Gynecomastia: modern ideas and approaches to treatment

Abstract

A literature review is devoted to the benign growth of glandular tissue of the breast in men. The prevalence of gynecomastia reaches 32–65 % depending on age and the criteria used to determine. Gynecomastia in childhood and during puberty is considered a benign condition, which in most cases passes spontaneously. Gynecomastia in adulthood is more common in the elderly, and targeted examination can reveal the underlying pathology in 45–50 % of cases. Today, most causes of gynecomastia remain unclear and are discussed at the hypothesis level. The tissue of the mammary glands is laid equally regardless of the sex of a child. The development of the mammary glands depends on the androgen-estrogen ratio (AER). With the predominance of estrogens during puberty and low androgen activity, the breast tissue develops and differentiates by the female type. At the return AER, breast tissue does not develop. The possibility of endocrine or systemic disease should be considered. It is usually sufficient to determine basal levels of testosterone, estradiol, luteinizing hormone, and follicle-stimulating hormone. With simple adolescent gynecomastia, there are no permanent hormonal changes. It is important to assess the degree of overall androgenization of the patient. Laboratory tests (clinical, biochemical, hormonal) should correspond to the specific clinical condition of each patient. The effectiveness of therapeutic treatment of gynecomastia in patients without obvious endocrine disorders with the use of hormonal drugs (testosterone, dihydrotestosterone) as well as tamoxifen, danazol, clomiphene should be considered unproven. Surgical treatment is recommended only for patients with prolonged gynecomastia, which does not regress spontaneously or after drug therapy. The extent and type of surgery depend on the size of the breast augmentation and the amount of adipose tissue.