Gynecomastia, a men's problem
Gynecomastia is the benign development of the mammary gland in men, caused by a dysregulation in the androgen (male)/estrogen (female) ratio with a predominance of estrogenic action stimulating the mammary tissue.
It can be physiological, pathological, or idiopathic. Physiological infertility occurs due to a normal imbalance during certain periods of life, such as the neonatal period (maternal and placental hormones pass to the fetus during gestation), resolving before the first year; pubertal infertility, the most frequent, resolves spontaneously in 12 to 18 months, with a maximum of 3 years; and senile infertility is due to decreased testicular function.
Pathological gynecomastia occurs outside of physiological stages and results from an underlying condition that leads to an androgen/estrogen imbalance; it should always be ruled out. Certain medications and other endocrinopathies can induce it. Breast cancer is more common in these patients.
It is usually asymptomatic, but the presence of other symptoms and the speed of onset should be monitored, warranting medical evaluation.
The diagnosis is primarily clinical and must be differentiated from adipomastia (fat accumulation in the breast area). A thorough clinical history and associated conditions, laboratory tests to evaluate hormonal axes, and imaging studies such as testicular and breast ultrasound (depending on the case) are essential. Other studies will depend on the physician's judgment.
The recommended therapeutic approach is monitoring, as it primarily resolves spontaneously; however, pharmacological and surgical therapy may occasionally be considered for resolution. In cases of pathological gynecomastia, the underlying cause should be treated.
Sometimes it can generate a significant component of anxiety, depression, isolation with an impact on self-esteem and body image; in these cases, pharmacological or surgical therapeutic approaches are also feasible.
Dr. Lucia M. Gonçalves Jardim
Internal Medicine Physician.
Specialist in Endocrinology and Metabolism
Email: luciamgoncalvesj@gmail.com
Telephone: +351 939 056 458