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This panel includes hormones that have been implicated in gynecomastia by several studies. Gynecomastia is a benign enlargement of the male breast resulting from a growth of the glandular tissue of the breast. It is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort and fear of breast cancer, early diagnostic evaluation is important, and patients usually seek medical attention. Causes include hormone imbalance and genetic predisposition.

Tests Include:

TESTOSTERONE, Free and Total, LC/MS Assay (T > 1,500 ng/dL)

DHT ( Dihydrotestosterone)

Low blood levels of testosterone and DHT in the presence of high estradiol, IGF-1, thyroid hormones or prolactin may accelerate the growth of breast tissue in men

ULTRA SENSITIVE ESTRADIOL

IGF-1 (Insulin Growth Factor 1)

PROLACTIN

TSH (Thyroid Stimulating Hormone)

FREE T3 (Free Triiodothyronine )

What is Gynecomastia and How to Diagnose it?

According to the National Institute of Health, gynecomastia can affect more than 50% of adolescent boys during puberty.

At the same time, gynecomastia can also affect up to 65% of men between 27 and 92, depending on their lifestyle, habits, drug intake, and other factors.

But what is gynecomastia and why so many men get it? Is it dangerous? And what can you do to treat it effectively and safely?

Keep reading this article to find out everything you need to know about gynecomastia, its types, causes, and treatment options.

Gynecomastia is a benign enlargement of the male breast resulting from a growth of the glandular tissue of the breast. It is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. At least 30% of males will be affected during their life. Since it causes anxiety, psychosocial discomfort, and fear of breast cancer, early diagnostic evaluation is important, and patients usually seek medical attention.

Evaluation of gynecomastia must include a detailed medical history, clinical examination, specific blood tests, imaging, and tissue sampling. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery.

Gynecomastia Symptoms

Men who start experiencing this problem complain of pain and tenderness around the nipple area. Gynecomastia was reported to cause an imbalance between estrogen and androgen action or an increased estrogen to androgen ratio, due to increased estrogen production, decreased androgen production or both. Androgens include testosterone and DHT. High estradiol in the presence of low testosterone and DHT, growth hormone (IGF-1 is a metabolite), and a genetic predisposition to gynecomastia can increase the size of breast tissue in men.

Potential Causes of Gynecomastia

Physiological gynecomastia is common in pubertal boys and appears to be associated with increased levels of insulin-like growth factor-1 (IGF-1) and pubertal growth, but not with a shift in the balance between estrogen and testosterone, a new study suggests. Researchers from the study said that IGF-1 and estrogen work together to help breast tissue grow, and it looks like IGF-1 is how growth hormone affects breast growth. "Estradiol increased the effect of IGF-1 on breast formation, and this was also seen in boys with gynecomastia in our study." However, serum testosterone was similarly elevated, leaving the estradiol/testosterone ratio unaltered."

Testosterone converts into estradiol, DHT, and other metabolites. Men with higher amounts of the enzyme aromatase usually have this problem even at lower doses of testosterone. A higher fat percentage, advanced age, excessive alcohol consumption, and the use of specific medications all have an impact on the growth of this glandular tissue. Gynecomastia rarely occurs in men using testosterone replacement since testosterone-to-estradiol ratios are improved.

In several studies on testosterone replacement, only a very small percentage of people receiving testosterone experience breast tissue growth. Dr. Judith Rabkin reported that two men out of the 150 men who participated in the study experienced this negative reaction in one HIV-specific study she conducted in New York.

Dihydrotestosterone (DHT) is a natural metabolite of testosterone that has antiestrogen activity and cannot be converted into estradiol at the tissue level. Systemic or locally administered DHT has been successfully prescribed for the treatment of patients with idiopathic and estrogen-induced gynecomastia.

Gynecomastia is also seen in men with androgen resistance with low testosterone and DHT, where unfettered estrogen can stimulate subsequent breast development. However, in men with normal androgen receptor activity, estradiol is unable to stimulate breast development. This is thought to be due to an imbalance between the inhibitory and stimulatory effect of these hormones.

Medications and Products That Can Cause Gynecomastia

Some medications have been reported in the medical literature to cause gynecomastia due to decreases in testosterone, increases in estradiol, or both. These include:

· Antiandrogens. 

· HIV medications. 

· Anti-anxiety medications.

. Finasteride

· Tricyclic antidepressants. 

· Glucocorticoid steroids.

· Antibiotics.

· Ulcer medication such as cimetidine .

· Cancer treatment (chemotherapy).

· Heart medications such as digitalis and calcium channel blockers.

· Anabolic steroids

· Soy and flaxseed

· Exposure to pesticides and byproducts of plastic processing has also been linked to increased estrogen and decreased sperm count in men.

If the gynecomastia is drug-induced, decreased tenderness and softening of the glandular tissue will usually be apparent within one month after discontinuation of the drug. However, if the gynecomastia has been present for more than one year, it is unlikely to regress substantially, either spontaneously or with medical therapy, because of the presence of fibrosis. In such circumstances, surgical subcutaneous mastectomy, ultrasound-assisted liposuction, and suction-assisted lipectomy are the best options for cosmetic improvement, as described in several case series.

During the rapid, proliferative phase, manifested clinically as breast pain and tenderness, medical therapy may be attempted. Most studies of drugs -- including testosterone (in patients without hypogonadism), have been uncontrolled and thus difficult to interpret because gynecomastia may resolve spontaneously. Small samples have generally been a limitation of the few randomized, double-blind, placebo-controlled trials.

How do you manage gynecomastia if it does occur?

Even though tamoxifen is not approved to treat gynecomastia, it has been shown to work in randomized and nonrandomized trials, with about 80% of patients showing partial regression of gynecomastia and about 60% showing complete regression. The drug is taken by mouth at a dose of 20 mg daily for up to 3 months. Patients in whom tamoxifen is effective usually experience a decrease in pain and tenderness within one month. In a retrospective analysis of a series of patients with idiopathic gynecomastia, 78% of patients treated with tamoxifen had complete resolution of gynecomastia, as compared with only 40% of patients receiving danazol. In case series describing the use of tamoxifen for this condition in more than 225 patients, adverse events were uncommon but can include body aches, low sex drive, and fatigue.

The aromatase inhibitor anastrozole was not shown to be more effective than placebo in a randomized, double-blind, placebo-controlled trial in boys with pubertal gynecomastia. Although in an uncontrolled study of 10 patients with pubertal gynecomastia, the selective estrogen-receptor modulator raloxifene was shown to result in more than a 50% decrease in the size of the gynecomastia in the majority of the boys, there is insufficient data to recommend its use at this time.

Lowering the testosterone dose had not proven helpful for the two patients in Dr. Rabkin's study. The use of antiestrogens, such as tamoxifen 10 mg twice daily, with lower doses of testosterone has been effective. Some physicians prescribe low dose aromatase inhibitors for men with early-onset gynecomastia. Gynecomastia can become permanent if the condition lasts very long, although it may reduce in size when androgen use is discontinued. In the absence of resolution, surgical correction may be necessary in severe cases.

For men who experience enlarged breast size, doctors usually check estradiol levels to determine whether too much testosterone is being converted into estrogen. However, physicians usually forget that other hormone metabolites like DHT and IGF-1 may be involved in the development of gynecomastia, so they do not include these tests in the diagnostic panel.

Warning: Bringing estrogen down to very low levels could cause health problems in men in the long run. Hair/skin quality and health, brain function, bone density, lipids, sexual function, and other important factors may be greatly influenced by estrogen.

More information about estradiol and gynecomastia.

Bibliography:

Braunstein, G. D., M.D. (2007). Gynecomastia. The New England Journal of Medicine, 357(12), 1229-1237.

Schulster M, Bernie AM, Ramasamy R. The role of estradiol in male reproductive function. Asian J Androl 2016;18:435-40

Gynecomastia FAQ

Here are a few answers to some of the questions you might have about gynecomastia.

1. Is Gynecomastia Painful?

Some patients might experience mild pain in their chest area as well as tenderness, especially when gynecomastia gets into an advanced state. However, the pain is not sharp or intense, and it usually goes away once proper treatment for gynecomastia is administered.

2. Does the Breast Tissue Subside Once Gynecomastia Is Treated?

One of the main concerns of patients with gynecomastia is whether the breast tissue will continue to "hang" after the condition is treated. Unfortunately, the tissue will not subside on its own in most cases, but there are solutions to this problem. Once the underlying cause of gynecomastia is treated, patients can perform small surgeries to remove the excess breast tissue and achieve a more "manly" chest.

3. Does Scarring Occur After Removing the Breast Tissue?

Luckily, the scarring is minimal around the nipple area and almost invisible. Patients can go to the beach and not worry that someone will see that they had gynecomastia surgery because the scarring is virtually non-existent.

4. Are There Any Other Drugs or Substances Which Cause Gynecomastia?

Certain drugs or substances might cause gynecomastia such as marijuana, steroids, or other performance-enhancing drugs. However, men might develop breast tissue enlargement as a result of consuming high amounts of alcohol too. Alcohol can damage the liver, which in turn decreases the production of testosterone.

At the same time, certain drugs such as spironolactone, ketoconazole, and others can also trigger the development of gynecomastia. Cimetidine, which is a drug used to treat ulcer, is also associated with this type of health issue.

Conclusions

Treating gynecomastia can be done with relative ease these days, as long as you are aware of its existence. For a complete and thorough test which helps you diagnose this condition quickly, check out the Gynecomastia Test Panel. You can use a blood sample to perform this lab test panel from Discounted Labs, and you receive the results in just a few business days. The results can help your doctor decide what therapies are best for you to eliminate your gynecomastia.

Reference:

Sansone A, et al. Gynecomastia and hormones. Endocrine. DOI 10.1007/s12020-016-0975-9

Suggested Reading: Testosterone Replacement Blood Test Targets

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