What is Gynecomastia how can i remove
The mammalian male gland tissue, under particular conditions, can proliferate
and increase in volume. This phenomenon - benign and usually reversible - is
called gynecomastia or male boobs
Gynecomastia is often felt as a mass of rubber that extends concentrically
under the areola and can affect a mammary gland or both. This more or less
pronounced volume increase of the mammary glandular tissue may be
associated with discomfort or pain. Sometimes the accumulation of adipose
tissue at the level of the breast can be confused with real
condition, particularly frequent in overweight subjects, takes the name of
and pseudoginecomastia are
present in the same subject at the same time.
Despite not being a condition that threatens health,
psychological disorders due to alterations in physical
Gynecomastia surgery in Lahore
Etiology and pathogenesis
The proliferation of mammary gland tissue is physiologically stimulated by
estrogen and inhibited by androgens. Therefore,
gynecomastia surgery is usually
caused by the difference in ratio with estrogens being higher than circulating
androgens or is the altered effect of these hormones on their corresponding
intracellular receptors in breast tissue.
are physiological in nature (neonatal, pubertal and
). Sometimes gynecomastia can be idiopathic
(approximately 25% of cases) 1 or, more rarely, secondary to pathologies that
influence levels of circulating sex hormones (ie, testicular or adrenal neoplasms ,
liver cirrhosis, hyperthyroidism, hypogonadism , obesity, feedback syndrome) In
the end, a consistent part of the cases of
as well as several active ingredients,
which have been associated with this condition. The active ingredients known to
are exogenous estrogens, antiandrogens,
5 alpha reductase inhibitors, spironolactone and cimetidine.
Antiandrogens (such as bicalutamide and flutamide) can cause
by an antagonistic action on testosterone and dihydrotestosterone in the
mammary glands. In addition - given that endogenous androgens inhibit the
negative feedback mechanism in the hypothalamo-pituitary-gonadotro axis- the
antiandrogens increase the levels of circulating testosterone that is converted
peripherally into estradiol, thus increasing the estrogen / androgen ratio.
appears during the first year of antiandrogen therapy
for 40-70% of patients on long-term treatment.
On the other hand, inhibitors of alpha-reductase 5 (such as finasteride and
dutasteride) act by preventing the conversion of testosterone to
dihydrotestosterone. As a result, unconverted circulating testosterone is
transformed into estradiol by aromatase and elevates the ratio of estrogens /
then increases by 1-2% for the treated patients.
Spironolactone, an aldosterone antagonist used for the treatment of high blood
pressure, has anti-androgenic and estrogenic activities. This drug can induce
after one month of treatment, with a dose-dependent incidence.
Among histamine H2 receptor blockers, cimetidine appears to be the active
ingredient that can most commonly cause
epidemiological study suggests a relative risk> 7 for treated patients, strongly
Other examples of drugs that can cause
for antiretroviral therapy (such as saquinavir or lopinavir), antipsychotics (such
as haloperidol), various chemotherapeutic drugs (such as methotrexate or
cyclophosphamide), and natural products containing phytoestrogens (eg, milk).
The National Pharmacovigilance Network informs
Among the ADR reports compiled by the National Pharmacovigilance Network
until December 31, 2012, most cases of
known to cause this side effect (bicalutamide, dutasteride, flutamide, finasteride
and the furosemide / spironolactone).
However, the Working Group for Signal Analysis (established by the Italian
Agency for Medicines) has identified cases of
two drugs never before linked to the disease or poorly documented:
and tamsulosin (respectively 4 and 7 reports) .
Further analysis has shown that
is a rare adverse effect probably correlated with all HMG-CoA reductase inhibitors (ie, statins). On the other
hand, for tamsulosin the effects on sex hormones are unknown, since there are
no other published cases. The signals from the passive surveillance systems are
not definitive evidence of the cause-effect relationship between the drug and the
event, but they are useful tools for early warnings about possible safety
problems of the drugs marketed.for more detail meet
gynecomastia surgeon in Lahore
What to do in case of gynecomastia
induced by drugs, it would be opportune
to consider the interruption of the treatment. In some cases, it may be useful to
reduce doses or replace the suspect drug with another drug belonging to the
same class, but with a weaker association to
The mammographic examination allows to distinguish with certainty between
and pseudogynecomastia. On the other hand, laboratory tests
are necessary to identify other possible causes, controlling the renal, hepatic
and thyroid functions and the levels of hormones of free circulation.
is usually reversible within 6 months or a year after
its onset. If interruption of the drug is not sufficient or is not possible (for
example, with antiandrogens), tamoxifen-based therapy (20 mg per day) may be considered.
In fact, despite not being approved for this indication, data from the literature
suggest a response rate of 50-80% of cases, with improvements detectable from
the first month of treatment. In the rare event that both the drug dechallenge
and tamoxifen are not successful, it is possible to resort to surgery or
radiotherapy, according to the needs of the patient.
List of medications that can cause gynecomastia
Medications that often cause gynecomastia
Antiandrogens - Bicalutamide, flutamide, finasteride, dutasteride
Antihypertensive - Spironolactone
Antiretroviral - Protease inhibitors (saquinavir, indinavir, nelfinavir,
ritonavir, lopinavir), reverse transcriptase inhibitors (stavudine, zidovudine, lamivudine)
Environmental exposure - Phenothrin (antiparasitic)
Exogenous hormones - Estrogens, prednisone (male adolescents)
Gastrointestinal drugs - Histamine H2 receptor blockers (cimetidine)
Drugs that possibly cause gynecomastia
Antifungal - Ketoconazole (prolonged oral use)
Antihypertensive - Calcium channel blockers (amlodipine, diltiazem, felodipine, nifedipine, verapamil)
Antipsychotic (first generation) - Haloperidol, olanzapine, paliperidone (high dose), risperidone (high dose), ziprasidone
Antiretroviral - favirenz
Chemotherapy - Methotrexate, cyclophosphamide, carmustine, etoposide, cytarabine, melphalan, bleomycin, cisplatin, vincristine, procarbazine
Exogenous hormones - Androgens (abuse of this medication by athletes)
Gastrointestinal medications - Proton pump inhibitors (omeprazole)
Cardiovascular drugs - Phytoestrogens (soy-based products, large amount)
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