More Gyne Info

[Gine2D]

From source:  Treatment under doctors care.

http://www.endotext.org/male/male14/male14.htm


" Tamoxifen, also an antiestrogen, has been studied in 2 randomized, double-blind studies in which a statistically significant regression in breast size was achieved, although complete regression was not documented (1). One study compared tamoxifen with danazol in the treatment of gynecomastia. Although patients taking tamoxifen had a greater response with complete resolution in 78 percent of patients treated with tamoxifen, as compared to only a 40 percent response in the danazol-treated group, the relapse rate was higher for the tamoxifen group (46). Although complete breast regression may not be achieved and a chance of recurrence exists with therapy, tamoxifen, due to relatively lower side effect profile, may be a more reasonable choice when compared to the other therapies. If used, tamoxifen should be given at a dose of 10 mg twice a day for at least 3 months (30). An aromatase inhibitor, testolactone, has also been studied in an uncontrolled trial with promising effects (51). Further studies must be performed on this drug before any recommendations can be established on its usefulness in the treatment of gynecomastia. Newer aromatase inhibitors such as anastrozole and letrozole may have therapeutic potential but no study has been published to confirm its efficacy in treatment of gynecomastia. (32)

SUMMARY

In summary, gynecomastia is a relatively common disorder. The causes of its development range vastly from benign physiologic processes to rare neoplasms. Thus, in order to properly diagnose the etiology of the gynecomastia, the clinician must understand the hormonal factors involved in breast development. Parallel to female breast development, estrogen, along with GH and IGF-1 is required for breast growth in males. Since a balance exists between estrogen and androgens in males, any disease state or medication that can increase circulating estrogen or decrease circulating androgen, causing an elevation in the estrogen to androgen ratio, can induce gynecomastia. Due to the diversity of possibly etiologies, including neoplasm, performing a careful history and physical is imperative. Once gynecomastia has been diagnosed, treatment of the underlying cause is warranted. If no underlying cause is discovered, then close observation is appropriate.

If the gynecomastia is severe, however, medical therapy can be attempted and if ineffective, glandular tissue can be removed surgically. "

There may be hope for reduction without surgery for the young men.  It is not self treatment.

G

[hypo]

Gine2d

Thanks-very good information.

There is a disagreement between endocrinologists World Wide as to whether hormonal pathology is required in all cases of gynecomastia, or as to whether or not it is required only in those that indicate a physical/manifest reason.

The main reason for this disagreement is cost/cost analysis.

Knowing the facts surrounding the aetiology of gynecomastia and other associated conditions I happen to firmly believe in the need for routine pathology testing in all cases of gynecomastia.


The reason for which are;

A) By doing this you will automatically diagnose 10% of all gynecomastia sufferes as having hypogonadism

and prevent those people needlessly suffering/developing more serious conditions that cost far greater sums to treat such as diabetes, osteoporosis, Cardio Vascular Disease etc  

B) By doing this you will automatically diagnose liver complications in 8% of all gynecomastia sufferers.

C) By doing this you will have a good chance of diagnosing the most common genetic condition in the world Haemochromatosis.  1- 250/300 births

A condition that is often not diagnosed until a man is in his fifties by which time he has usually developed diabetes, liver disease often hepatocellular carcinoma and osteo conditions- often a death sentence.  

D) By doing this you find earlier diagnosis of the 1-500 people who have Klinfelters Syndrome and the 1-1500 people who have Kallmans syndrome and other genetic conditions.

E) By doing this you would find the 2% of men who are suffering undiagnosed from hyperthyroidism.

F) By doing this the 8- 16% of all testicular cancer sufferers who have gynecomastia, would have a chance at being able to be diagnosed earlier-  saving lives.

G) The rarer condition like breast cancer and hepatocellular carcinoma would have a chance of being diagnosed earlier and this would save lived

H) The men that have pituitary issues such as Prolactinomas would be be able to be diagnosed earlier and get more effective treatment.

I) Men who have developed gynecomastia who have high estrogen levels could be treated sooner with drug therapies which would lesson the gynecomastia and the potential for psychological trauma.

J) Men of middle age who are suffering from raised SHBG and estradiol levels (a form of metabolic hypogonadism) could be diagnosed and treated.

There are probably a few more reasons but i'll stop there.