A 12-year-old boy has a sore mammary gland. Teenager: what are the rates and deviations of sexual development. Treatment of breast diseases in boys

Juvenile gynecomastia is a benign enlargement of the mammary glands during puberty in young men, associated with an acute imbalance in sex steroids.

This pathology affects about 50% of adolescents, aged 12 to 15 years.

This is a visible or perceptible manifestation that can vary in size from the smallest to the size of the glands of an adult woman.

The disease, in most cases, goes away on its own, but it can cause physical and psychological discomfort.

Overview of Gynecomastia

It is important to remember that in some cases, gynecomastia is a precursor to the appearance of a malignant tumor, so you should not ignore its appearance.

Signs of the disease

You can independently detect gynecomastia in a teenager if you examine and feel the mammary glands. In case of illness, they can be enlarged, and the nipples are pigmented.

A young man may complain of itching, burning and pain in the area of ​​the mammary glands, especially in the nipple area. Swelling of the glands can be symmetrical when both glands are enlarged and asymmetric - one gland is larger than the other.

It also increases the size of the nipple from 1 to 3 cm and increases its sensitivity. Adolescent gynecomastia is dangerous because it can cause breast cancer.

In this case, these painful signs should alert the young man:

• Ulcers near the nipple of the breast
• Bloody issues
• Swollen lymph nodes in the armpit
• Changes in the skin of the breast

If even one of the listed symptoms appears, you need to contact an endocrinologist who will conduct an examination and prescribe an appropriate examination for a teenager.

Reasons for the appearance

Most often, the cause of gynecomastia in adolescents is associated with an imbalance in the hormones testosterone and estrogen.

Here are some more possible causes of this pathology:

Survey

When a teenager turns to a doctor, to clarify the correct diagnosis, an examination is carried out, which includes several stages:

• Visual examination of the patient's mammary glands, and then their palpation.
• Information about a hereditary predisposition to gynecomastia is being clarified.
• Examination of the lymph nodes for enlargement.
• A teenager is asked about the medications he takes, sports, alcohol, drugs and other significant factors.
• A blood test is performed for the content of testosterone, estradiol, prolactin and other hormones.
• An ultrasound of the mammary glands is prescribed to determine the type of gynecomastia.

In some exceptional cases, a breast puncture is taken, an X-ray of the lungs, a tomography of the brain, adrenal gland and ultrasound of the scrotum are prescribed.

Types of gynecomastia

There are two types of adolescent glandular disease.:

1. True... Pathology is associated with an increase in the mammary gland due to imbalance in hormones.
2. False... In this type of disease, the breast is enlarged due to adipose tissue.

True gynecomastia

It is divided into:

• Physiological... It can affect a newborn, adolescent, and adult male.
• Medicinal... Most often, this pathology is reversible and goes away after the withdrawal of certain medications. Usually, these are hormonal or anticancer medications.
• Idiopathic... If, after a complete examination of the body, no facts have been identified confirming the cause of the breast tumor, then the diagnosis is "idiopathic gynecomastia."

Stages of gynecomastia

There are several stages in the development of this disease.:

• The initial... It lasts about 3 months and with proper consultation with a doctor and subsequent treatment, the disease can be eradicated.
• Intermediate... Its period lasts from 4 to 12 months. In this case, the problem area is pronounced, the process is already irreversible and requires serious treatment.
• Fibrous... In which connective tissue is deposited in the mammary gland and, as a result, fatty tissue develops. At this stage, only surgical intervention will help get rid of gynecomastia.

The degree of breast hypertrophy:

1. First, the breast is slightly enlarged
2. The second - the enlargement of the gland is less than the diameter of the areola of the nipple
3. Third - the breast is enlarged within the areola
4. Fourth - the diameter of the seal exceeds the size of the areola of the nipple

The size of the mammary glands is distinguished:

• Moderate gynecomastia - up to 6 cm.
• Average gynecomastia is 6 to 10 cm.
• Severe gynecomastia - more than 10 cm.

Treatment

The method of treatment for adolescent gynecomastia, which is prescribed by an endocrinologist or an endocrinologist-andrologist, depends on the degree and stage of the disease and other significant aspects.

If, after the examination, no dangerous abnormalities are detected, then a moderate degree of gynecomastia is left untreated, but under the close supervision of the attending doctor for 6 months.

Typically, after this period, gynecomastia regresses.

Drug therapy

If gynecomastia persists for more than 6 months, then the doctor prescribes drug treatment, after identifying progressive factors affecting the course of the disease.

Most often, drugs are prescribed that suppress the release of prolactin and stimulate the secretion of luteinizing hormone. These drugs are prescribed with an individual approach to the patient.

It is unacceptable to determine the dosage on your own, as this can lead to a deterioration in the health of a teenager and cause the development of serious complications. In addition to these drugs, vitamins of groups A, B and E are often prescribed.

Diet

With false gynecomastia, when the growth of the mammary glands is due to the overweight of a teenager, adherence to a certain diet will help.

Its principle is as follows:

It is best to consult a professional dietitian for the treatment of gynecomastia for a complete and balanced diet.

Exercises

With true gynecomastia, physical activity will help the production of male hormones, and with false gynecomastia, it will get rid of the adolescent's excess weight.

Exercises can be done independently, at home, for example:

For greater effect, in this direction, you can use the advice of an experienced trainer. Under his clear guidance, a teenager can perform a set of exercises in the gym, designed specifically for him.

Operation

Severe gynecomastia in young men very rarely goes away on its own. If, within 2 years, it is not possible to get rid of gynecomastia, thanks to conservative methods of treatment, then in this case, the endocrinologist recommends surgical intervention.

There are three types of operations, which, as a rule, take place under general anesthesia and last about an hour each.

The choice of the method of surgical intervention to eliminate gynecomastia depends on the type and degree of breast hypertrophy.

In this matter, you need to completely rely on the advice of an experienced specialist.

Nipple pain can be caused by hormonal changes in the body, which are diagnosed by an endocrinologist. But hormones aren't the only factor contributing to nipple soreness. So why can boys' nipples hurt?

Causes of painful nipples in boys:

• Growing up in adolescence. Pain when touched. This condition is temporary, it is associated with a restructuring of the hormonal background;
• Blow, bruise, cut;
• Allergic reaction;
• Wound infection (purulent inflammation resembling mastitis);
• - endocrine disease accompanying breast augmentation;
• Testicular disease;
• Diseases of the pituitary gland;
• Diseases of the adrenal glands. This gland, together with the testes and pituitary gland, is responsible for the production of male hormones. Disruption of their work leads to the predominance of female hormones in the body;
• - a rather rare phenomenon. Moreover, in addition to pain in the nipples, there may be discharge from them;
• Diabetes mellitus (endocrine disorders occur)
• Stop taking aabolic steroids. Many steroids are testosterone analogues that can convert to female sex hormones and suppress the production of natural testosterone. Athletes, after stopping the use of the course of anabolic steroids, observe not only pain in the nipples, but also breast enlargement, as well as a decrease in testicles in size.

Gynecomastia is the cause of nipple pain in boys

The most common condition that can cause nipple pain in males is gynecomastia. I would like to consider this disease in more detail. So, gynecomastia is manifested by an increase in the mammary glands. The disease can be true and false. The false nature of gynecomastia can be associated with the usual increase in body weight, that is, with obesity. True gynecomastia is caused by hormonal imbalances in the body, a decrease in the secretion of sex hormones, an increase in the level of female hormones, which often occurs due to kidney disease. At the same time, there is a sharp decrease in the function of decomposition of female sex hormones (estrogens).

Gynecomastia treatment includes identifying the cause of the disease and taking appropriate measures to eliminate this cause. If the nipples continue to hurt after treatment, the doctor decides on the introduction of male hormones into the body until the pain in the nipples disappears completely.

Unfortunately, nipple pain is not uncommon. But as such, it does not pose a danger, subject to careful examination. Therefore, when soreness in the juices appears, it is necessary to consult a doctor for examination, diagnosis and treatment.

Gynecomastia is a benign enlargement of the mammary glands in male children and adolescents, resulting from hyperplasia of the glandular passages and connective tissue. According to various researchers, gynecomastia is observed in 42-75% of adolescents in puberty. Gynecomastia is not an independent disease, but a manifestation of a number of symptom complexes, which in turn lead to disruption of the endocrine-vegetative balance in the body.

Breast development

The laying of the mammary glands in human embryogenesis begins at the end of the first month of embryonic life. This process occurs regardless of the future sex of the embryo, since sex differentiation occurs somewhat later and does not affect the formation of the breast rudiment. The mammary glands are derivatives of the ectoderm and are formed from two pectoral combs, on which a protrusion is formed by the third month - the lactation point. Its top is gradually flattened, then a kind of "pocket" is formed at this place. This is how the rudiments of the mammary glands are formed. Their epithelial boundaries are delineated, giving rise to the development of the milk canals. There are no alveoli in such a gland.

In the postnatal period and further until the onset of puberty, as in embryogenesis, the development of the mammary glands in girls and boys occurs in the same way. Their mammary glands have the same potential to develop into a functionally active gland. During this period, the glandular tissue in children continues to develop very slowly due to the proliferation of the canals.

Starting from puberty, the development of the mammary glands in children of different sexes is different. In adolescents, the mammary glands stop their development at this prepubertal stage of proliferation.

Histologically, the mammary gland in the antenatal period of its development is a rapidly proliferating structure of epithelial cells. During this period, their greatest mitotic activity is noted. Subsequently, the accumulation of cellular material ensures the construction of the secretory sections of the gland - the alveoli, which is a reflection of the proliferation process.

Further, the development of the gland enters the next stage, which is characterized by its alveolar-lobular development; while cell proliferation and mitotic activity of the mammary epithelium decrease, cells differentiate and are ready to perform their specific function - milk secretion.

Alveolar-lobular growth differs significantly from proliferative growth, since in this case the main role belongs not to the formation of new cell populations, but to the process of organizing the structure of the gland with the formation of alveoli. In this case, the volume of the gland increases sharply, and the number of epithelial cells may not increase.

As follows from the above, in boys, the development of the mammary glands stops at this first proliferative stage (the lobes and ducts are in the embryonic state, and the nipple and areola are much smaller than in girls), while the mammary glands of girls who have entered during puberty, they undergo pronounced alveolar-lobular development.

Many hormones affect the development and regulation of the mammary gland. The main ones are estrogens, progesterone and prolactin. Estrogens affect the growth and formation of ducts and connective tissue, stimulating cell division indirectly through growth factors. Progesterone promotes the growth of glandular tissue by increasing the number of alveoli and the growth of lobules. Prolactin (PRL), which is synthesized in the adenohypophysis, stimulates the formation of estrogen receptors in the cells of the mammary glands, thereby multiplying the reproduction of secretory cells. Prolactin activates the synthesis of protein and other components of human milk. During pregnancy, the formation of the fetal mammary gland is greatly influenced by chorionic somatomammotropin (placental lactogen). For the development of the mammary glands, other hormones are also needed: insulin, thyroid, corticosteroids. Insulin can play the role of an intermediary in the processes of cell growth caused by progesterone, prolactin. Thyroid hormones - triiodothyronine (T 3), thyroxine (T 4) - stimulate the secretion of prolactin and increase the prolactin-binding capacity of breast secretory cells. Corticosteroids promote the formation of prolactin receptors and stimulate the growth of epithelial cells of the gland. Androgens inhibit the development and differentiation of breast tissue. Any imbalance in the balance of hormones is accompanied by changes in the tissue of the mammary glands.

Gynecomastia pathogenesis

Most researchers believe that the basis of the pathogenesis of gynecomastia is a decrease in the androgen-estrogen ratio (AES) or a change in the sensitivity of steroid receptors to sex hormones.

All androgens are C 19 steroids and have different biological activities. Leydig cells in the testicles secrete testosterone, an androgen with high biological activity. Along with it, androgens with insignificant biological activity circulate in the blood: Δ5-androstenedione, Δ4-androstenedione, androsterone and dehydroepiandrosterone (DHEA). These steroids are precursors or products of peripheral testosterone metabolism.

When interacting with a target cell, testosterone is exposed to the tissue enzyme 5α-reductase, converting into 5α-dihydro-testosterone (5α-DHT), which has maximum androgenic activity. 5α-reductase gene mutation can cause false male hermaphroditism.

Free androgens enter the target cell and bind to androgen receptors. The latter are found both in the cytosol and in the cell nucleus. The androgen receptor gene is located on the short arm of the X chromosome. Currently, more than 200 mutations of this gene have been described, leading to the development of various forms of androgen insensitivity syndrome.

Estrogens (C 18 -teroids) in the male human body are formed by converting androgens of the testicles and adrenal glands in peripheral tissues, mainly in adipose tissue. This process is provided by the enzyme aromatase. Activating mutations of the aromatase gene (P450 arom) in males lead to gynecomastia, and inactivating mutations - to tallness and a decrease in reproductive activity.

Degradation of sex steroids and their metabolites occurs in the liver due to the processes of conjugation with glucuronic acid and sulfonation. They are excreted from the body mainly in the urine.

The development of the mammary glands depends on androgenic or estrogenic stimulation. With an excess of estrogens and low androgen activity, the formation of glandular tissue of the mammary gland occurs. A similar process can be observed with normal estrogen levels, but with a decrease in the androgen content. An imbalance of nuclear power plants is observed with damage to the liver and kidneys.

So, the pathogenetic mechanisms of the development of gynecomastia are extremely diverse and insufficiently studied.

Morphologically distinguish between true gynecomastia and false. With true gynecomastia, the mammary glands enlarge as a result of hyperplasia of the lobar milk ducts and hypertrophy of the connective tissue of the gland, i.e., macroscopically, it is an increase in glandular and stromal tissue. In this case, as a rule, there is a typical change in areoles - partial formation of the nipple in the female pattern; glandular tissue is determined by palpation. False gynecomastia (lipomastia) is caused by the excessive development of subcutaneous adipose tissue and is not related to the dyshormonal hyperplasia of the gland, which is characteristic of true gynecomastia.

Physiological gynecomastia

An increase in one degree or another of the mammary glands during the neonatal period is observed in almost 50% of boys. Neonatal breast enlargement usually occurs during the first month of life and resolves on its own in the next few weeks or months. The mechanism of gynecomastia during this period is not clear enough. Perhaps this is due to an increase in the level of pituitary hormones - luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin - from 6-7 days of the boy's life. By the end of the month, their testosterone concentration is comparable to that of adult men. By 3-4 months of life, the concentration of the above hormones decreases.

Other authors believe that the occurrence of gynecomastia in infants is due to the effect of maternal estrogens. Practice shows that in breastfed children, breast enlargement persists for a longer time than artificially. With breast milk, the baby receives maternal hormones.

In most young men, gynecomastia occurs in adolescence and is one of the symptoms of the physiological manifestation of puberty. The mammary glands enlarge symmetrically, their maximum development coincides with the 3-4 stage of sexual development. In some adolescents, at first, there is an increase in the mammary gland on one side. Visually, the glandular tissue is swollen, compacted to the touch, heterogeneous, and may be painful. In some boys, the mammary glands are visually indistinguishable from the glandular tissue of adolescent girls.

The question of why pubertal gynecomastia occurs remains open. During this period, the impulse secretion of gonadotropin-releasing hormone (releasing hormone (factor) of luteinizing hormone, LH-RH) is triggered, followed by an increase in the secretion of pituitary gonadotropic hormones, androgens and estrogens, which act through the induction and regulation of specific receptors. Some researchers have found transient increases in estrogen and BPD in these adolescents. Others have linked to excess conversion of androgens to estrogens under the influence of excess aromatase enzyme activity.

Physiological gynecomastia in infants and adolescents does not require treatment in most cases. After 1-2 years, the symptoms of pubertal gynecomastia disappear on their own.

In some adolescents, gynecomastia persists after the end of puberty. It is not always possible to identify the reason for it. The development of glandular tissue occurs when the nuclear power plant is unchanged. Then it is referred to as persistent gynecomastia.

Symptomatic gynecomastia

Pathological gynecomastia in children and adolescents can be a consequence of diseases accompanied by androgen deficiency (absolute or relative), excess estrogen production, impaired peripheral conversion of androgens to estrogens. Gynecomastia occurs in children with congenital abnormalities of gonadal and genital differentiation.

Klinefelter's syndrome

In Klinefelter's syndrome, the frequency of gynecomastia, according to various authors, is 23-88%. The disease is caused by an additional X chromosome (one or more) in the male XY karyotype. The presence of an additional X chromosome does not affect the differentiation of the testicles and the formation of male genitalia, but spermatogenesis is impaired.

Before puberty, this syndrome is rarely diagnosed. Boys may have cryptorchidism, small testicles. Some children have moderate mental retardation, difficulties in communicating with peers.

Gynecomastia during puberty is more often the reason for visiting a doctor in patients with Klinefelter's syndrome. It is bilateral, painless, visible on examination. There is a typical change in the areola (pigmentation, expansion of borders, swelling). On palpation, the lobular structure of the gland is determined. Gynecomastia in such adolescents persists throughout their lives.

Androgen deficiency forms hypergonadotropic hypogonadism. In this regard, the linear growth of the limbs continues up to 18-20 years, which leads to tall stature. Patients may have a variety of bone anomalies, heart defects.

Adolescents with Kline-felter syndrome from 13-14 years old should be prescribed prolonged testosterone preparations to stimulate the development of secondary sexual characteristics. This can significantly reduce the manifestations of gynecomastia. With late diagnosis and treatment, gynecomastia becomes irreversible. In some cases, cosmetic surgery is necessary.

Reifenstein syndrome

Reifenstein's syndrome (testicular feminization syndrome, or incomplete androgen insensitivity syndrome) is one of the causes of false male hermaphroditism. It occurs with a frequency of 1: 50,000 newborns. Karyotype in all patients with XY. The disease is associated with a mutation of the androgen receptor gene. There are two clinical variants of this syndrome: incomplete and complete insensitivity.

In Reifenstein's syndrome (incomplete form), the structure of the external genitals has various defects: scrotal or penile hypospadias, a reduced and curved penis, a split scrotum, hypoplastic testicles and are located in the scrotum or inguinal canal.

During puberty, patients have gynecomastia. Hairiness on the face and in the armpits is scarce, on the pubis it is distributed according to the female pattern. Derivatives of the wolffian ducts (vas deferens, seminal vesicles and epididymis) are visualized. The blood levels of testosterone and LH are increased.

Morris Syndrome

The full form of testicular feminization syndrome (Morris syndrome) is characterized by the lack of sensitivity of target tissues of patients with genetic and gonadal male sex to androgens, while maintaining sensitivity to estrogens. The external genitals have a normal female structure. In puberty, a female body type is formed, the mammary glands are well formed, there is no hair growth. The karyotype corresponds to the male. Small gonads are identified in the abdominal cavity or in the inguinal canal. The choice of gender is beyond doubt. Such patients have high terminal stature. It is recommended to remove testicles at puberty due to possible malignancy.

The psychosexual orientation of patients is female. Intelligence is well developed. The reason for going to the doctor is amenorrhea.

Lawrence-Moon-Barde-Biedl Syndrome

Lawrence-Moon-Barde-Biedl syndrome is a genetically heterogeneous disease, which is accompanied by obesity, mental retardation, pigmentary reticulopathy, hypogonadism. Along with these main symptoms are abnormalities of the kidneys, liver, diabetes mellitus. Poly- and syndactyly is detected in 50% of patients.

Hypogonadotropic hypogonadism is one of the leading symptoms. Boys have no testicles in the scrotum, spermatogenesis is impaired. Obesity manifests itself already in the first year of a child's life and gradually progresses, reaching III-IV degrees. Excessive fat deposition is common in the chest and pelvis. In obese children and adolescents, there are pronounced deposits of adipose tissue on the chest. By palpation, it is possible to establish the presence of lipomastia or gynecomastia, but this can only be clarified when conducting an ultrasound examination (ultrasound). Gynecomastia is mixed.

Prader-Willi syndrome

Prader-Willi syndrome is a hereditary autosomal dominant disease caused by a defect in the 15th chromosome. In the first year of life, it is manifested by severe muscle hypotonia, cardiovascular disorders, growth retardation, and mental retardation. In subsequent years, polyphagia develops, leading to morbid obesity.

In boys, at birth, hypogenitalism is noted, which is characterized by hypoplasia of the penis and scrotum, and during puberty, symptoms of hypogonadism are revealed, which is hypogonadotropic. Gynecomastia in patients is mixed.

Kalman's syndrome

For Kalman's syndrome, a combination of hypogonadism with anosmia (lack of smell) associated with the pathology of migration of olfactory and LH-RH neurons is typical. Other organ malformations are possible. Occurs in the population with a frequency of 1: 10,000.

The cause of hypogonadism in patients with Kalman's syndrome is impaired secretion of LH-RH by the hypothalamus. The point of application of LH-RH is the cells of the adenohypophysis, which secrete gonadotropins (LH, FSH). With this disease, the function of gonadotrophs decreases. In puberty, boys lag sharply behind in sexual development.

Of the clinical symptoms during this period, pre-pubertal testicular volumes (< 4 мл), микропенис, значительное снижение обоняния, на которые пациенты не обращают внимание. Талия располагается высоко, склонность к избыточному весу. Гинекомастия смешанного типа. Исходно показатели ФСГ, ЛГ и тестостерона низкие.

To stimulate the development of secondary sexual characteristics in adolescents with this syndrome, it is advisable to use combined therapy with androgen drugs (testosterone enanthate, Sustanon-250) and human chorionic gonadotropin. This achieves satisfactory physical development, testicular enlargement and elimination of mental discomfort.

XX-male syndrome

The 46XX karyotype in phenotypic boys occurs with a frequency of 1: 20,000. The structure of the internal and external genitals corresponds to the male type. The penis is either normal in size or reduced. The scrotum is formed, the testicles are hypoplastic, located in the inguinal canal. At puberty, hypergonadotropic hypogonadism is revealed - the level of testosterone is reduced with an increase in the content of LH and FSH. Gynecomastia is common during this period. When examined in the tissue of the testicles, the same changes are found as in Klinefelter's syndrome. Unlike the latter, there is no tall stature or impaired intelligence. The cause of the disease is not well understood. Treatment is the same as for Klinefelter's syndrome.

True hermaphroditism

True hermaphroditism is the simultaneous intrauterine formation of gonads of both sexes. Gonadal abnormalities can occur in various combinations: ovarian and testicular tissue can exist in isolation or combine within the same gonad (ovotestis). The karyotype in true hermaphroditism is variable.

Clinical manifestations are diverse and depend on the activity of the ovarian or testicular tissue. At birth, the external genitals are bisexual. The structure of the internal genital organs reflects the predominance of certain sex steroids.

During puberty, ovarian activity may predominate, which causes intense secretion of estrogen. In adolescents with a male phenotype, the mammary glands are enlarged. The final diagnosis is made after histological examination of the gonads during diagnostic laparotomy.

Hypothyroidism

Hypothyroidism can be accompanied by gynecomastia, which has been noted for a long time. This is due to hyperstimulation of the adenohypophysis under the influence of excessive production of thyrotropin-releasing hormone (TRH), which is characteristic of primary hypothyroidism. Gynecomastia occurs only in severe decompensated primary hypothyroidism. Due to the low content of thyroid hormones in the blood, the secretion of TRH increases, which enhances the formation and release of not only thyroid stimulating hormone of the pituitary gland, but also prolactin. It is possible that TRH has a stimulating effect on the secretion of prolactin through an increase in the expression of genes for prolactoliberin and its receptors directly in the adenohypophysis. With prolonged uncompensated hypothyroidism, pituitary hyperplasia is often detected.

Confirmation is the rare Van Wick-Grombach syndrome in boys, which is characterized by primary decompensated severe hypothyroidism, premature sexual development, gynecomastia, and testicular enlargement. These patients show significant increases in thyroid-stimulating hormone (TSH), PRL, and gonadotropic hormone levels. Some authors explain the low testosterone concentration by the inhibitory effect of PRL.

Thyroid hormone replacement therapy normalizes the clinical picture.

Thyrotoxicosis

Gynecomastia occurs in severe thyrotoxicosis. Thyroid hormones have a stimulating effect on sex hormones, causing an increase in the production of testosterone and estradiol. At the same time, the synthesis of globulin that binds sex steroids (sex-binding globulin, SSG) increases. It is believed that aromatase activity increases, which contributes to the excessive conversion of testosterone to estradiol. All this shifts the nuclear power plant towards estrogens, which stimulates the development of glandular tissue in the mammary glands. Compensation of thyrotoxicosis leads to the disappearance of gynecomastia.

Hyperprolactinemia

Gynecomastia can be one of the symptoms of hyperprolactinemia. The synthesis and secretion of prolactin occur in the acidophilic cells of the anterior pituitary gland and are under the control of the hypothalamus. The main target organ for prolactin is the mammary glands. Prolactin stimulates the growth and development of the mammary glands and increases the number of lobules and ducts in them.

One of the factors that inhibit PRL is dopamine, which is synthesized in the nucleus of the hypothalamus. Stimulates the production of prolactin TRH, a vasoactive intestinal polypeptide that suppresses the synthesis of dopamine, as well as gonadotropin-releasing hormone and estrogens. The latter increase the secretion of PRL in the pituitary gland and increase the sensitivity of lactotrophs to the stimulating effect of other hormones.

Diagnosis of prolactinemia syndrome in boys is difficult due to the absence of specific symptoms. In the presence of a pituitary macroadenoma, the first complaints may be headaches, dizziness, narrowing of the visual fields, weight gain, breast enlargement, and delayed sexual development.

There is an assumption that excessive secretion of PRL inhibits the pulsed secretion of LH-RH and, therefore, causes a deficiency of gonadotropins. Under physiological conditions, PRL inhibits the formation of 5α-dihydrotestosterone from testosterone by reducing the activity of 5α-reductase.

Thus, delay in sexual development, gynecomastia, galactorrhea require exclusion of hyperprolactinemia.

Diagnosis of prolactinemia is based on the study of the patient's hormonal status (FSH, LH, cortisol, testosterone, estradiol, PRL), visualization of the hypothalamic-pituitary region.

Congenital dysfunction of the adrenal cortex

Congenital adrenal cortex dysfunction (ACD) is a large group of diseases that have one or another genetic enzymatic defect in various stages of steroid hormone biosynthesis, leading to insufficient secretion of cortisol. Cortisol deficiency stimulates the production of adrenocorticotropic hormone (ACTH) in the adenohypophysis, which causes adrenal hyperplasia. The clinical picture depends on the level of enzymatic disturbance.

3β-hydroxysteroid dehydrogenase deficiency

A deficiency of 3β-hydroxysteroid dehydrogenase (3β-HSD) causes a disruption in the synthesis of steroids both in the adrenal glands and in the gonads, which leads to a lack of biosynthesis of cortisol, mineralocorticoids and to a disruption in the production of sex hormones in the testicles, and, consequently, in a fetus with genetically male sex already in utero forms hypogenitalism.

At birth, boys have an underdeveloped penis, hypospadias, urogenital sinus, and the skin is pigmented. In the first month of life, indomitable vomiting, loose stools appear. A blood test determines a low level of renin, hyperkalemia, hyponatremia. The content of pregnenolone and DHEA is increased. It is noticed that with an excess of androstenedione, the level of estradiol increases sharply. Molecular genetic studies are required to confirm the diagnosis. In genetic boys during puberty, depending on the degree of musculinization, gynecomastia may be detected. In most cases, hormone replacement therapy is indicated.

Type 3 17β-hydroxysteroid dehydrogenase deficiency

Type 3 17β-hydroxysteroid dehydrogenase (17β-HSDZ) acts only in the gonads, converting androstenedione (A), a sex hormone with low biological activity, into testosterone and estrone into estradiol. Deficiency of this enzyme is not accompanied by impaired synthesis of glucocorticoids and mineralocorticoids. A defect in the 17β-HSDZ gene leads to a deficiency of the gonadal form of the enzyme and severe intrauterine testosterone deficiency, leading to a clinic of false hermaphroditism in boys. Newborn boys with this defect have a female phenotype.

In the prepubertal period, a high level of adrenal steroids (androstenedione and estrone) is detected with a reduced or normal level of testosterone, which is synthesized in peripheral tissues from androstenedione (A). During puberty, the activity of the testicles increases, leading to a significant increase in the level of androgens, which masculinize the physique and external genitals. At the same time, gynecomastia develops. The diagnosis is confirmed by molecular genetic testing.

Estrogen-secreting tumors

Estrogen-secreting adrenal and gonadal tumors are rare in boys. Corticoestromas originate from the fascicular and reticular areas of the adrenal cortex. The clinical picture is variable, but the symptoms of hypercortisolism are more common. Gynecomastia is detected with excess secretion of estrogen. In the hormonal profile, attention is drawn to a sharp increase in the content of DHEA-S, estradiol and other steroids (cortisol, testosterone). Dexamethasone test does not lead to a decrease in steroid hormones. The search for a tumor is carried out using ultrasound scanning, computed tomography or magnetic resonance imaging.

Sertolioma, a hormone-active tumor of the testicles, secretes estrogens. In the clinic, boys develop gynecomastia, the growth rate accelerates. The affected testicle is enlarged, dense to the touch, bumpy. The content of estradiol in the blood rises. If necessary, ultrasound of the scrotum is performed. Tumors are subject to prompt removal.

Gynecomastia may for a long time be the only symptom of an ectopic hCG-secreting tumor. HCG (human choriogonic gonadotropin) contains α- and β-subunits and is a product of placental syncytiotrophoblast. The production of hCG in quantities sufficient to increase its level in the blood can be observed in the central nervous system, liver, testicles. Expression of the β-subunit of hCG (β-hCG) more often occurs in less differentiated tumor cells. Up to 30% of germ cell tumors are malignant. The clinic is characterized by gonadotropin-independent premature sexual development. Germ cell tumor cells stimulate the production of weak androgens and estrogens in the testicles.

All boys with hCG-secreting tumors have high testosterone levels reaching sexual maturity. In some patients with gynecomastia, an increase in the content of estrogen is noted, which is associated with an increase in the aromatase activity of the tumor tissue.

In the diagnosis of germ cell tumors, they rely on the content of the β-subunit of hCG.

Familial gynecomastia

Familial gynecomastia is a disease with high aromatase activity and is transmitted in an autosomal dominant manner. Gynecomastia may be the only symptom and persists for a long time. Steroid hormones in the blood may be within the normal range.

Role of drugs

Many drugs can affect the androgen-estrogen ratio, causing signs of gynecomastia. It can be true, false or mixed. Among the drugs that cause gynecomastia in boys, it should be noted psychotropic (clozapine, aminazine, haloperidol, Sonapax, etc.), hormonal (chorionic hormone, androgens, anabolic, glucocorticoids). Estrogens that contribute to the development of gynecomastia can be ingested with food. Patients have elevated levels of PRL. Medicinal gynecomastia disappears when the drug is discontinued.

The cause of true gynecomastia may be associated with impaired seizure and processing of sex steroids and their metabolites in the liver and their excretion by the kidneys, which occurs in chronic hepatic and renal failure.

False gynecomastia

False gynecomastia (lipomastia) is not associated with hormonal imbalances, it is excess fat deposition in the mammary glands in obesity.

Lipomastia is often found in constitutional-exogenous obesity, in which there is a relative and absolute leptin deficiency against an alimentary-hypodynamic background.

The mammary glands, on palpation, have a soft-textured consistency, painless, well displaced, the nipple-areola complex is omitted. Pseudogynecomastia is often bilateral, but it can also be unilateral.

Currently, abdominal fat is considered as an independent endocrine organ in which various biologically active substances are synthesized, including estrogens. The latter contribute to the deposition of female-type fat on the thighs, buttocks and in the area of ​​the mammary glands. In these cases, mixed gynecomastia develops.

A common form of secondary obesity with mixed gynecomastia in adolescents is the hypothalamic syndrome of puberty. In this disease, the neurohumoral regulation of the hypothalamus is disrupted, causing an increase in the secretion of ACTH and adrenal cortex hormones, the secretion of gonadotropins. Post-traumatic (birth trauma), inflammatory or congenital changes in the central nervous system, leading to an increase in intracranial pressure, can play a role in the development of the disease.

Teenagers complain of headaches, overweight, fatigue, and hunger. In growth, they overtake their peers. Obesity is uniform II-III degree with fat deposition in the pubic area, mammary glands, shoulder girdle. The skin has streaks of stretch from pinkish-reddish to purple-cyanotic color. Facial vegetation is sparse. Transient arterial hypertension is often detected. Gynecomastia is of a mixed nature. Along with an increase in adipose tissue in the area of ​​the mammary glands, a seal can be palpated under the nipple, which may indicate diffuse changes in the glandular tissue.

Treatment for false gynecomastia focuses on lifestyle changes that involve adequate exercise and a low-calorie diet. In hypothalamic disorders, agents are prescribed that improve trophism and microcirculation in this area.

Breast tumors are rare in boys. You can think about them in the case of unilateral breast enlargement. A nodule appears on the affected side that can be felt. With the growth of a cancerous tumor, the skin above it is swollen, wrinkled or retracted. Erosions, ulcers, oozing, bloody discharge may appear, axillary lymph nodes are palpated. If a tumor is suspected, an ultrasound-guided biopsy is performed.

Swelling of the mammary gland may be associated with an inflammatory process in it. In this case, skin redness, swelling, increased local temperature, and soreness are characteristic.

Patient examination

If gynecomastia is suspected in boys and adolescents, it is necessary to examine and palpate the mammary glands, pay attention to secondary sexual characteristics (size and density of the testicles), pubic and axillary hair growth, growth leap.

Between the ages of 1 year and puberty, breast enlargement is uncommon in boys. Adolescent gynecomastia develops after the onset of puberty, therefore, in the case of gynecomastia in a boy or adolescent without other signs of puberty, one should think about endocrine disease and, first of all, about a hormone-producing tumor.

In obese children and adolescents, an increase in the area of ​​the mammary glands is more often due to excess deposition of fatty tissue. However, these children may also develop mixed and true gynecomastia.

With a prolonged course of gynecomastia, it should be clarified whether the child has not taken hormonal or anabolic drugs that can stimulate the growth of the mammary glands.

In physiological gynecomastia, determination of the level of LH, FSH, estradiol and testosterone is usually sufficient. In other cases, an in-depth study may be needed: PRL, DHEA-S, TSH, thyroxine (T4), β-hCG, α-fetoprotein (AFT), SSG. Determination of hormones in dynamics.

Instrumental research methods include: ultrasound examination (ultrasound), mammography of the mammary glands, fine-needle aspiration biopsy. According to indications - ultrasound of the scrotum, computed tomography (CT) or magnetic resonance imaging (MRI) of the adrenal glands, MRI of the brain, karyotyping.

Treatment

Physiological gynecomastia in infants and adolescents does not require treatment, since in most cases spontaneous remission occurs. Dynamic observation is recommended.

However, in some cases, enlargement of the mammary glands negatively affects the emotional well-being of young men and traumatizes their psyche. Teenagers become isolated, become inactive. They have a feeling of their own inferiority, they are embarrassed to undress in front of their peers. The specialist must be a good psychologist, knowing how to tactfully find an approach to such a patient.

There is no cure for idiopathic gynecomastia. In some patients, breast tissue decreases with the use of tamoxifen (an antiestrogen) and testolactone (blocks aromatase activity). Drugs are prescribed when parents and adolescents insist on treatment, while preserving pubertal gynecomastia for more than 3 years. With secondary gynecomastia, treatment is aimed at compensating for the underlying disease.

Surgical treatment of gynecomastia should have a corrective effect in young men with psychological discomfort or in connection with fibrosis of the mammary glands.

Gynecomastia can be complicated by bacterial inflammation - the infection enters the mammary gland through ducts or microtrauma in the nipples. Mastitis develops, which requires appropriate treatment.

Literature

1. Zhukovsky M.A., Lebedev N.B., Semecheva T.V. Violation of sexual development. M., 1989.272 p.
2. Ma N. S., Geffer M. E. Gynecomastia in prepubertal and pubertal boys // Curr Opin Pediatr. 2008, 20: 465-470.
3. Frantz F. G., Wilson J. D. Endocrine disorders of the breast // Williams textbook of endocrinology. 1998.877-900.
4. Nordt C. A., DiVasta A. D. Gynecomastia in adolescents // Curr Opin Pediatr. 2008, 20: 375-382.
5. Wilson J. D., Aiman ​​J., MacDonald P. C. The Pathogenesis of Gynecomastia // Advanc. in intern. Med. 1980, 25: 1-32.
6. Differential diagnosis and treatment of endocrine diseases (hand-in). M., 2002.
7. Dedov I.I., Semicheva T.V., Peterkova V.A. Sexual development of children: norm and pathology. M .: Color it Studio, 2002, 232 p.
8. Endocrinology. National leadership / Ed. I.I.Dedova, G.A.Melnichenko. M .: GEOTAR-media, 2008.
9. Balabolkin M.I., Klebanova E.M., Kreminskaya V.M. Fundamental and Clinical Thyroidology. M .: JSC "Medicine", 2007.
10. Zhurtova I. B. Hyperprolactinemia syndrome in children and adolescents: optimization of diagnostic and treatment methods. Abstract of thesis. dis. doc. honey. sciences. 2012.
11. Bulard J., Mowszwicz I., Schaison G. Increased Aromatase Activity in Pubic Skin Fibroblasts from Patients With isolated Gynecomastia // J. Clin. Endocr. Metab. 1987, 64: 618-623.
12. Kolodkina A. A., Kalinchenko N. Yu., Nizhnik A. N., Nokel M. A., Tyulpakov A. N. Clinical, hormonal and molecular genetic characteristics of two cases of sex formation disorder 46XY, caused by deficiency of type 3 17β-hydroxysteroid dehydrogenase // Problems of endocrinology. 2011, no. 3, p. 26-30.
13. Ivanov V.A., Ozerskaya I.A., Akimov D.V. Diagnostics and treatment of gynecomastia: Methodical recommendations. Moscow: Vidar, 2013.64 p.

V. V. Smirnov 1, Doctor of Medical Sciences, Professor
L. D. Sahakyan

GBOU VPO RNIMU them. N.I. Pirogova, Ministry of Health of the Russian Federation, Moscow

Gynecomastia is quite common. This pathology represents a significant increase in the mammary glands in men. The most common cause of this condition is hormonal problems in an adult man. The amount of estrogen in the blood rises rapidly, while androgens are significantly reduced. This pathology is accompanied not only by aesthetic defects, but also adversely affects the psychological state of a person.

Before starting treatment, it should be established what exactly could lead to the appearance of such a pathological condition. To date, the most common causes of the development of the disease are:

• an increase in the level of the hormone prolactin in the blood of a man
• imbalance between estrogens and androgens
• dysfunction of the pituitary gland
• taking hormonal drugs to quickly increase testosterone in the blood
• constant heavy physical activity
• frequent beer consumption
• wearing an uncomfortable bra in women
• taking certain antifungal medicines and diuretics
• chronic liver disease
• problems in the functioning of the digestive tract
• frequent grueling diets with the wrong diet
• uncontrolled use of steroids by athletes

In some cases, pathology does not appear as a separate disease, but is a consequence of other health problems. Gynecomastia in adolescents can also appear after prolonged use of hormonal drugs.

Gynecomastia in women and men, as well as the juvenile form of the disease, does not pose a particular health hazard in general. But if it is not cured in time, then the pathology can develop into breast cancer. In men, the mammary glands do not always enlarge evenly. It so happens that one breast remains normal and does not cause any discomfort, and the other begins to hurt a lot and protrude. Many men suffering from this disease have psychological problems.

The main risk group is children and adolescents. Their hormonal background is established for a long time, which can affect the state of health. Elderly men are also susceptible to the development of pathology, in whom the amount of androgens in the blood decreases during the aging process.

Gynecomastia in puberty often goes unnoticed, because in adolescence, many men still do not understand what exactly is happening to them, and do not attach much importance to body changes.

Classification of gynecomastia

Gynecomastia is usually divided into true and false.

ICB code 10 N62.

False gynecomastia is common in overweight men. This is due to the rapid growth of adipose tissue in the chest area. True gynecomastia is divided into the following forms:

• pathological
• physiological

The physiological form is quite easily treated at home. The main task of the therapy is to eliminate the main cause of the pathology. The following age groups of men are most susceptible to this form of the disease:

1. Newborns and children under one year of age. In this case, the cause of gynecomastia can be the constant intake of hormonal drugs while carrying a baby. This type of gynecomastia does not provide for special treatment and goes away without any medical intervention as the child grows.
2. Teenagers. Juvenile gynecomastia is quite common. The period of puberty in boys is characterized by hormonal changes and a surge in hormones. All this can lead to the predominance of female sex hormones over male ones. If there are no concomitant pathologies, then adolescent gynecomastia is not treated in any way and goes away after a while on its own.
3. Elderly men. After 50 years in the body of a man androgens practically cease to be produced, while female hormones are produced in the same amount. In this case, gynecomastia develops due to hormonal imbalance.

Experts also talk about unilateral gynecomastia, when only one gland suffers and increases in size, and about a bilateral form of pathology that covers both breasts.

The presence of pathology is determined by the presence of specific symptoms. The main signs of gynecomastia directly depend on the stage of development of the disease:

1. At the very beginning, there is an uncontrolled proliferation of connective tissue. Gynecomastia affects both the smallest and largest thoracic ducts. This condition usually lasts about 4 months. With the correct treatment, the pathology does not develop further and recovery occurs.
2. The intermediate stage of gynecomastia is most often delayed up to six months. A man's chest is rapidly increasing in size due to excessive growth of glandular tissue.
3. The last stage consists in the fact that fibromatosis of the connective tissue joins the active growth of fat cells. All this leads to the appearance of seals in the thickness of the gland. In this case, conservative treatment may not give positive results. It is better for a man to seek the help of a qualified surgeon.

Gynecomastia in men is often accompanied by specific nipple discharge that resembles colostrum. The patient may not experience any painful sensations. He is only worried about the heaviness and discomfort in the chest. Even in the case when only one gland is enlarged, the second can also be covered by the pathological process.

If the pathology is bilateral or unilateral, but with specific seals that bring pain and discomfort, and the skin of the gland changes in color and becomes tense, a man should immediately consult a doctor. In the case when an increase in axillary lymph nodes is added to the manifestations on the chest, we are talking about the presence of a neoplasm.

Why is gynecomastia dangerous for a man?

Physiological gynecomastia does not pose a threat to a man's health. She can regress on her own. In this case, only emotional and aesthetic discomfort arises, which eventually disappears.

Nodular gynecomastia, as well as fatty gynecomastia in men, progresses rapidly and can provoke the appearance of breast cancer. This applies to both men and gynecomastia in women. The appearance of bloody discharge from the nipples and dense formations in the gland itself requires immediate medical attention.

Diagnosis of the disease

The question often arises as to which doctor to contact for the final diagnosis of gynecomastia. In this case, the man should consult an endocrinologist. After a thorough examination, palpation and examination of complaints, the patient may be referred for such additional examinations:

• blood chemistry
• Ultrasound of the scrotum and bilateral examination of the mammary glands in a man
• CT of the lungs
• MRI of the adrenal glands

If, when studying the test results, a significant increase in the average level of the hormone hCG and estradiol is revealed, the man will definitely need to undergo studies that will help exclude the presence of a malignant tumor. If concomitant pathologies are identified, they require immediate treatment.

Treatment in this case depends on the cause that caused the appearance of gynecomastia in the man. Before the final diagnosis is made, the presence of a malignant tumor is excluded. A man is recommended to be observed by several narrow-profile specialists. Improvement occurs approximately six months after starting treatment. If no positive dynamics is observed, drug therapy is corrected.

Proper nutrition for gynecomastia

When gynecomastia appears in men, a strict diet is required. This is necessary to increase or correct the level of testosterone production. With proper nutrition, a man quickly regains a normal rational hormonal balance. All this contributes to the tuning and significant acceleration of all metabolic processes and the rapid elimination of toxins from the body.

The diet should include: porcini mushrooms, boiled dietary meat, berries, cereals and fresh fruits. With such a diet, estrogens from a man's body begin to be excreted faster, which reduces the possibility of malignant tumors.

It is very important for gynecomastia to make the correct drinking regimen. A man needs to drink at least 2 liters of still water per day. The hormones you need are released faster with regular exercise. Sport often helps a man to overcome many diseases.

Conservative treatment

In most cases, various hormonal drugs are used for treatment, based on pure progesterone. They work well in case of failure of one or both testicles, as well as some antiestrogens that can block the main hormones of women.

For gynecomastia in men, the following drug therapy regimen is predominantly used:

1. Thiamine Bromide in the form of a common B vitamin for the rapid transformation of male to female hormones. Assign once a day in the form of injections for 14 days.
2. Vitamins B1, which is mainly used to block the production of the hormone aromatase. Used for gynecomastia intramuscularly. Injections are recommended for at least 20 days.
3. Androgel is an ointment based on pure testosterone. It is applied only in the morning.
4. Dydrotestosterone. The drug promotes the speedy utilization of excess adipose tissue in the case of poor development of the sex glands in men.
5. Tamoxifen is intended to reduce the level of estrogen production, which increases the susceptibility to the formation of neoplasms of various etiologies.
6. Clomiphene citrate significantly reduces the level of estrogen in the blood, which prevents the growth of breasts in men. It is used for 1 tablet for 30 days.
7. Sustanon is a unique blend of essential testosterone esters. This oil is applied intramuscularly. It is usually introduced once every 3 weeks for 3 months.

Each of these hormonal drugs is prescribed only by the attending physician individually for a particular man.

There are other medications available for treatment without surgery. They can be in the form of creams and ointments:

• Anastrozole
• Ganaton
• Dimexide
• Letrozole
• Proviron
• Progestogel
• Turinabol
• Tamoxifen

Do not self-medicate. To exclude the development of unwanted side effects, all drugs and their dosage should be prescribed by a qualified specialist.

Surgical intervention

Treatment should be based on the elimination of the main cause that caused the appearance of the disease. Removal of gynecomastia in men is prescribed only in the most severe cases, when no previous drug treatment brings the desired results.

4 main methods of surgical treatment:

1. Mammoplasty with superficial liposuction. In this case, all excess adipose tissue is excised, and the breast acquires its initially normal shape.
2. Mastectomy is a radical and most complete excision of the entire affected breast.
3. Endoscopy - removal of the gland using a special endoscope. Small incisions are made in the skin, usually under the armpit, and an endoscope is used through them.
4. Laser removal - all abnormal tissues are removed with a laser, and later their contents are pumped out through small incisions in the skin using a vacuum.

If the operation to eliminate gynecomastia in a man took place without any complications, the patient is allowed to go home and monitored for the next six months. At the same time, supportive drug therapy is prescribed, the duration of which depends on the patient's condition.

Traditional methods in the fight against the disease

In the postoperative period, long-known folk remedies are often used. However, they are only welcomed if added to the main treatment. Most often, medicinal decoctions based on honey, ginseng and lovage petals are used to treat gynecomastia.

• To combat pain in the mammary glands in men, special honey compresses are put. It is applied to the painful area and covered with cellophane, after which it is fixed with a tissue. The compress is put on at night.
• Ginseng broth is drunk 3 times a day before meals for three months. The infusion of lovage root is poured exclusively with red wine. Insist for 3 days and drink 100 ml after meals.
• They also take baths from a decoction of thyme 2 times a week for about 20 minutes.

Home treatment can only help at the onset of the disease, when the pain has only recently begun to bother the man. Before using all the decoctions, it is advisable to treat the breast with hydrogen peroxide. In the later stages, the treatment no longer gives the expected results.

Predictions of disease progression

The prognosis of physiological gynecomastia in men is almost always favorable. If this is pubertal gynecomastia, then with proper growth and normal hormonal background, all symptoms disappear after the end of adolescence. With the progression of a disease such as gynecomastia, the prognosis can also be favorable if the man adheres to all the recommendations of the attending physician and undergoes treatment on time.

A man is obliged to completely abandon all bad habits, strictly adhere to the most correct lifestyle and, without fail, follow the established diet. Treatment of this pathology must be correct and justified. Only then can the disease be overcome.

The desire to be ordinary is quite normal for any teenager, but gynecomastia is one of those pathologies that can cause a lot of inconvenience and even plunge into depression. To prevent such problems, the boy needs not only doctor's consultations and medication, but also psychological support.

Photo: enlarged mammary glands in a man

Gynecomastia in adolescents is a visible or palpable enlargement of the mammary gland, which can range from small to the size of the glands of an adult woman.

True gynecomastia is closely related to adolescent puberty and is a clinical manifestation of an acute imbalance in sex steroids.

Most often this occurs at the age of 12-14 and is noted in 30% of growing up boys. It goes away on its own in most cases, but this pathology still cannot be underestimated.

Juvenile gynecomastia at 17 is normal, but it should go away on its own after a few months. If this does not happen, you should immediately consult a doctor.

Reasons for the appearance

The most common cause is an imbalance between two hormones: testosterone and estrogen.

In fact, the male mammary gland is nothing more than a rudimentary (residual) organ, but with certain hormonal changes, it can enlarge and turn into small tubercles, consisting of glandular tissue.

This phenomenon creates many psychological problems, as it becomes the reason for the appearance of such negative emotions as fear, shame, and awkwardness.

Youthful gynecomastia in men causes many complexes and the appearance of low self-esteem. As a result, despite its harmlessness and reversibility, it can cause serious psychological trauma in both a teenager and an adult man.

In total, there are more than thirty possible causes of this pathology, among which three large groups can be distinguished:

1. The predominance of female hormones in the body.
2. Decreased levels of male hormones.
3. The use of certain medications.

As for diseases that can lead to the appearance of gynecomastia, they include the following:

• cirrhosis;
• kidney disease;
• neoplasms;
• Klinefelter syndrome (a genetic disorder associated with chromosomes);
• diabetes;
• tuberculosis;
• intoxication and metabolic disorders;
• diseases of the thyroid gland;
• prostate adenoma.

Video: Getting Rid of Gynecomastia

Views

There are several types of pathology, but two can be distinguished at once:

• true;
• false.

In the first case, breast enlargement is associated with an enlargement of the breast, while in the case of false gynecomastia, breast enlargement is associated with the deposition of excess fat.

In turn, the true one is divided into:

• physiological;
• medicinal;
• idiopathic.

Physiological gynecomastia in adolescents is observed at the age of 12-15 as a result of a decrease in testosterone levels in the body. It is normal, although not everyone has it at this age.

Physiological is divided into:

• gynecomastia in a newborn;
• gynecomastia in adolescents;
• gynecomastia of the elderly.

Medicinal gynecomastia

This type occurs after taking certain medications. Most often, such a pathology is reversible and passes after the abolition of medications on its own, if irreversible changes in the tissues of the glands did not have time to occur. Most often, the group of such drugs includes hormone replacement and anticancer drugs.

Idiopathic gynecomastia- This is gynecomastia, the causes of which have not been clarified. If an examination of the body is carried out and facts are revealed that do not fit into the usual picture of the course of physiological gynecomastia, then the diagnosis "idiopathic gynecomastia" is made.

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Possible complications

The danger lies in the possible protracted nature of the course of the disease, which can subsequently cause breast cancer.

The following symptoms, in the case of the duration of the illness, should seem suspicious:

• the appearance of seals in the chest area;
• discoloration of the skin near the formations;
• the appearance of discharge from the nipples;
• an increase in axillary lymph nodes.

If such symptoms appear, you should immediately consult a doctor.

Diagnostics

Photo: enlargement of one breast

Often, patients with gynecomastia immediately turn to a surgeon and choose surgery as their treatment. This leads to the removal of the mammary glands, but not always to the elimination of the problem itself, because after the operation it can return, say, from the other side.

First of all, when the first signs of pathology appear, it is better to contact an endocrinologist... Diagnostics will consist in examination, palpation, determination of the type, cause and stage of pathology, a complete history, hormonal blood test and a study of the work of other body systems to identify various diseases should also be carried out.

Stages of the disease

There are three stages of the course of the disease:

1. initial stage called "developing" and lasts about four months. Changes at this stage are reversible when correct and timely treatment is prescribed.
2. Intermediate stage lasts from four months to a year. At this time, the symptoms of pathology increase, the changes become almost irreversible.
3. Fibrous stage characterized by the deposition of connective glandular tissue in the enlarged gland, around which fatty deposits subsequently develop. At this stage, even conservative intervention does not give results and the changes are already irreversible.

Video: Mixed gynecomastia

Treatment of gynecomastia in adolescents

How to treat adolescent gynecomastia? Concerned parents often ask themselves this question, but adolescent gynecomastia most often goes away on its own and does not require either medication or surgery, but if it turns out to be protracted, then you cannot refuse treatment. Another sign that should alert you is the magnification size, which exceeds three to three and a half centimeters.

If the cause is poor androgen secretion, then it is possible to prescribe the intake of sex hormones (omnadren, sustanon, etc.).

The Androgel gel, which contains testosterone, is also recognized as effective (patients rub it into their skin every day). If the mammary glands are significantly enlarged in size, and medicinal methods do not help, most often they resort to surgical intervention in order to give the breasts an aesthetic appearance.

It is worth noting that gynecomastia in adolescent girls is also possible as in boys. It is impossible to self-medicate in either case. With the question of how to get rid of gynecomastia, it is better to consult a specialist.

Rehabilitation period

The operation is required when all medicinal methods are useless or it becomes clear in advance (for example, in case of tumor lesions).

The bottom line is to remove breast tissue and restore its correct, original contour.

This operation is called "mastectomy" and is performed under general anesthesia. Most often, it does not take more than an hour and a half and is well tolerated by most patients. The recovery stage takes no more than a month: the first day is spent in a hospital, in the next two or three days, bed rest is prescribed.

For fourteen days, you need to wear compression underwear, and after four weeks all bruises and swelling disappear. Nevertheless, the breast finally takes on its previous contours not earlier than six months after the operation.

Video: The Truth About Juvenile Gynecomastia

Prices

The cost of an operation to remove gynecomastia varies from 65,000 to 130,000 rubles, depending on the clinic and the "package of services" that are included in this procedure.

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FAQ

At what age is it possible for boys to develop gynecomastia?

Which specialist should be consulted first of all for breast augmentation?

It directly depends on what the patient is worried about. If there is pain in the chest area, then it is better to contact a mammologist. If the very fact of the increase is worried, then you can contact an endocrinologist, and subsequently, a surgeon.

How common is gynecomastia in adolescents?

It occurs in about 30% of adolescent boys.

What are the main signs?

The main signs of pathology in adolescents are as follows:

• enlargement of the mammary glands in diameter;
• an increase in the diameter of the nipple and areola;
• the presence of increased pigmentation of the areola;
• increased sensitivity of the nipples, causing discomfort.

When is it worth resorting to surgical intervention in adolescent boys?

Juvenile gynecomastia does not require treatment, as such, because it most often goes away on its own. If the pathology lasts a long time and medical intervention has not yielded results, an operation is prescribed.

How difficult is the operation and the recovery period after it?

The operation "mastopathy" is considered uncomplicated and well tolerated. Of course, like any other surgical intervention, it carries a fraction of the risk, but the statistics are encouraging. The rehabilitation period does not last long - about a month.

How long does it take to start exercising?

After two weeks after the operation, you can engage in any physical exercise, of course, taking into account the fact that the load on the pectoral muscles will be sparing.

Photos before and after surgery