Characteristics of gynecomastia

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. At Cosmoplast Dr Amin Yousaf offer gynecomastia

What is Gynecomastia 

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 gynecomastia . This 

condition, particularly frequent in overweight subjects, takes the name of 

 pseudoginecomastia . Often gynecomastia and pseudoginecomastia are 

present in the same subject at the same time.

Despite not being a condition that threatens health, gynecomastia can cause 

psychological disorders due to alterations in physical 

appearance.Gynecomastia surgery is done with liposuction

Etiology and pathogenesis

The proliferation of mammary gland tissue is physiologically stimulated by 

estrogen and inhibited by androgens. Therefore, men boobs  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. 

Most cases of gynecomastia are physiological in nature (neonatal, pubertal and 

senile gynecomastia ). 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 gynecomastia , around 20%, is 

iatrogenic .

Medications involved

Many drugs can cause gynecomastia as well as several active ingredients, 

which have been associated with this condition. The active ingredients known to 

most commonly cause gynecomastia are exogenous estrogens, antiandrogens, 

5 alpha reductase inhibitors, spironolactone and cimetidine.

Antiandrogens (such as bicalutamide and flutamide) can cause gynecomastia 

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. 

Typically, gynecomastia 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 / 

androgens. The risk of gynecomastia surgery 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 

gynecomastia 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 gynecomastia in Pakistan : a retrospective 

epidemiological study suggests a relative risk> 7 for treated patients, strongly 

dose-dependent.

Other examples of drugs that can cause gynecomastia are protease inhibitors 

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). 

soy).

The National Pharmacovigilance Network informs

Among the ADR reports compiled by the National Pharmacovigilance Network 

until December 31, 2012, most cases of gynecomastia are due to drugs already 

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 gynecomastia associated with 

two drugs never before linked to the disease or poorly documented: 

rosuvastatin 

and tamsulosin (respectively 4 and 7 reports) .

Further analysis has shown that gynecomastia 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 

What to do in case of gynecomastia

In case of suspicion of gynecomastia tratment 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 gynecomastia .

The mammographic examination allows to distinguish with certainty between

 gynecomastia surgery 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.

Iatrogenic gynecomastiais 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 in Men

Before Gynecomastia in Lahore Please read following

• 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)

Why do I have gynecomastia in Lahore!?

Gynecomastia is that condition that makes many men uncomfortable. It is an imbalance in the hormones that the breast augmentation generates . The truth is that despite not being so well known, it is a very common situation that many men at different times of their lives must face. To Know about what specifically causes gynecomastia or men’s breasts surgeon in Lahore?

In principle, it should be kept in mind that most cases of gynecomastia have a physiological cause: in newborns, in puberty and in the elderly. At the same time, a large part of gynecomastia does not have an explanation so far, that is, the cause is unknown.

Physiological gynecomastia

Elderly: senile gynecomastia

In the case of the elderly, gynecomastia is mainly due to an increase in fat tissue with a marked conversion of androgens to estrogen ; to a reduction of the testosterone generation by the testicles; and the use of medications.

Approximately half, that is, 50% of men who are between 50 to 80 years old possess some degree of gynecomastia

Puberty: pubertal gynecomastia.

During puberty, gynecomastia can be detected at ages 10 to 14 years and at this time of life is caused by the momentary and organic increase in estrogen.

As with newborn children, this is a temporary process that will be reversed after months. It is difficult to observe that pubertal gynecomastia extends beyond 17 years. Gynecomastia is present in an average of 20% to 70% of children and adolescents between the ages of 10 to 14 years.

Newborns: neonatal gynecomastia

Gynecomastia is present in approximately 75% of newborns . In this case, the condition is generated by maternal estrogens that are transferred through the placenta. As in adolescents and children, in newborns gynecomastia is momentary and should disappear well after 2 or 3 weeks after birth.

Causes of Pathological Gynecomastia

Many diseases can cause a pathological gynecomastia or male boobs that can cause severe problems for the patient’s health.

This type of gynecomastia has the peculiarity that the imbalance between estrogens and androgens does not occur throughout the body, but only in the breasts of man. However, this type of gynecomastia surgery are under study and their explanations are still transitory.

• When there is an excess of estrogen
• Estrogen-producing tumors
• Testicular tumors
• Adrenal tumors
• Some other tumors such as lung, liver, kidney, gastric, etc.
• When There Is an Increase in the Conversion of Androgens to Estrogens
• Obesity
• Liver problems
• Renal insufficiency
• Hyperthyroidism
• Poor nutrition
• When there is a failure in the production of testosterone
• Reasons that are from birth (lack of testes, resistance to androgens, for example)*
• When Some Specific Drugs are Consumed
• Gynecomastia by drugs is one of the most common gynecomastia. Usually occurs in any type of patient, here what matters is the medication consumed.
• Drugs used in pneumology
• Drugs used in Psychiatry (diazepam, for example)
• Medicines used for cardiovascular problems
• Medications that produce hormonal alterations: steroids, growth hormones, testosterone, antiandrogenic (Finasteride, ketoconazole, for example), estrogen, etc.
• Medications used in prostate problems such as cancer (Finasteride, dutasteride, for example). These medications used reduce and inhibit the hormone 5-alpha reductase.
• Medications used in hormonal problems linked to prostate cancer (flutamide, for example).
• Medications to treat ulcers (raniditidine, omeprazole, for example)
• Some antimicrobial medications (Metronidazole, for example)
• Varied medications such as Minoxidil, penicillamine, mildopa, etc.
• There are many medications or drugs that can cause gynecomastia surgery as a side effect. That is why reading carefully the prospects becomes very important.