How to treat gynecomastia in men with folk remedies. Treatment of gynecomastia in men (with medications and surgery). Three types of pain relief are used

Many doctors believe that the only treatment for gynecomastia is surgery. Others argue that gynecomastia in men can be treated without surgery, it all depends on the form of the disease. Only those men whose disease is in advanced stages need surgery.

What it is?

Gynecomastia is an enlargement of breast tissue in men, accompanied by a change in the volume of glands and fatty structures. The breast diameter of a man with gynecomastia reaches 10 centimeters, although this figure often varies from 2 to 4 cm.

Development mechanism

In men, the mammary glands are a vestigial organ that has lost its original purpose in the process of evolutionary development. They consist of adipose tissue, a small amount of glandular tissue with ducts, a nipple and an areola.

The development of glandular tissue and ducts, as well as their functioning, depend primarily on estrogens (female sex hormones) and progesterone, as well as prolactin (a pituitary hormone), which stimulates the formation of estrogen-sensitive receptors in the mammary glands.

Androgens (male sex hormones) are synthesized in the testes and adrenal glands. In peripheral tissue, mainly adipose tissue, under the influence of the aromatase enzyme, they are partially transformed into female sex hormones. In liver cells, estrogens are rapidly destroyed by combining with sulfur and glucuronic acid and are excreted by the kidneys. In the male body, estrogens normally constitute an insignificant fraction (0.001%) of the content of androgens - testosterone and its more active form, dihydrotestosterone.

Under the influence of certain factors, the ratio of sex hormones changes in favor of estrogens, as a result of which changes in the mammary glands corresponding to the syndrome occur. The main causes of gynecomastia are as follows:

• an absolute increase in the content of estrogen in the blood, associated with an increase in their production by glands or a hormone-producing tumor;
• a relative increase in estrogen (with normal levels in the blood), which is the result of a decrease in androgen levels;
• a decrease in the sensitivity of target tissue cells to the effects of androgens with normal levels of female and male sex hormones in the body, as a result of which the effect of estrogens predominates.

Pathological processes can also be the cause of the developing growth of male mammary glands:

• deficiency of male hormones;
• overproduction of estrogen;
• hyperprolactinemia (increased prolactin production);
• uncontrolled use of medications, steroids (tamoxifen, creatine, methane, etc.), drugs (marijuana, amphetamines);
• mammary cancer;
• other diseases (liver cirrhosis, overactive or insufficient thyroid gland, renal failure).

Gynecomastia can also appear due to genetic and hereditary factors. Very often it is idiopathic, associated with unknown causes, or is a consequence of obesity or hormonal problems.

If you are experiencing other symptoms in addition to breast enlargement, such as loss of libido, impotence, chronic fatigue or anxiety, you should consult your doctor as these may indicate more serious conditions. Medical diagnosis performed in such cases usually includes analysis of certain hormones in the blood, ultrasound or computed tomography.

Classification

Experts distinguish several classifications of the disease:

1. Symmetrical, bilateral, and asymmetrical, unilateral, gynecomastia. With the first, both mammary glands are enlarged, and with the second, only one is enlarged. In this case, special attention should be paid to the second option, since this may indicate oncology, especially with hardening of the mammary gland.
2. False and true gynecomastia. With false glands, they enlarge due to adipose tissue, which is usually a consequence of overweight and obesity, and with true glands, they enlarge due to glandular tissue.

It is customary to distinguish 3 stages of breast disease:

1. Proliferating, or developing, is the first stage of the disease. Its duration is no more than 4 months. At this stage, the disease can be cured conservatively without resorting to surgery. In addition, the cost of such treatment will be much cheaper than surgery.
2. The intermediate stage is characterized by the maturation of breast tissue, but it does not disappear. The stage lasts from 4 to 12 months. At this stage, the disease can still be treated with medication if tissue scarring has not occurred.
3. The fibrous stage is accompanied by the appearance of mature connective tissue in the mammary gland, and fatty deposits begin around the glandular tissue. At this stage, it is almost impossible to return the mammary gland to its previous size.

If you suspect a pathological process in the mammary gland, you should see a doctor, because in the early stages, treatment of gynecomastia brings positive results, and the price of therapy is affordable for any patient.

Why is gynecomastia dangerous?

Physiological gynecomastia is not dangerous and regresses on its own. A boy or man may be embarrassed by the appearance of his breasts and experience some complexes, but understanding the cause of this condition or working with a psychologist can smooth out these unpleasant experiences.

Long-term pathological gynecomastia, in addition to the fact that it accompanies a progressive underlying disease, can cause the development of breast cancer. This cancer is quite rare in men, but is accompanied by the same severe consequences as malignant breast tumors in women.

The appearance of bloody discharge from the nipple, dense formations, ulcerations, changes in the appearance of the skin over the lumps and enlargement of nearby lymph nodes - such signs should alert a man and become a reason for immediate contact with a surgeon or oncologist.

Symptoms of gynecomastia, photos

Gynecomastia is an increase in the size and volume of the mammary glands in men due to hypertrophic processes in glandular and fat cells. Diagnosis of this condition does not present any difficulties, since the altered organs are accessible to visual inspection.

Characteristic symptoms of gynecomastia (see photo):

• the appearance of swelling in the nipple area;
• spherical formation in the peripapillary region, determined by palpation;
• an increase in the volume of tissue in the projection of the pectoral muscles, combined with their sagging;
• sore nipples;
• discharge when pressing on the nipples.

In total, there are 3 degrees of mammary gland enlargement in men:

• first (moderate) – breast volume does not exceed 6 cm.
• second (medium) – enlargement of the mammary gland from 6 to 10 cm.
• third (pronounced) – the breast increases by more than 10 cm.

What gynecomastia looks like, the photo can be seen below:

Diagnostics

Using various diagnostic methods, a specialist can determine the degree of progression of the disease. The doctor conducts an initial examination and questions the patient about the presence of diseases and alcohol and drug addiction. To clarify the diagnosis, the following studies are carried out:

1. Blood test - to detect estrogen levels.
2. Sperm analysis - to assess the condition of the reproductive system and detect signs of feminization.
3. Breast ultrasound - to determine the structure of the mammary gland, the size of the lesion, and the presence of signs of inflammation.

If a blood test shows an increased level of testosterone, creatinine and prolactin, an ultrasound examination of the testicles is prescribed, which helps determine the stage of development of the disease. Diagnosis can sometimes be made using a chest x-ray.

Treatment of gynecomastia in men

The tactics for treating gynecomastia in men without surgery depends on the cause that caused it.

Physiological gynecomastia of newborns in the vast majority of cases does not require treatment and disappears on its own. Gynecomastia, especially during puberty, often goes away on its own within about six months. Therefore, in the absence of signs of malignancy, observation is preferable in many cases. If there is no positive dynamics within 6 months, drug therapy is usually prescribed.

Independent, uncontrolled use of these drugs without identifying the exact cause of gynecomastia can lead to worsening of gynecomastia, progression of the disease, or severe side effects.

1. Tamoxifen (Nolvadex), a selective estrogen receptor modulator, is most often used for severe and painful forms of gynecomastia.
2. Clomiphene is an antiestrogen often used to treat gynecomastia.
3. Testosterone - prescribed to patients with low testosterone levels, older men; for patients with normal testosterone levels, it is usually ineffective.
4. Danazol is a synthetic derivative of testosterone, reduces the synthesis of estrogen in the testicles, and is used to treat gynecomastia much less frequently than other drugs.

For gynecomastia caused by taking medications, the issue of replacing the drug or reducing the dose is decided. Gynecomastia caused by diseases of internal or endocrine organs requires treatment of the underlying disease.

Gynecomastia in bodybuilding

Nutrition rules

The main causes of the disease are obesity, poor nutrition, and alcohol consumption. First of all, in order to get rid of pathology, and for preventive purposes, you should adjust your diet and change your eating habits.

A man's nutrition should be complete:

• you need to consume all the necessary vitamins and microelements.
• You also need to reduce your consumption of fast carbohydrates and fats.
• It is extremely important to eat more protein.
• eat more vegetables, fruits and grains.
• you need to stop consuming sweets and starchy foods.
• include fish oil and omega 3, 6 in your diet.
• eat foods with a lot of zinc - dried fruits, nuts, yoghurts, sea fish.

With an integrated approach, herbal treatment should be included. It is advisable to drink infusions and decoctions from:

• golden root;
• plantain;
• raspberry leaves;
• hibiscus;
• hops;
• red clover;
• sage

These herbs can stabilize hormonal levels and reduce excess amounts of female hormones.

Surgery

Depending on the prevalence and type of pathological process, the following operations can be performed:

1. Endoscopic mastectomy: can be performed with minimal breast enlargement, this is a minimally invasive operation, performed using an endoscope;
2. Areola-sparing mastectomy: performed via para-areolar approach;
3. Mastectomy with liposuction: performed through a para-areolar approach, additionally removing excess fatty tissue.

Endoscopic and subcutaneous mastectomy are well tolerated by patients. The patient recovers quickly after the operation and after 2 days he can be discharged from the hospital.

In the postoperative period, he must follow a number of recommendations: limit physical activity and wear special underwear for 2-3 weeks to correct the muscle contour and correct skin contraction. After a week, the patient can begin light work, and after a month, more intense physical activity or sports training is allowed.

Forecast

Physiological gynecomastia in most cases is characterized by favorable prognosis and disappears on its own. In 75% of adolescents, hormonal levels are restored within two years.

A more favorable course is typical for gynecomastia caused by taking medications, and a less favorable course for gynecomastia caused by diseases.

Gynecomastia in men is an enlargement of the mammary glands in men, often this simply causes physical and psychological discomfort and can be resolved in mild form with the help of sports training and diet, but the disease has several causes:

• hormonal imbalance
• transitional age
• age

Often, treatment can proceed without extreme measures - surgery; in these cases, pills and diets and other methods are prescribed, but it also happens that gynecomastia becomes severe and surgical intervention is required, because this disease can cause breast cancer. But statistics show that a significant portion of operations are performed for aesthetic purposes and have no compelling reasons. Read further in this article about the causes and methods of treatment.

Brief characteristics of gynecomastia

The name of the disease “gynecomastia” is derived from two Latin words – gynes (woman) and mastos (breast). That is, the literal translation of the term “gynecomastia” is female breasts, which fully corresponds to the main external manifestation of the essence of the disease.

After all, gynecomastia is a benign increase in the size of the mammary glands in men. To put it simply, representatives of the stronger sex grow female breasts.

Breast enlargement can occur due to the proliferation of ducts and glandular tissue or due to fat deposits. If the breasts increase due to the growth of glandular tissue, then gynecomastia is considered true, and the increase in breast volume due to fat deposits is false gynecomastia.

The severity of breast enlargement can vary - from 1 to 10 cm, and involve one or both mammary glands. More often, symmetrical damage to both mammary glands occurs simultaneously; enlargement of only one breast with gynecomastia is quite rare. Enlarged mammary glands with gynecomastia usually look like slightly pendulous small female breasts.

Development of gynecomastia

The development of gynecomastia of any type is based on an imbalance of sex hormones with a predominance of estrogens. That is, any diseases, medications, drugs and other items that can lead to more estrogen in a man’s body than testosterone can cause gynecomastia.

• The fact is that the predominance of estrogens leads to the fact that they begin to affect tissues that are sensitive to them, which include the ducts of the mammary glands.
• Under the influence of estrogens, breast tissue, which in men is in its infancy, begins to actively grow, forming breasts.
• That is, there is a process similar to what happens in the body of young girls during puberty, when their breasts begin to grow, the pelvic bones increase, etc.

The effect of estrogen on male breasts

Normally, breast formation does not occur, since the estrogens present in the male body do not have an activating effect on breast tissue for two main reasons.

• Firstly, there are very few estrogens, so their effect on the glandular tissue of the breast is not able to remove the latter from the embryonic state in which it is located.
• Secondly, estrogens are suppressed by a large amount of testosterone, which is produced in the male body and determines characteristic sexual characteristics.

But if for some reason the amount of estrogens increases and they begin to prevail over testosterone, then the growth of tissues that are normally in the male body in their infancy is activated. As a result, the feminization of the man occurs, that is, female sexual characteristics appear, which include breasts.

Thus, gynecomastia develops if estrogen predominates over testosterone in a man’s body.

Moreover, the cause of hormonal imbalance is not important, since gynecomastia is triggered precisely by an increase in the content of estrogen relative to testosterone.

Stages of gynecomastia

During the course of gynecomastia, three successive stages are distinguished, such as proliferating, intermediate And fibrous. At the proliferation stage, the process of proliferation of the ducts and glandular tissue of the mammary gland occurs, which lasts an average of 4 months.

Next, in the intermediate stage, which lasts 4–12 months, the mammary gland matures. During the fibrotic stage, dense connective tissue and fatty deposits appear in the mammary gland, which completes the complete formation of the organ. Accordingly, during the first 4 months a person notices that his breasts are growing, and then they notice their tightening.

Treatment of gynecomastia can be conservative or surgical. In all cases, they first resort to conservative therapy, which makes it possible to stop the progression of the process and in many situations achieve complete “resorption” of the already formed breast.

Surgical treatment of gynecomastia

Surgical treatment of gynecomastia is carried out only if there is a tumor formation in the mammary gland or the man is not satisfied with the appearance of the chest for aesthetic reasons.

If there is a tumor in the mammary gland, surgery for gynecomastia is mandatory.

But operations to remove breasts for aesthetic reasons are not always performed, since in many cases the appearance of the chest after surgery may be even worse than before it.

Conservative treatment of gynecomastia

Conservative treatment, begun in the proliferating stage, allows for complete involution and disappearance of the breast, since all changes are still reversible.

Conservative treatment started at an intermediate stage can only stop the progression of the process, but reverse involution and disappearance of already grown breasts can be achieved only in rare cases.

Conservative treatment at the fibrotic stage also only allows you to stop the progression of the process, but with its help it is impossible to achieve the disappearance of the breast under any circumstances.

This means that in order to eliminate formed breasts, you will have to resort to surgery, during which glandular and fatty tissue is removed.

Classification and characteristics of types of disease

Currently, depending on the nature of the causative factor and the type of tissue that forms the enlarged mammary gland, gynecomastia is divided into four main types:

1. False gynecomastia;
2. Idiopathic gynecomastia.

Some scientists and doctors distinguish only two main types of gynecomastia - true and false, and physiological and idiopathic are classified as variants of true. However, in world practice, the above version of the classification is used.

We believe that these differences between classifications are not fundamental, since regardless of whether idiopathic and physiological gynecomastia are included in the true gynecomastia or are separated into separate varieties, their essence and characteristics are unchanged.

To avoid classification confusion, we will consider the characteristics of all types of gynecomastia in separate subsections with appropriate names.

Physiological gynecomastia is a variant of the age-related norm in which the glandular tissue and ducts of the mammary glands grow.

It is not a sign of any disease, goes away on its own, and therefore does not require special treatment. Physiological gynecomastia occurs in males during age periods in which hormonal changes occur.

Thus, the following variants of physiological gynecomastia are distinguished, occurring at different age periods in males:

• Gynecomastia of newborns;
• Adolescent gynecomastia (pubertal);
• Senile gynecomastia.

Gynecomastia of newborns

Appears in infant boys in the first days of life and goes away on its own within 2 to 4 weeks. Typically, gynecomastia occurs in 60–80% of newborn boys and is caused by exposure to maternal estrogens that penetrate through the placenta.

When all the estrogens that enter the baby’s blood from the mother’s body during pregnancy are utilized, the gynecomastia will go away, and the mammary glands will involute, turning into completely flat formations with protruding small nipples.

Adolescent gynecomastia

It is also called pubertal because it occurs at puberty, when the child reaches puberty and undergoes dramatic hormonal changes. In boys aged 12–15 years, gynecomastia is observed in 30–60% of cases, and, as a rule, both mammary glands become enlarged.

But in rare cases, gynecomastia affects only one breast. The resulting asymmetry is very noticeable. Sometimes a whitish fluid is released from the nipples of enlarged breasts.

This type of gynecomastia is a variant of the age norm, goes away on its own within 1 to 2 years and does not require treatment. However, if after 2 years the gynecomastia has not gone away, then it is called persistent, is considered pathological and, accordingly, requires treatment.

Causes of teenage gynecomastia

Unfortunately, the exact causes of teenage gynecomastia have not yet been established. However, it is known that in the early stages of puberty in boys, estrogens are produced in greater quantities compared to testosterone, which is the triggering factor for the development of temporary gynecomastia.

• As long as estrogens prevail over androgens in a young man’s body, he will have gynecomastia.
• But when the balance of hormones returns to normal, involution will occur and the grown breasts will collapse.

In principle, teenage gynecomastia is not a pathology, but it can cause serious psychological and sexual disorders in a teenager who experiences fear due to the “wrong” appearance.

Therefore, a boy suffering from gynecomastia needs psychological help and moral support for the entire period until his body returns to its normal state.

However, parents should remember that if a boy with gynecomastia does not have other signs of puberty (hair growth on the body, in the armpits, on the pubis, change in voice, etc.), then breast enlargement is a symptom of severe endocrine diseases, such as hormone-producing tumors of various locations.

Senile gynecomastia

develops in men aged 55–80 years due to a decrease in testosterone production. Due to a decrease in testosterone levels, estrogens begin to prevail, as a result of which gynecomastia develops. As a rule, both breasts become enlarged. Involution of senile gynecomastia occurs rarely, but this condition is a normal variant, so it is almost never treated.

False gynecomastia

False gynecomastia is also called pseudogynecomastia or adiposomastia. With false gynecomastia, enlargement of the mammary glands occurs due to the deposition of fat under the skin in the area of ​​the areola of the nipple.

The difference between false gynecomastia and all its other types (true, physiological and idiopathic) is the enlargement of the mammary glands due to fat deposition.

And with other types of gynecomastia, enlargement of the mammary glands occurs due to the proliferation of glandular tissue and ducts.

As a rule, false gynecomastia develops against the background of general obesity and can be significantly expressed.

True gynecomastia is an enlargement of the mammary glands due to the proliferation of glandular tissue and ducts; it is a pathology and requires treatment. True gynecomastia develops when estrogen prevails over androgens in a man’s body.

However, hormonal imbalance is only a trigger factor and provides the necessary conditions for the proliferation of glandular tissue and breast growth.

Accordingly, the causes of gynecomastia are factors that cause hormonal imbalance. And the reasons that cause hormonal imbalance with a predominance of estrogen levels over androgens are very diverse, and therefore the range of factors that can lead to true gynecomastia is wide.

It has now been established that The causes of true gynecomastia may be the following factors:

• Production of large amounts of estrogens by hormonally active tumors of the testicle, liver or lungs (for example, germinoma, leydigoma, etc.);
• Insufficient utilization of estrogen in the liver in severe diseases of this organ (for example, cirrhosis, chronic hepatitis, etc.);
• Taking medications that increase estrogen levels and suppress testosterone production (for example, anabolic steroids, glucocorticosteroids, estrogen preparations, cardiac glycosides, drugs, ACE inhibitors, calcium channel blockers, Spironolactone, Furosemide, Diazepam, Reserpine, Theophylline, Methyldopa, etc.);
• Hyperthyroidism (increased levels of thyroid hormones in the blood) or hypothyroidism (reduced levels of thyroid hormones in the blood);
• Androgen deficiency caused by underdevelopment of the genital organs due to genetic diseases (Klinefelter syndrome, Reifenstein syndrome, etc.);
• Testicular feminization syndrome;
• Hermaphroditism;
• Prostatitis;
• Dystrophy due to starvation;
• Diseases of the adrenal glands;
• Obesity;
• Acromegaly;
• Itsenko-Cushing syndrome;
• Hypogonadism;
• Impaired functioning of the testicles due to injury, orchitis, infectious diseases or exposure to ionizing radiation;
• Castration;
• Brain damage (consequences of traumatic brain injury, Parkinson's disease, syringomyelia, epilepsy, meningoencephalitis, Friedreich's disease, pituitary tumors, etc.);
• Continuous use of plasmapheresis against the background of chronic renal failure.

Idiopathic gynecomastia

Idiopathic gynecomastia is a variant of true gynecomastia, in which it is not possible to determine the cause of the disease.

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Symptoms

The main characteristic symptoms of gynecomastia are enlargement of the mammary gland and breast growth. It should be noted that breast enlargement in a man due to the proliferation of adipose tissue does not indicate this pathology and is called pseudo-gynecomastia.

• The increase in size and engorgement of the mammary glands in newborn boys is insignificant and does not cause serious inconvenience to the child. With other types of gynecomastia, the breasts can increase to 15 cm in diameter and weigh about 160 g. More often, the mammary glands enlarge on both sides.
• Sometimes one gland is more enlarged than the other. Unilateral gynecomastia, which is less common, has the same symptoms, but the condition significantly increases the risk of developing breast cancer.
• Patients with this pathology rarely complain of pain, but note a feeling of pressure, discomfort and increased sensitivity of the nipples (especially when wearing clothes). In some cases, gynecomastia is accompanied by milky discharge from the nipples. Their areolas can become hyperpigmented and expand up to 3 cm in size.
• Gynecomastia, which was caused by hyperprolactinemia, is accompanied by signs of damage to the central nervous system, oligospermia and impotence.
• Potency disorders in other types of this pathology are observed only in the case of a significant increase in estrogen levels and a significant decrease in the amount of testosterone. In some severe cases, libido may be completely absent.

The following signs may indicate an increase in estrogen levels in men: a change in the timbre of the voice (it becomes higher), excessive irritability and tearfulness, loss of hair on the face and body. With pathological gynecomastia, changes in shape, swelling and swelling of the testicles may be detected. All of the above symptoms should be a reason for immediate medical examination.

During pathological gynecomastia, three stages can be distinguished:

• proliferating (first 4 months): accompanied by initial symptoms that can regress with adequate therapy;
• intermediate (about 4-12 months): accompanied by the maturation and growth of breast tissue;
• fibrous: accompanied by the appearance of connective and adipose tissue in the mammary gland, breasts with dense seals, regression of the pathological process at this stage is almost impossible.

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Treatment

General principles of therapy

Physiological gynecomastia is not treated, because it goes away on its own after the hormonal balance in the body is normalized. Fatty gynecomastia does not require treatment, since it is completely safe, and therefore its therapy is carried out only at the insistence of the patient who wants to eliminate enlarged mammary glands for aesthetic reasons. In this case, liposuction surgery is performed, during which the fatty tissue is removed and the breasts acquire normal shape.

• Conservative and surgical methods are used to treat pathological and idiopathic gynecomastia.
• Conservative treatment should be comprehensive and aimed simultaneously at eliminating the underlying disease that provoked gynecomastia and at relieving the effects of estrogen.
• Often, when the underlying disease cannot be treated (for example, taking medications, etc.), gynecomastia is treated with drugs that suppress the effects of estrogen.
• Surgical treatment is resorted to only if conservative therapy has proven ineffective within 2 years of its implementation, and the person insists on complete removal of the overgrown mammary glands for cosmetic reasons.

If gynecomastia is caused by a tumor formation in the mammary gland, then the only method of treatment used is surgery to remove the tumor.

It is strictly forbidden to squeeze the mammary glands with tight bandages in order to stop breast growth, since this is not only ineffective, but also dangerous due to impaired blood flow.

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Conservative treatment - without surgery

List of Essential Medicines

The most common way to combat gynecomastia without surgery is drug therapy that helps normalize hormone levels in the patient’s body. For these purposes, men are prescribed medications containing large amounts of androgen or substances that block estrogen (the type of hormonal drug is selected depending on the cause of the disease). We list some tablets and ointments that can be used for treatment.

Tamoxifen

A good effect is achieved by using a medication such as Tamoxifen, which blocks the effects of female sex hormones in the patient’s body and affects the condition of the mammary glands. Note that drug treatment of gynecomastia in men, unlike surgery, is a rather lengthy process; the first results from Tamoxifen may appear no earlier than after 3–4 months of the therapeutic course.

Clomiphene citrate

The drug is usually prescribed to women who have difficulty conceiving. In men, it works as a regulator of estrogen surplus and a testicular stimulator for the production of androgenic hormone. Within 16–20 days, natural testosterone production returns, which helps in the treatment of gynecomastia without surgery.

Proviron

A synthetic drug that does not have an anabolic effect. Unlike previous medications, Proviron does not block estradiol receptors, but reduces its amount in the blood. Use 25 mg per day for a couple of months. The course is determined by the complexity of gynecomastia.

Progestogel is a gestagen that is used for external use. The ointment contains progesterone, which is the active substance that provides non-surgical treatment of gynecomastia.

Selection of hormonal drugs, determination of their dosage and duration of use is the task of a qualified specialist.

Only with full control and strict adherence to medical instructions will the treatment be extremely effective, safe and without surgery!

Diet therapy to help pills

Effective treatment for representatives of the stronger sex suffering from gynecomastia involves following a strict diet and changing eating habits. Proper nutrition and adherence to diet therapy will help avoid surgery.

The patient's daily diet should be balanced and include a minimum content of easily digestible carbohydrates and fats. Fiber, proteins and vitamins, on the contrary, are mandatory for successful therapy.

Zinc has the same effect, so young people suffering from this pathology are recommended to include the following zinc-containing products in their diet:

• like sea fish
• dried fruits
• nuts and yoghurts.

It will be very useful to consume fish oil, which contains a large amount of amino acids necessary for additional testosterone production.

Herbal remedies and other folk methods

Treatment of gynecomastia in men can be carried out using traditional medicine. The patient may be recommended to take decoctions and infusions of Leuzea and golden root. According to experts, these plants help stabilize hormonal levels, reducing the amount of female sex hormones in a man’s body, which is extremely important for successfully defeating gynecomastia. Using flax seeds or milk thistle will be effective.

In addition, the patient can use the following recipes from traditional medicine:

1. Turmeric drink. Turmeric promotes active burning of subcutaneous fat and increases the level of the hormone testosterone. Therefore, patients suffering from gynecomastia will find a drink made with this spice very useful. The medicine is made extremely simply: a teaspoon of turmeric is diluted until completely dissolved in a glass of warm water.
2. Ice compresses. Treatment in this way involves exposure to low temperatures, causing contraction and reduction of male adipose tissue. Ice cubes are wrapped in thin cloth and applied to the chest area. The optimal time for the procedure is 1.5–2 minutes.
3. Salt baths. Hot baths with sea salt help eliminate swelling and improve blood circulation, promoting a speedy recovery. It is recommended to carry out this procedure several times a week, for 15–20 minutes.

Comprehensive patient care measures

We have described the main ways to reduce the size of the mammary glands. But it is also important to understand that without eliminating the root cause, the disease cannot be completely defeated. The occurrence and development of gynecomastia in men may be associated with the influence of various internal and external factors. Doctors say: in order to correctly and effectively treat this disease, it is necessary to first identify the cause and begin to treat it.

Here are the reasons why breast hypertrophy can develop:

• Testosterone deficiency: for treatment, hormonal drugs containing an artificial androgen substitute are taken.
• Pathological processes in the thyroid gland: medications with certain hormones are prescribed.
• Liver fibrosis: you need to take drugs to inhibit the activation of liver cells and relieve inflammation.
• Reproductive system disorders: testicular or prostate stimulant drugs are taken.
• Reifenstein or Kallmann syndrome: Medications that increase sensitivity to androgens are prescribed.
• Hypogonadism: you need to take testosterone pills.
• Adverse reactions of chemotherapy. Treatment consists of the use of antihypoxants, anti-inflammatory drugs, vitamins and antioxidants.

Only by identifying the cause of gynecomastia can a specialist create a comprehensive treatment program, consisting of two parts: treatment of the disease that provoked gynecomastia, and elimination of the pathology of the male mammary glands.

Contrary to popular belief, treating gynecomastia in men without surgery can be very effective. However, achieving favorable results is only possible if the choice of medications and other therapeutic methods is made by the attending physician after a thorough medical examination.

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Operating rooms treatment of gynecomastia

Gynecomastia is a change in the mammary glands in a man in the form of their enlargement against the background of dyshormonal changes in the body.

One of the debated issues regarding this topic is determining the advisability of surgical treatment.

This article is devoted to the key points of treatment tactics for gynecomastia.

Goals of the intervention

Surgery for gynecomastia is aimed at removing the pathologically changed mammary gland.

Such events cannot be called a radical solution to the problem, since gynecomastia is always just a symptom of a number of diseases.

First of all, the cause of hormonal imbalances must be identified and eliminated.

Only after this can the question of the feasibility of the operation be considered.

Indications

The main indications for the removal of pathological gynecomastia are:

• tumor degeneration of an enlarged mammary gland or suspicion of cancer;
• formation of nodes and cysts;
• persistent unilateral gynecomastia;
• true or mixed gynecomastia that is not amenable to conservative treatment;
• long-lasting pain syndrome with mammary gland enlargement of any degree;
• any form of gynecomastia that is a cosmetic defect and brings discomfort to a man.

Important to remember! By removing the mammary gland, you can get rid of aesthetic discomfort and reduce the risk of breast cancer.

Contraindications

Surgical treatment of gynecomastia is not possible in all cases, even if indicated.

Contraindications to breast removal are:

• severe heart failure;
• decompensated liver and kidney diseases;
• any acute diseases of infectious and non-infectious nature;
• exacerbation of chronic diseases;
• inflammatory and suppurative processes in the area of ​​the upcoming operation;
• first and second degrees of true or mixed gynecomastia without attempting conservative treatment;
• severe obesity.

Restrictions

In clinical practice, there are cases of gynecomastia in which surgery can either be delayed or performed for special indications.

Such restrictions include:

• Gynecomastia in boys during puberty.
  

  If the degree of enlargement of the mammary glands is insignificant, the lesion is bilateral, and the duration of the disease does not exceed 6 months, surgery is not indicated. In case of true or mixed bilateral gynecomastia of 2-3 degrees, amenable to drug correction, the operation should also be performed for limited indications.

• False bilateral gynecomastia. It does not carry any risks, and if it does not cause aesthetic complaints, it is better to refrain from surgery.
• Gynecomastia with a risk of developing breast cancer in patients with concomitant chronic diseases of internal organs. The operation is best performed after the patient’s general condition has stabilized. Failure to comply with this condition sharply increases operational risks.
• True or mixed gynecomastia 3rd degree. Surgical treatment must be preceded by hormone therapy.
• Gynecomastia in men with obesity of 2-3 degrees. It is better to delay the operation in order to bring the patient’s weight to the corresponding normal values.

Operation methods

Surgical treatment of gynecomastia is represented by several techniques and surgical methods:

• liposuction;
• laser removal.

Liposuction

It is an operation in which fatty tissue is removed from the area of ​​the enlarged mammary gland.

This type of surgical treatment is indicated for severe false gynecomastia.

Its therapeutic capabilities are represented by the correction of a cosmetic defect.

The effectiveness of such treatment is quite high when combined with measures aimed at normalizing the patient’s weight and correcting obesity.

Important to remember! Liposuction in an isolated form should not be performed for mixed forms of gynecomastia, and surgical treatment should be represented by a combination of liposuction with mastectomy.

Mastectomy

In a mastectomy, the entire enlarged breast is removed during surgery.

The main condition that determines the possibility of performing such an intervention is the true form of gynecomastia.

Laser or scalpel?

The tissue of the hypertrophied mammary gland can be removed either mechanically using a scalpel or by laser vaporization.

None of the methods is perfect, as it has certain advantages and disadvantages.

The peculiarity of laser vaporization is that the tissue is burned through a small puncture of the skin by a source of laser radiation connected to the gland.

The best decision when choosing the type of surgery is to trust your doctor. Only he, having studied all the intricacies of the disease, will make the most correct decision.

How does a doctor choose a method?

Some experts advise using laser techniques, while others adhere to the principles of traditional surgical treatment.

For the most part, all disputes are caused by the commercial side of the issue and the availability of equipment necessary for a particular technique.

The principles of expediency when choosing a method are as follows:

• any of the methods involves the removal of breast tissue;
• laser removal is less traumatic, but less radical;
• the size of the incision during traditional surgery is larger than during laser vaporization, but this should not be the only criterion when choosing the method of operation;
• it is much more difficult to control the volume of tissue removed during laser treatment than during direct excision under visual control;
• laser vaporization is best used in the treatment of true bilateral gynecomastia in young men with 1-2 degrees of mammary gland enlargement without signs of cancerous degeneration;
• traditional surgery is the method of choice for gynecomastia of any degree with signs of malignancy, mixed and false forms of the disease, true gynecomastia of the 3rd degree;
• the presence of doubts about the benign nature of gynecomastia should be a reason for radical open surgical treatment.

Is laparoscopy used?

Recently, operations to remove gynecomastia are carried out endoscopically: during endoscopy, apart from a small puncture in the armpit, no further damage to the skin is required.

Not all experts have a positive attitude towards this method due to certain technical difficulties.

The rationale for introducing such an operative technique into clinical practice is based on the need to achieve maximum cosmetic effect.

Preparation period

Despite the fact that surgery to remove gynecomastia is a simple intervention, preparation for it must be complete.

Its duration depends on the general condition of the patient, the type of gynecomastia and its complications.

Preparation includes:

1. Full laboratory examination and consultations with specialists.
2. Instrumental examination (ultrasound, radiography, ECG).
3. Breast biopsy with histological examination (if indicated).
4. Treatment of chronic diseases that can affect the outcome of surgery.
5. Consultation with an anesthesiologist to select the optimal method of pain relief.

Worth remembering:

1. If the patient’s condition allows the operation to be performed, a few days before the operation it is better to refrain from drinking alcoholic beverages, eliminate or limit smoking as much as possible.

2. The evening before the intervention, a light dinner is allowed.
3. In the morning, if the operation will be performed in the morning under anesthesia, it is forbidden to eat or drink.
4. Preparation of the surgical area includes shaving the hair, which is carried out on the morning of the operation.

Analyzes

Laboratory examination includes:

• general clinical blood test;
• clinical examination of urine;
• biochemical blood test;
• determination of blood group and rhesus affiliation;
• Wasserman reaction (RW);
• study of the hormonal spectrum of blood (testosterone, prolactin, estrogen, FSH);

Choice of anesthesia

The choice of anesthesia method during gynecomastia removal surgery is carried out by an anesthesiologist or operating surgeon, taking into account the patient’s wishes - as with laser otoplasty, transconjunctival blepharoplasty, Asian eye blepharoplasty, vertical mastopexy, and so on.

Three types of anesthesia are used:

1. Local anesthesia– tissue infiltration with a local anesthetic solution. During the operation, the patient does not feel pain, but remains conscious.
2. General anesthesia (anesthesia). Intravenous and inhalation anesthesia are quite effective, during which the patient is in a state of narcotic sleep.
3. Combined anesthesia– putting the patient into a superficial medicated sleep in combination with local anesthesia.
4. Each method of pain relief has its own advantages and disadvantages.

Most often they resort to intravenous anesthesia.

Stages and progress of the operation

The operation to remove gynecomastia consists of the following steps:

• treating the intervention area with antiseptic solutions and limiting the surgical field with sterile linen;
• achieving complete pain relief;
• performing surgical access - a small incision along the edge of the nipple areola during a classic operation, puncturing the skin in the axillary area when performing liposuction, endoscopic intervention or laser vaporization;
• removal of excess and pathologically altered tissue (acute excision during standard surgery, burning with aspiration during laser vaporization, vacuum aspiration during liposuction);
• drainage of the postoperative wound cavity with suturing with a cosmetic suture;
• applying an aseptic pressure bandage to the wound.

Possible complications and consequences

In most cases, the postoperative period after removal of gynecomastia proceeds smoothly.

Within a few weeks, patients return to their normal lives and only memories remain from the operation.

But no one is immune from the occurrence of various kinds of complications in the form of:

• postoperative edema and hematomas;
• bleeding from the wound;
• thromboembolic complications;
• poor healing and suppuration of the postoperative wound;
• disorders of skin sensitivity in the area of ​​surgical intervention;
• changes in skin color in the form of increased pigmentation;
• allergic reactions of local and general type;
• necrotic changes in the skin and deep tissues;
• severe pain in the postoperative wound;
• damage to the venous and arterial vessels of the axillary region;
• formation of rough and keloid postoperative scars;
• deformation, violation of the contour and symmetry of the nipples and chest;
• relapse and cancerous transformation of gynecomastia.

Rehabilitation period

Rehabilitation measures after removal of gynecomastia should begin as early as possible in the postoperative period.

In typical cases, 2-3 weeks are enough for the patient to fully recover.

Of these, the patient spends 2-3 days in the hospital, and follows a gentle regimen for a week.

Rehabilitation includes:

1. Daily dressings with monitoring of the condition of the postoperative wound and the surgical area.
2. Exercise therapy and physiotherapeutic procedures.
3. Use of compression stockings.
4. Medications.

Procedures

Physiotherapeutic procedures (magnetic therapy, UHF, electrophoresis, paraffin baths) accelerate the healing of postoperative wounds and the resorption of hematomas, reduce pain and tissue swelling.

From the first hours after surgery, exercise therapy is prescribed, which involves a gradual expansion of motor activity in general and the upper limbs in particular.

Compression underwear

The use of compression hosiery products (various types of elastic corsets) is a mandatory part of the rehabilitation period after removal of gynecomastia.

A rigid corset can be used on the first postoperative day. After the first dressing, the rigid corset is replaced by a soft-elastic one.

The compression created by the crest is sufficient to support the tissues and does not cause excessive compression.

Against this background, swelling and hematomas disappear faster and wound healing accelerates.

The duration of use of compression garments is 2-3 weeks.

Drugs

The following medications can speed up the recovery of patients in the postoperative period:

Prevention of relapse

It is not always possible to prevent the recurrence of gynecomastia after radical surgical treatment - it depends on many factors.

Definitely useful preventive measures are:

• thorough examination of the patient in the preoperative period, identification and elimination of the causes of gynecomastia;
• correct choice of surgical method and strict adherence to surgical technique when performing it;
• compliance with diet and prevention of obesity;
• correction of the pathology that caused gynecomastia;
• correction of hormonal disorders;
• eliminating the impact on the body of environmental factors that provoke the development of gynecomastia (medicines, steroids, phytoestrogens).

FAQ

When can I exercise after gynecomastia removal?

Typically, physical education in the form of standard exercises involving the muscles of the upper limbs is allowed after 2 weeks.

Strength training and sports can begin 4-5 weeks after surgery.

It is important to follow the principle of gradually increasing loads.

Are scars visible after surgery?

If gynecomastia was removed endoscopically or by laser vaporization, the postoperative period proceeded without complications, no scars remained.

The mark from a standard operation from a small paraareolar incision in typical cases may be slightly noticeable within 4-5 months after the intervention.

With any type of intervention, there may be hematomas and bruises within 2 weeks, which resolve without leaving any traces.

When can you drink alcohol and smoke?

There are no immediate contraindications for drinking alcoholic beverages and smoking after 7-10 days of the postoperative period.

Drinking alcohol and smoking are only allowed if we are talking about drinking a small amount of alcohol and smoking tobacco in moderation.

Such lifestyle features will not have a direct negative impact on the outcome of the operation and the patient’s health.
Alcohol abuse and heavy smoking are strictly prohibited at any time after surgery.

When can I have a massage after liposuction?

If we are talking about a light lymphatic drainage massage, then it can be performed a week after the wound has healed. Sometimes it is possible earlier.

One of the main criteria for performing a massage is the absence of pain.

If they occur, the massage is either temporarily canceled or the intensity of the massaging movements is reduced.
A full massage can be performed no earlier than a month after the wound has healed.

Will there be a need for repeat gynecomastia after the intervention?

Even a carefully planned and correctly performed surgical intervention cannot guarantee the absence of recurrence of gynecomastia in the long-term postoperative period.

This is due to the fact that the causes of the disease lie in dishormonal disorders in the body.

In the vast majority of cases, relapses of gynecomastia do not occur after surgery.

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Causes

Normally, in men, the mammary glands are in an underdeveloped state and are a rudimentary organ, which consists of a small volume of glandular and adipose tissue, short ducts and a nipple. The formation and development of breasts depends on the content of female sex hormones in the body - estrogens and prolactin, which is produced by the pituitary gland. In the body of men, estrogens are found in negligibly low doses in relation to androgens, and at the same time they are rapidly destroyed in the liver. The percentage of male and female hormones may change towards an increase in the latter, and sometimes tissues lose sensitivity to the effects of testosterone. Under the influence of estrogens, mammary glands in men grow according to the female type with intensive development of glandular tissue. In the presence of a pituitary adenoma, which produces prolactin, deposition of adipose tissue is observed in the mammary glands. With gynecomastia, over time the glands increase in size and become denser.

True pathological gynecomastia in men can be provoked by the following factors:

a violation of the ratio of testosterone and estrogen can be observed with Addison's disease, hormonally active tumors, prostate adenoma and inflammatory damage to the testicles;

hyperprolactinemia caused by increased production of prolactin in pituitary tumors and hypothyroidism;

diseases associated with metabolic disorders, such as diffuse toxic goiter, diabetes mellitus, obesity, pulmonary tuberculosis;

diseases of non-endocrine etiology due to intoxication, liver cirrhosis, renal or cardiovascular failure, HIV infection, chest injuries, herpetic lesions of the chest, normalization of nutrition after exhaustion;

taking drugs that act on receptors in mammary gland tissue and increase the production of estrogens or prolactin, which block gonadotropin receptors that have a toxic effect on the testicles;

drug use and alcoholism.

Symptoms

With gynecomastia in the neonatal period, slight engorgement and enlargement of the mammary glands are detected, sometimes with colostrum-like discharge. In other forms of gynecomastia, the mammary glands can increase from 2 to 10 times, which is equal to 15 cm in diameter and can reach a weight of up to 160 g. The nipple increases, the areola becomes sharply pigmented and expanded from 2 to 3 cm in diameter. In rare cases, milky discharge from the nipple is observed. Usually, enlarged glands are painless, but they may feel a feeling of pressure, increased sensitivity of the nipples and discomfort when wearing clothes.

The unilateral form of the disease is characterized by a high predisposition to the development of neoplasms.

With unilateral gynecomastia, the likelihood of tumor damage to the mammary gland increases. Hormonally active tumors that produce estrogen and human chorionic gonadotropin cause rapid enlargement of the mammary glands, their soreness and a feeling of fullness. Gynecomastia caused by hyperprolactinemia is accompanied by oligospermia, impotence and signs of damage to the central nervous system.

Diagnostics

When making a diagnosis, the patient undergoes a visual examination, palpation of the mammary glands and testicles, assessment of the severity of secondary sexual characteristics, clarification of family and drug history and existing hereditary diseases, the presence of alcohol and drug addiction.

If symptoms of the disease occur, to determine the causes of the pathology, the patient is prescribed a determination of the blood levels of estradiol, testosterone, LH, FSH, thyrotropin, prolactin, hCG, liver transaminases, nitrogen, creatinine, urea. The patient may also need an x-ray of the lungs, a computed tomogram of the adrenal glands, brain and other organs. If a testicular tumor is suspected, an ultrasound examination of the scrotal organs and, if necessary, the mammary glands is performed.

Treatment

Sometimes hormonal drugs can be used to suppress high concentrations of estrogen in physiological gynecomastia in adolescents: clomiphene, tamoxifen, dihydrotestosterone, danazol, testolactone. If drug treatment does not lead to a reduction in the size of the mammary glands, then plastic surgery, based on the removal of breast tissue and liposuction, comes to the rescue.

Treatment of pathological gynecomastia is determined by the underlying disease that caused the enlargement of the mammary glands.

Prevention

Prevention of gynecomastia is based on timely and correct treatment of any diseases that can cause its development.

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Symptoms

The symptoms of gynecomastia (regardless of its type) are absolutely the same and differ only in the time of onset of the disease.

Gynecomastia in newborns is manifested by slight swelling of the mammary glands. In this case, a small volume of whitish liquid, which is a prototype of human milk, may be released from the nipple. It is important to note that palpation of the mammary gland does not cause pain. The condition is not considered a pathology and goes away on its own within one to two weeks.

Gynecomastia in adolescents, which occurs due to changes in hormone levels in the blood, is also a temporary condition. It usually occurs in boys 12-15 years old and is manifested by the following symptoms: slight swelling of the mammary glands (without pain and without changes in the skin).

The first signs of gynecomastia in men are breast engorgement and slight discomfort in this area. Most often, most people ignore this condition and do not seek specialized medical help, which leads to the progression of the disease and the development of complications. The lesion is most often bilateral; unilateral breast enlargement is extremely rare. At the same time, glandular and adipose tissue gradually grows, which leads to the formation of “female” breasts of various sizes - from 2 to 15 cm.

Patients continue to complain about a feeling of pressure, internal discomfort in the chest and its increased sensitivity to external influences (unpleasant sensations when wearing clothes, etc.). Sometimes a milky fluid may come out of the nipple. The areolas often become hyperpigmented and increase in size to several centimeters.

If gynecomastia is caused by endocrine diseases, such as hyperprolactinemia, etc., then the symptoms may also include signs of damage to the central nervous system, changes in the functional state of sperm, impotence and, ultimately, secondary infertility.

Impaired potency and decreased libido can develop due to a decrease in testosterone levels and an increase in the concentration of estrogen in the blood of a man. In some cases, this can lead to a complete lack of libido. In addition, an increase in estrogen in a man’s body leads to other changes. First of all, the timbre of the voice begins to change (it acquires a high, “feminine” tint). Men become irritable and nervous, and hair loss occurs on their face and body.

In the absence of adequate treatment, irreversible changes occur in the testicles, which can lead to the development of infertility.

Symptoms of gynecomastia also depend on the stage of the disease:

• During the proliferation stage (the first 4-5 months from the onset of the disease), a slight enlargement of the mammary gland occurs, which goes away very quickly when rational therapy is prescribed.
• In the intermediate stage (up to one year), active growth of the glandular tissue of the mammary gland occurs, which is accompanied by the appearance of discomfort and milky discharge.
• During the fibrosis stage, connective and adipose tissue grows, forming dense lumps in the breast. This condition is irreversible even with adequate treatment.

Gynecomastia in bodybuilders, which develops as a result of taking steroid hormones, is manifested by similar symptoms: breast enlargement, itching and discomfort around the nipples, milky discharge.

Symptoms of gynecomastia in women are much more difficult to suspect. The main complaint is spontaneous breast enlargement (unilateral or bilateral), while many women ignore such a change and thereby contribute to the progression of the disease. An increase in the size of the mammary gland may be accompanied by a whitish discharge from the nipple, the appearance of small lumps in the breast tissue that are easily determined by palpation, and the occurrence of unpleasant or even painful sensations in the nipple area.

If you do not seek medical help in a timely manner or receive inadequate treatment, you may develop breast cancer due to gynecomastia. The first signs of this formidable complication are the appearance of pain in the mammary gland, the appearance of changes in the skin in the form of cracks, ulcers, and bleeding from the nipple. In addition to breast cancer, gynecomastia can cause mastitis, which is characterized by the development of purulent inflammation of the breast tissue. In this case, pain occurs, redness of the skin and symptoms of general intoxication: headache, increased body temperature up to 39o C, a feeling of malaise and muscle weakness.

Diagnostics

Diagnosing gynecomastia in most cases does not present serious difficulties for doctors. The following methods are used for diagnosis:

• Questioning the patient about the course of the disease and assessing possible risk factors for gynecomastia;
• External examination, which includes a thorough examination of not only the mammary glands, but also other organs;
• Biochemical blood test to determine the patient’s hormonal status;
• Mamography (x-ray examination of the mammary glands);
• Computer and magnetic resonance imaging;
• Ultrasound examination of the mammary glands;
• Biopsy followed by histological examination.

Correct use of these diagnostic methods and rational interpretation of their results will allow you to correctly diagnose gynecomastia and prescribe a rational type of therapy.

If you suspect the development of gynecomastia, you must immediately contact a medical institution to receive qualified medical care.

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Etiology and pathogenesis

The normal ratio of androgen (testosterone) and estrogen production is 100:1, and their concentration in the bloodstream is 300:1. Gynecomastia occurs as a result of a change in this balance in favor of estrogen. Another cause of the disease is an increase in the sensitivity of the glandular tissue of the breast to the normal level of estrogen circulating in the blood.

Estrogens cause hyperplasia of the ductal epithelium, their elongation and branching, proliferation of periductal fibroblasts and increased vascularization. The histological picture of the male breast as a whole becomes similar to the female mammary gland ( rice. 1).

Estrogen production in men occurs primarily as a result of the conversion of androgens (testosterone and androstenedione) to estradiol and estrone by the enzyme aromatase- mainly in muscles, skin and adipose tissue. The testes produce 6–10 mg estradiol and 2.5 mg estrone per day. An increase in estrogen production and/or tissue sensitivity to it can occur in one of two locations:

1. In the testes - associated with tumors or ectopic production of human chorionic gonadotropin (hCG). The latter option occurs with extragonadal gonocytomas, as well as with metastases of lung, kidney and gastrointestinal cancer.
2. In the periphery - associated with increased aromatase activity in chronic liver disease, digestive disorders, hyperthyroidism, adrenal tumors or familial gynecomastia.

observed in newborns, adolescents and the elderly. This condition usually does not require treatment (except in cases of excessive breast hypertrophy). For example, pubertal gynecomastia ( rice. 2) in 90% of patients goes away on its own within a period of several weeks to three years.

Pathological gynecomastia caused by an increase in the production of estrogens and/or an increase in the sensitivity of tissues to them, as well as a decrease in the production of androgens and/or a decrease in the sensitivity of tissues to them.

In addition, gynecomastia can be idiopathic, that is, for no apparent reason. This diagnosis is made after a complete examination of the patient, when the provoking factor cannot be identified.

Causes of pathological gynecomastia:

• Testicular injury - the damaged organ produces androgens worse.
• Viral orchitis - an inflammatory process in the testicle reduces the production of androgens.
• Congenital anorchia - the absence of testicles introduces an imbalance in the antrogen-estrogens ligament.
• Malignancies that increase serum human chorionic gonadotropin (hCG) levels.
• Pituitary tumors or abnormalities leading to hyper- or hyposecretion of luteinizing hormone.
• Hyperthyroidism - gynecomastia is caused by increased aromatase activity and increased levels of sex hormone binding globulin (SHBG).
• Chronic digestive disorders - cause a decrease in the level of gonadotropin and testosterone compared to estrogen. Moreover, after normalization of nutrition, the patient’s condition may worsen due to an accelerated increase in the production of estradiol compared to testosterone.
• Klinefelter syndrome is a hereditary disease, the manifestation of which is the presence of small, dense testicles and gynecomastia in men.
• Kallmann syndrome is a combination of hypogonadism with olfactory disorders and insufficient secretion of gonadotropin-releasing hormone (GnRH).

Some medications can cause gynecomastia in men - antiandrogens (ketoconazole, finasteride, spironolactone), cytostatics (methotrexate), antihypertensive drugs (digoxin, amiodarone), hormonal drugs (phenothiazine derivatives), anti-infectives (isoniazid, metronidazole), drugs (amphetamines, methadone) and etc.

Clinical manifestations

Generally speaking, gynecomastia in men is manifested by enlarged breasts. In this case, one should distinguish between true gynecomastia and pseudogynecomastia.

Pseudogynecomastia occurs in overweight men. In this case, fat deposits are found only in the subareolar area (around the nipple), on both sides. Over time, such breasts do not change shape or size, unless there is a significant increase in aromatase activity in the adipose tissue, then true gynecomastia can occur.

Differential diagnosis of these states is carried out as follows. The patient is placed on his back with his hands behind his head. Then the doctor places the thumb and index finger on the outside of the nipple opposite each other, as if he wants to pinch it. Next, he begins to slowly bring his fingers together - to make a “pinch”. With true gynecomastia, a glandular mobile mass characteristic of the female breast will be felt in the area of ​​the areola. With pseudogynecomastia, the moving mass is not felt.

If you suspect gynecomastia in a man, you should evaluate his appearance (eunuch-like habitus), examine the testicles (reduction in size, pronounced asymmetry, etc.), and look for signs of chronic diseases of the liver, thyroid gland or kidneys.

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Gynecomastia is a disease in which a man’s mammary gland begins to grow and increase in volume. When feeling it, the man feels pain, the chest seems full and heavy. Many doctors believe that the only treatment for gynecomastia is surgery. Others argue that gynecomastia in men can be treated without surgery, it all depends on the form of the disease. Only those men whose disease is in advanced stages need surgery.

Forms of gynecomastia

This disease may be:

• One-sided, when the problem is in one male mammary gland;
• Bilateral, when both mammary glands begin to grow. In most cases, men have bilateral gynecomastia.

It is important to know: in men with advanced obesity, false gynecomastia may occur. In the true form of the disease, the mammary gland grows.

Forms of true gynecomastia:

• Pathological.
• Physiological.

It is with physiological gynecomastia that surgery is not required; you can completely get rid of the problem with the help of therapy at home. The main goal of such treatment is to prevent the development of the pathological form of the disease.

The physiological form is classified by age groups:

Causes of gynecomastia

Factors that can provoke the disease:

• Hormonal imbalance.
• Prostate diseases.
• Pathologies of the endocrine system.
• Pathologies of the thyroid gland.
• Cancer diseases.
• Reproductive system disorders.
• Hepatitis.
• Hereditary predisposition.
• Liver diseases.
• Insufficient amount of testosterone.
• Radiation and chemotherapy.

It is important to know: men who drink alcohol or drugs and are obese are at risk.

For what symptoms should treatment be started?

1. A sharp increase in body weight, breast enlargement.
2. Nipple discharge.
3. Formations on the mammary glands.
4. Enlarged lymph nodes.
5. Painful sensations when feeling the mammary gland.
6. Feeling of fullness and heaviness in the mammary glands.

The operation is prescribed for the following symptoms:

• Severe enlargement of the mammary gland.
• The appearance of tumor formations.
• Long course of the disease.
• The appearance of an aesthetic defect.
• Lack of results from conservative treatment.

Diagnosis of gynecomastia

• Blood tests.
• Biopsy.
• Breast puncture.

Drug therapy

When gynecomastia occurs in men, treatment without surgery is quite possible! First, you should undergo a full diagnostic examination, after which the doctor assesses the patient’s condition and decides whether there is a chance to get rid of gynecomastia using conservative methods without resorting to surgery.

One of the most common methods of getting rid of this problem is drug treatment. The goal is to balance female and male hormones in the patient’s body. The doctor prescribes drugs that increase testosterone in a man.

It is important to know: treatment with medications in men, unlike surgery, is a long process. However, after a few months, positive results may already appear. Doctors often prescribe the drug Tamoxifen. It suppresses female hormones in the male body.

Hormonal medications are prescribed only by a specialist. Treatment is also carried out under the supervision of a doctor. If there is no effect of treatment within 3-4 months, surgery is inevitable.

Diet therapy for the treatment of gynecomastia

The main causes of the disease are obesity, poor nutrition, and alcohol consumption. First of all, in order to get rid of pathology, and for preventive purposes, you should adjust your diet and change your eating habits.

A man's nutrition should be complete:

Herbal treatment

With an integrated approach, herbal treatment should be included. It is advisable to drink infusions and decoctions from:

• golden root;
• plantain;
• raspberry leaves;
• hibiscus;
• hops;
• red clover;
• sage

These herbs can stabilize hormonal levels and reduce excess amounts of female hormones. Also effective in treating pathology is the use of flax seed infusion. To increase testosterone levels, you can use tinctures of Eleutherococcus and ginseng.

Traditional methods

Our ancestors several hundred years ago used folk remedies to treat many ailments. In the early stages of the disease, the following recipes can be used:

• Salt baths. It is recommended to take a hot bath with plenty of sea salt. Salt relieves swelling and helps normalize blood circulation. It is advisable to take such baths 3-4 times a week.
• Ice compresses. Ice should be applied to reduce fat deposits. Low temperatures have a beneficial effect on fat burning. You need to apply ice cubes to the mammary glands and hold the compress for 3-5 minutes.
• Physical exercise. For prevention and complex treatment, it is recommended to play sports. Great help: running, swimming, cycling.

If there is no improvement after therapy, you should consult your doctor and agree to undergo surgery. Be healthy!

Currently, diseases associated with hormonal imbalance are becoming more and more widespread. One of these popular diseases is. With gynecomastia, growth of the mammary glands in a man is observed, which is accompanied by the growth of fatty, glandular and muscle tissue. Such organ growth is often accompanied by painful sensations.

The disease can appear in completely healthy men at different ages. For example, in about 70% of children born, swelling of the glands is immediately noted, associated with the influence of maternal estrogens on the fetus. Almost half of young men suffer from enlarged breasts during puberty. Breast growth can also occur in older men. This is due to a decrease in testosterone levels in the body. Such manifestations of gynecomastia are physiological and usually go away on their own.
For men, treatment of this disease is of great importance. Thus, enlarged breasts often turn out to be the cause of an inferiority complex. However, the appearance of this disease may be a signal of a malfunction of the body.

The causes of the failure may be: infections of the genital organs, which lead to insufficient testosterone production and disease of the internal organs and glands.

Diagnosis is carried out by palpating the glandular tissues and lymph nodes located in the axillary region. To make an accurate diagnosis, an ultrasound examination of the breast and axillary lymph nodes and laboratory tests to determine hormone levels are prescribed.

How to treat gynecomastia in men

Treatment of gynecomastia in men is possible at home. It is carried out by taking medications. Their action is aimed at restoring balance and estrogen. When in the body of a man, drugs that contain artificial testosterone are prescribed. And if there is excess estrogen, estrogen suppressing medications are used.

An experienced endocrinologist will tell you how to get rid of gynecomastia, who will draw up the correct treatment regimen.

Self-medication can lead to progression of the disease and serious complications. It is worth noting that the use of hormone therapy may cause side effects. That is why drugs are prescribed strictly by a specialist.

Drug treatment

Treatment without surgery comes down to taking medications. All drugs against gynecomastia can be divided into two groups: drugs from the testosterone and anti-estrogen groups.

• Testosterone drugs. If the level of the male hormone, testosterone, is reduced, prescribing a drug from this group is most correct. An indication for this is poor testicular function. Testicular failure is accompanied by a decrease in the level of male hormone. The use of a drug of this group in the case of a physiological form of breast enlargement in adolescents does not always help.
• Antiestrogens group drugs. The indication for use of the drug is to increase the level of female hormones - estrogens in the male body. The drug is effective due to its ability to block estrogens, preventing their effects on the male mammary gland.

Such drugs include:

• Thiamine bromide. It slows down and prevents the production of the aromatase enzyme, which converts male testosterone into female estrogen.
• Vitamin B1. Taking the vitamin intramuscularly normalizes the proper functioning of protein, fat, and carbohydrate metabolism in the body. The course of treatment is 20 injections;
• Clomiphene citrate. It is an anti-estrogenic drug. Stimulates a rise in the level of male hormones. It is recommended to use for 10 days in an amount of 50-100 mg in the morning and evening. The course will be repeated 3 times with a break of 1-3 months. The concentration of the drug is adjusted depending on body weight.

• Tamoxifen. Used as an anti-estrogen, tamoskyfen binds to and blocks estrogen in the mammary gland. It is necessary to use 10-30 mg per day. The treatment period ranges from 4 to 6 months;
• Danazol. The drug contains an artificial androgen, which includes a group of male hormones. Danazol is taken 400 mg per day. The amount of time during which it is necessary to take the pills is prescribed by the endocrinologist;
• Dihydrotestosterone. Available in gel form. Contains a strong androgenic steroid. Use 50-100 mg of gel per day;
• Testolactone. Blocks the release of the aromatase enzyme, which converts testosterone into estrogen. The recommended dose is 250 mg 4 times a day;
• Formestan. It is an aromatase blocker. Reduces the concentration of estrogen in the blood and increases testosterone levels. You should use 250 mg per day until the symptoms of gynecomastia disappear;

• . The active component of the drug is mesterolone, which compensates for the lack of testosterone. It is recommended to use 40 mg per day for the first week, and then reduce the dose to 20 mg and take another 1-2 weeks;
• . Active component – ​​. It is an ester of natural testosterone. Available in ampoule format. One ampoule contains 1 ml. The injection is administered intramuscularly once every 10-14 weeks. This frequency of injections ensures the maintenance of a normal amount of testosterone in the body. The substance should be administered very slowly;
• Omnadren is a drug containing testosterone. It tends to remain in the body for a long period of time. One ampoule contains 1 ml of solution. Administered intramuscularly;
• . Contains a mixture of various testosterone esters. One ampoule contains 1 ml of substance. Should be used intramuscularly once every 3 weeks.

It is definitely worth paying attention to the fact that if breast enlargement is caused by a malignant process, then it is not possible to do without surgical intervention.

Diet

Another method of treatment for gynecomastia may be diet therapy. An effective approach to solving the problem of the disease and treatment is a strict diet. Treatment at home involves changes in your eating habits.
Everyday nutrition should be rational, contain the required amount of proteins, minerals and trace elements, and exclude easily digestible carbohydrates and fats. And the content of proteins, vitamins, and fiber is a prerequisite for the daily diet. It is worth including the following foods in your meals: lamb, beef, oysters, peanuts, sesame seeds, beef liver.

You need to exclude foods containing natural estrogens: grains, legumes, nuts, dairy products, spinach, dates, apricots.

It will be necessary to give up sweet and flour products. These products are not acceptable for proper nutrition. Taking fish oil, which includes amino acids that produce testosterone, will be very useful.

Traditional methods

When fighting gynecomastia, herbal treatment will be a good addition to complex treatment. The use of decoctions of Leuzea and golden root can reduce the level of estrogen in the body of men, thereby normalizing hormonal levels.
Drinking an infusion of flax seeds and milk thistle will also have a beneficial effect. This infusion should be drunk twice a day. For this disease, experts recommend including foods containing zinc in your menu. Zinc-containing foods include: sea fish, yogurt, nuts and dried fruits.

Taking bee bread and sea cucumber extract have positive results. Bee bread is taken twice a day, half a teaspoon. It is best to take the bee product on an empty stomach in the morning.

Sea cucumber extract is a product made from sea cucumber. Should be taken 2 times a day, 30 minutes before meals, a teaspoon.
In the event that the cause of gynecomastia is a hormonal imbalance, it would not be superfluous to use tinctures of peony, motherwort and valerian.

The use of folk remedies for the treatment of gynecomastia will be effective in the initial stages of the disease.

The following herbs and drinks are beneficial:

• . Eat a piece of the plant's root every day, chewing thoroughly. Ginseng tastes unpleasant. But it helps to cure gynecomastia and other diseases of the genital organs.
• Lovage. Make wine from lovage root and drink 50 grams every evening an hour after meals. Lovage root contains phytosterol, which lowers cholesterol levels and reduces the risk of heart disease. Taking this miraculous plant improves digestion and eliminates hormonal imbalances.
• A drink made from turmeric. Turmeric increases the amount of male hormone and burns subcutaneous fat. To prepare a drink from this spice, you need to dilute a teaspoon of turmeric in one glass of warm water until completely dissolved.
• Cold compresses. The use of cold compresses is that cold causes contraction and reduction of fatty tissue. Ice is wrapped in cloth and applied to the chest. The procedure takes about 1.5-2 minutes.
• Salt baths. Taking warm baths with sea salt will help eliminate swelling and improve blood circulation. This procedure can be repeated several times a week for 15-20 minutes.

It is not possible to completely cure gynecomastia using folk remedies. The use of folk remedies gives a positive effect only as an additional treatment.

If the patient has been diagnosed with gynecomastia, then the question of surgical treatment of the disease arises, but gynecomastia without surgery is also possible. Doctors use surgical techniques, but this is not a panacea. The essence of treatment and all methods used to combat the disease depend on the form of the disease and the factors that provoked the occurrence of the disease.

Let’s take a closer look at what the disease is, and also consider the question that worries those who are faced with it: how to remove gynecomastia without surgery.

What is gynecomastia?

Gynecomastia is a disease in which the mammary glands voluntarily enlarge. In this case, the symptom is a feeling of discomfort in the chest area, accompanied by other unusual feelings.

According to medical classification, the disease is divided into a number of forms:

• Unilateral, when the disease affects one of the mammary glands;
• When both glands are affected. Then it is two-sided.

The second form of the disease is often observed with characteristic growth of the mammary gland.

Also highlighted:

• False gynecomastia. May cause fatty tissue deposition;
• True, when growth or hypertrophy of the stoma occurs, represented by a special tissue. She performs the connecting
  function and is glandular.

True gynecomastia is divided into:

• Pathological;
• Physiological.

The first is characterized by the departure of tissues from the normal state accepted by medicine. The second is easier.

The pathological form in one hundred percent of cases is treated through surgery. But physiologically, no.

Physiological form

This form can be observed at all age intervals. When taking this factor into account, doctors adopted an additional classification, according to which, within the framework of the division into types of physiological gynecomastia:

• In newborns. This problem occurs in almost 70% of children. This is due to the influence of pregnant hormones on the fetus. In the overwhelming majority of cases, all symptoms and signs of the disease disappear without any kind of intervention at all a month after the baby is born. Gynecomastia in newborns will go away on its own without other interventions, and this is more than normal;
• At puberty. About 50% of all children over the age of 13 are faced with the disease in question. Its occurrence is explained by hormonal changes in the body of adolescents. In this case, treatment is not required; with subsequent stabilization of hormonal levels, the disease goes away. Typically, after a period of up to two years;
• In the elderly. It appears in adults from the 5th decade. The reason, as before, is hormones.

Gynecomastia in men and treatment without surgery are acceptable. But only in the listed cases. Whatever it is and no matter how severe or mild the case is, you need a visit to the doctor. To get advice and identify the need for treatment.

About conservative treatment

Gynecomastia and its treatment without surgery is possible. Let's figure out how. Therapy in this case will be of a special nature. Its task is to prevent the transition from physiological to pathological. The latter will definitely require surgical intervention. As already noted, methods of treating and combating the disease will largely depend on the phenomenon that triggered its occurrence. The main factors:

• Restructuring of hormonal levels. It often occurs for age-related reasons (adolescence, aging, etc.). In cases where the attending physician’s suspicions are serious, he can prescribe strong hormonal agents (as well as treatment methods using folk methods or homeopathic remedies). Such approaches will be sufficient to avoid surgical intervention;
• Taking medications. They can often cause an imbalance in the hormonal system. Then the doctor may decide to replace the drug or stop taking it. This measure will be enough to ensure that all signs of the disease go away on their own.

In any case, treatment methods must be determined by a doctor, since no one else can take into account all the intricacies of the ongoing disease. It is not recommended to try to overcome the disease on your own; you should consult a doctor.

Treatment with drugs

It is worth getting acquainted with the possible options for medications that can be prescribed by a specialist for treatment. A striking example is the drug testosterone. It is prescribed in cases where the content of male sex hormones in the body is reduced for some reason. The indication will be hypogodanism or incomplete functioning of the testicles. It is worth noting that testosterones may not help and then alternative treatment will be carried out.

It will be informative about the reduction procedures.

Antiestrogenic agents may be prescribed. The indication for prescription and use is excessive levels of female hormones. Drugs of this group can have a blocking effect on estrogens without affecting the mammary gland.

Some of the drugs have pronounced side effects and effects. For example, nausea, acne, excess weight, etc. It is recommended to take them strictly as prescribed by the doctor and only in dosages that do not exceed the norm.

The effectiveness of drug treatment is noted in the first months after the discovery of gynecomastia. In cases of prolonged progression, medications may not help. If gynecomastia lasts about a year or more, then taking medications is pointless.

About prevention

Any disease is easier to prevent than to overcome. Even when the first signs of gynecomastia make themselves felt and are pronounced, prevention will not become useless, but on the contrary, especially for the physiological form.

It is worth highlighting the main and most effective preventive measures. This:

• Minimizing alcohol consumption. Alcoholic drinks significantly affect hormonal balance and reduce the overall level of testosterone in the body. From this point of view, beer drinks are especially harmful. Its excessive consumption can increase the level of female hormones in the body of any man. That’s why it’s so important to give up alcohol in favor of other drinks, because if you don’t want to experience gynecomastia, it’s better to think about it in advance;
• The measure is relevant for athletes. Modern men combine the usual strength training in the gym with the use of anabolic steroids, which is undesirable to do not only from the point of view of the likelihood of gynecomastia. Anabolic steroids are often the cause of hormonal imbalance or imbalance and, as a result, gynecomastia;
• Proper nutrition. We need a measure and a norm. It will be relevant for people who are overweight; their likelihood of being diagnosed with gynecomastia is quite high. The importance of controlling your weight and calorie intake is undeniable. Avoiding quick snacks in youth cafes will be beneficial; preference should be given to healthy foods: fruits, vegetables, boiled or stewed meat. And less fried food!

A healthy diet and an active lifestyle, giving up alcohol and bad habits are the basis for any person. If he wants to be healthy and avoid the formation of gynecomastia.