Treatment of Gynecomastia Number of Factors, Including The Cause, and Duration

Treatment of gynecomastia. Gynecomastia is an increase in breast size in men due to abnormalities in hormone levels, which can also be a symptom of certain diseases. Find out their possible causes and treatment. Surgery is used when gynecomastia does not respond to medical treatment.

The treatment of gynecomastia depends on a large number of factors, including the cause, duration, severity and presence or absence of other symptoms. The main pillars of breast augmentation in men are:

Expectant attitude: The most common and recommended position when observing true gynecomastia, taking into account that in most cases the problem is physiological, temporary or secondary to a cause that can be treated or suspended. We should reassure the patient about the problem diet and we conduct reviews every 3 to 6 months to see evolution.

Drugs:

• Tamoxifen: is a selective estrogen receptor modulator (SERM). Is the most studied drug, and at present, which shows the best results. It has good results in reducing breast size, improving associated symptoms such as pain, and even complete remission in a few years in 50-80% of cases. No significant recurrences or side effects were observed. This is a first line treatment.
• Raloxifen: It is also a selective receptor for estrogen receptors that inhibits the effects of estrogen in the breast. Although the results look good, their long-term effects are unknown.

Others

• Danazol: It is androgen reduces the production of FSH, LH and estrogen. It has harmful effects such as weight gain.
• Anastrozole: is an selective inhibitor of aromatase that reduces the levels of estrogen and increases the concentration of testosterone.

Surgery: Dedicated to confirmed cases of breast cancer, or when the gynecomastia is correct, which continues despite medical treatment or an important aesthetic or psychological problem for the patient. There are different techniques, the most commonly used are subcutaneous mastectomy, breast beautification, or liposuction. The results are usually very aesthetically good for presentation.

Preventive treatment of gynecomastia in patients receiving hormone therapy for prostate cancer: Because of the high rate of gynecomastia in these patients (which may be the reason for giving up treatment) preventive treatment has been suggested to prevent the appearance of gynecomastia. The two most common alternatives are radiotherapy and tamoxifen.

Gynecomastia depends on the type of patient, age or disease.

Gynecological treatments according to the type of patient

Depending on the patient's age and other characteristics, different treatments are used to treat gynecomastia:

Teenagers:

• In most adolescents with gynecomastia, it is recommended to monitor and re-evaluate in a period of 3 to 6 months, because most of them decide automatically.
• In young people with obvious gynecomastia, where it has been shown that glandular tissue is already present in the breast, and that they are self-conscious due to severe gynecomastia, SERM can be used as tamoxifen for three months. Raloxifen is not recommended (lack of experience with this drug in such young patients).
• Hormone inhibitors are not recommended, as they do not appear to be effective.

Adults:

• In most adult men with gynecomastia, initially, it is recommended to observe and wait. Patients suffering from drug-induced gynecomastia or produced by underlying latent disorder will be followed (such as hypothyroidism or hyperthyroidism), because once the trigger is processed, gynecomastia disappears.
• In these men who are not recognized for the cause of gynecomastia and continue for more than three months, it is recommended to start treatment with SERM for 3 to 6 months, the most common is tamoxifen (there is little experience with Raloxifen). Hormone inhibitors are not very effective according to the results of recent studies.
• In men who suffer from continuous gynecomastia (more than a year or two), where this assumes the presence of stigma and surgery is complicated, it is recommended to perform cosmetic surgery, because the breast tissue after this long time is already fiber, there will be no drug response.

Patients with prostate cancer:

• For prevention of gynecomastia in men with advanced prostate cancer who are subject to high doses of antandrogen in monotherapy, treatment with tamoxifen is recommended to reduce the risk of gynecomastia. Radiation can be performed proactively to prevent the appearance of gynecomastia in some cases.
• The use of aromatase inhibitors is not recommended for the prevention of gynecomastia, as it does not appear to be effective.
• In those men who have already developed gynecomastia by treatment with anti-androgens, treatment with tamoxifen is recommended.