New England Journal of Medicine (New Engl J Med or NEJM) is a English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It is one of the most popular and widely-read peer-reviewed general medical journals in the world. It is also the oldest continuously published medical journal in the world.
It was founded by Dr. John Collins Warren in 1812 as a quarterly called The New England Journal of Medicine and Surgery. In 1828, it became a weekly, and was renamed The Boston Medical and Surgical Journal; one hundred years later, it took on its present name.
It publishes editorials, papers on original research, widely-cited review articles, correspondences, case reports, and has a special section called "Images in Clinical Medicine".
Authors have included Oliver Wendell Holmes, Sr., Hans Zinsser, and Lewis Thomas. One of its early editors, Jerome V. C. Smith, resigned in 1857 to assume his duties as mayor of the City of Boston.
The website for the George Polk Awards noted that its 1977 award to the New England Journal of Medicine "provided the first significant mainstream visibility for a publication that would achieve enormous attention and prestige in the ensuing decades"[1]
The journal usually has the highest impact factor of the journals of clinical medicine (including the Journal of the American Medical Association, and The Lancet); in 2006, the impact factor was 51, according to Journal Citation Reports, the first research journal to break 50.
Open access policy
NEJM provides delayed free online access to its research articles (it does so six months after publication, and maintains that access dating back to 1993). This delay does not apply to readers from the least developed countries, for whom the content is available at no charge for personal use.
NEJM also has two podcast features, one with interviews of doctors and researchers that are publishing in the journal, and another summarizing the content of each issue. Other offerings include Continuing Medical Education, Videos in Clinical Medicine (showing videos of medical procedures), and the weekly Image Challenge.
I found an interesting report published at The Windsor Star that seemed to have been inspired by the aforementioned NEJM article entitled: More men busting out with 'man boobs' by Sharon Kirkey.
A worthwhile excerpt:
QUOTE (http://www.canada.com/windsorstar/news/story.html?id=43c70157-aed6-4978-bd70-1295f6c5ed5e)
More men busting out with 'man boobs'
Sharon Kirkey , CanWest News Service
Published: Wednesday, September 19, 2007
...
Dr. Glenn Braunstein, chair of the department of medicine at Cedars-Sinai Medical Center in Los Angeles, says at least a third of all men are affected by gynecomastia - or the benign enlargement of male breast tissue, colloquially known as "man boobs."
Low testosterone, drugs or medical disorders can cause the condition. So, too, can obesity.
"As you increase the BMI (body mass index) in both adults and adolescents, you increase the prevalence of gynecomastia," Braunstein says.
Fat tissue is very metabolically active. It converts testosterone to estrogen, which can act locally on the breast tissue.
The result? "You can get a lot of glandular tissue and a lot of fat tissue and the combination can give you really pendulous breasts," Braunstein said in an interview.
Researchers have known for years that men tend to shrug off fat around their bellies, despite the serious health risks. But male breasts?
...
Anyways, above you'll find another reason to get your testosterone levels checked! If you didn't know yet, it seems ~1/4 men over 30 Testosterone Deficient. Obesity is another cause, too bad I missed a workout today.
Isn't this just so exciting?
Take care.
