Gynecomastia is described as enlargement of the mammary glands in men. Gynecomastia is usually bilateral, but it can also be unilateral. It can be observed frequently in newborns, adolescence and the elderly. Transient breast enlargement can be seen in up to 70% of boys during the transition to puberty. In one study, it was found in approximately 20% of men over the age of 60 and in 50% of men over the age of 80. While estrogens provide the development of breast tissue, androgens act in action. Gynecomastia is usually caused by an imbalance of estrogen and androgen hormones either proportionally, or in efficiency, or both proportionally and in favor of estrogen in terms of effectiveness. As a rule, in parallel with aging and weight gain, adipose tissue increases and gynecomastia is more common. Every patient who applies to the clinic with gynecomastia does not need to be examined in detail. In an asymptomatic healthy man, stable gynecomastia, which is stated to be present for a long time, does not need to be examined after a detailed history and physical examination, if the findings are natural. One of every four adult gynecomastia cases is responsible for the factors used, therefore a detailed history should be taken. Also in the story; The duration of gynecomastia, presence of sensitivity, presence of concomitant disease (such as hyperthyroidism, chronic liver or kidney disease, hypogonadism, prostate cancer), possible chemical exposure should be questioned. Systemic physical examination, especially breast, testis and secondary sex characteristics should be done. Gynecomastia with acute onset, rapid and excessive growth, observed in sensitive and thin men should be investigated. In particular, hard, asymmetrical masses that fix the skin, subcutaneous structures or nipple, accompanying ulceration and/or nipple discharge, presence of axillary lymph nodes may indicate malignancy and should be evaluated. After excluding pubertal and drug-related gynecomastia, investigation should be started. Kidney, liver and thyroid function tests should be done. Serum testosterone, ostradiol, androstenedione, luteinizing hormone (LH) and HCG levels should be measured. If testicles are small, karyotype analysis should be performed to rule out Kleinefelter syndrome. The risk of breast cancer in gynecomastia accompanying Kleinefelter syndrome is 20 times higher than in normal men. Except for this syndrome, the presence of gynecomastia does not increase the risk of breast cancer. Obesity in men is also an important risk factor for breast cancer. It is not necessary to treat long-standing gynecomastia in asymptomatic healthy men. If pubertal gynecomastia is painful and causes anxiety and social stress in the adolescent, treatment with danazol may be considered. In painful gynecomastia patients who were not candidates for surgery, antiestrogen treatment such as tamoxifen or raloxifene was observed to reduce pain and reduce breast tissue size in two-thirds of the patients. If there is an underlying cause of gynecomastia, it will improve with treatment.
Should male breast enlargement (gynecomastia) be treated?
