Enlargement of the male breast tissue. Greek word Gynae-women mastos-breast Presence of >2cm of palpable,firm,sub areolar gland and ductal breast tissue. A benign enlargement of the male breast resulting from a proliferation of the glandular component of the Brest. It may cause due to the changes in endocrine system, presence of chronic diseases, certain metabolic dysfunctions. Gynaecomastia is the enlargement of male breast tissue. It’s a common, benign (not cancer) condition that mainly affects teenage boys and older men, but it can affect men at any age.

1. GYNAECOMASTIA
BY -- Mocharlla . Mallikarjuna
Ratnam Institute Of Pharmacy
Pidathapolur,Muthukur
SPSR Nellore,A.P-524346
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GYNAECOMASTIA
BY -- Mocharlla . Mallikarjuna
Ratnam Institute Of Pharmacy
Pidathapolur,Muthukur
SPSR Nellore,A.P-524346

2. Introduction
Enlargement of the male breast tissue.
Greek word Gynae-women
mastos-breast
Presence of >2cm of palpable,firm,sub areolar gland
and ductal breast tissue.
A benign enlargement of the male breast resulting
from a proliferation of the glandular component of the
Brest.
It may cause due to the changes in endocrine
system, presence of chronic diseases, certain
metabolic dysfunctions.
Gynaecomastia is the enlargement of male breast
tissue. It’s a common, benign (not cancer) condition
that mainly affects teenage boys and older men, but it
can affect men at any age.

4. Sings & Symptoms
Brest enlargement with soft,compressible,and mobile
subcutaneous chest tissue palpated under nipple areola
in contrast to softer fatty tissue.
Enlargement may occur on unilaterally or bilaterally, or
both.
Appear anxious or stressed due to concerns about the
possibility of having breast cancer.
An increase in the diameter of the areola and
asymmetry of chest tissue.
Swollen breast gland tissue.
Breast tenderness.

5. Causes
It may occur at any time and there are number of
causes.
Physiologic
Many new born infants of both sexes show breast
development at birth or in the first weeks of life.
During pregnancy, the placenta converts the androgenic
hormones DHEA and DHEA Sulphate to the estrogenic
hormones.
After these estrogens are produced by the placenta,
they are transferred into the baby’s circulation thereby
leading to temporary gynaecomastia in the baby.
In some infants fluid can be expressed.
Non-physiologic
10 to 25% of cases are estimated to result from the use
of medications.

6. Anti fungal agents-ketoconazole
Corticoids-gonadotropin releasing hormone.
Anti androgens used to treat prostate enlargement
e.g.: flutamide-proscar
finasteride-propecia
spironlactone-Aldactone.
Anabolic steroids and androgens
It can develop in HIV+ve patients, who are receiving a
treatment regimen called highly active anti retro viral
therapy(HAART).eg:efavirenz-sustiva is more commonly
associated with gynaecomastia than other HIV
medications.
Anti anxiety-diazepam(valium)
Tricyclic anti depressents,Antibiotics
Duodenal ulcer patients after more than four months
treatment with cimetidine 1.6 g daily.
Abused to alcohal,marijuana,heroine etc,.

7. Chronic disease
1. Kidney failure
Patients experience a hormonal imbalance due to the
suppression of testosterone production
Leads to testicular damage from high levels of
urea(uremia-associated hypogonadism)
2. Liver failure or cirrohosis
Metabolize hormones such as estrogens may be
impaired
Those with alcoholic liver disease or further put at risk for
development of gynaecomastia
Ethanol directly disrupt testosterone ratio
Cystic fibrosis or ulcerative colitis may also produce
gynaecomastia due to malabsorption.

8. Tumours
Peutz-jeghers syndrome result in testicular tumours such
as leydig cell tumours or sertoli cell tumours.
Prolactinoma is a pitutory gland tumour can produce
hormones that alter the male-female hormone balance
and cause gynaecomastia.

9. Grade or Type Description Severity
1
A localized button of
tissue that is
concentrated around the
areola
Very mild
2
Moderate breast
enlargement exceeding
areola boundaries
with edges that are
indistinct from the chest
Mild to high
3
Moderate breast
enlargement exceeding
areola boundaries
with edges that are
distinct from the chest
with skin redundancy
present
High and visible
4
Marked breast
enlargement with skin
redundancy and
feminization
Severe and visibly
feminine

10. Pathophysiology
Oestrogen stimulates breast tissue growth while androgens
inhibited.therefore,it may be caused by:
Conditions which cause raised oestrogen levels
Conditions which cause low testosterone levels
Conditions which affect levels of sex hormone-binding
globulin(SHBG),as it affects the free testosterone:
oestrogen balance
Conditions which cause androgen resistance
Aromatase :
1.p450 enzyme
2.cyp19 gene
3.located in chromosome15 in endoplasmic reticulating
cell
4.action on testes,brain,skinfibroblasts,adipocytes.
5.incresed levels of aromatase

11. Dehydroepi androsterone
Androstenedione Estrone
Testosterone Estradiol
Estriol
Role of aromatase in synthesis of sex hormones
Aromatase
Aromatase

12. MOA :

13. Epidemiology
Gynaecomastia is common and is thought to be
present in at least a third of men in the course of theire
lifetime.
Prevalence of asymptomatic gynaecomastia is reported
as 60-90% of neonates,50-60% of adolescents, and
70% in men aged 50-69.
Breast cancer is only detected in 1% of cases of male
breast enlargement.
Diagnosis
 Pseudogynecomastia
Breast carcinoma
Neurofibroma(a case of prepubertal gynaecomastia)
Lipoma
Dermoid cyst

14. Blood tests
Renal function.
LFTs
TFTs
Hormone
profile:estradiol,testosterone,prolactin,beta-human
CG levels, alpha-fetoprotein
LH levels
high LH,low testosterone-testicular failure
LH,testosterone both low-increased oestrogens
LH,testisterone both high-androgen resistance or
neoplasm secreting gonadotrophins.

15. Mammogram of ductal tissue :

16. Basically this means a guy has enlarged breast.
 This is relatively common in people who are
overweight, though gynecomastia is not usually
accompanied by lactation.
The causes of gynecomastia are a little
mysterious, but it’s generally thought to be caused
by an imbalance of sex hormones — too much
estrogen or not enough testosterone, or both.
 It may also be caused by changes in the breast
tissue that makes the tissue more sensitive to the
action of even the low level of estrogen normally
found in men.
‘Why is my friend’s boyfriend
lactating?’
Is the reason gynaecomastia ?
(http://www.drharryfisch.com/male-lactation)
CASE STUDY :

17. Treatment
By using medicines
Tamoxifen (soltamox)
Raloxifene (Evista)
By surgery
Liposuction:-removal of breast fat
not breast gland tissue
Mastectomy:-removal of breast gland by
introducing small incision

20. LIPO SUCTION :

22. Mastectomy :

24. 1. Turmeric
Turmeric is a well-known home remedy for gynecomastia.
This spice can increase the testosterone hormone levels in
males. When the level of testosterone becomes high, large
breasts in men naturally reduce in size. Plus, turmeric
promotes liver health and helps burn fat.
Add 1 or 2 teaspoons of turmeric to a cup of water and
heat it for 10 minutes. Drink it 2 or 3 times a day and
especially before going to bed. Repeat daily and within a
few weeks you will notice the changes.
You can also take turmeric capsules under the guidance
of a doctor.
Note: Consult your doctor before taking turmeric as a
remedy as it can make stomach problems like GERD
worse in some people. Plus, it may worsen gallbladder
problems and interfere with blood thinning medications.

25. 2. Fish Oil
Fish oils are rich in omega – 3 fatty acids that
are beneficial for men with gynecomastia
because they help in the production of
testosterone.
Plus, these fatty acids help reduce estrogen
levels, which is one of the reasons behind the
growth of male breasts.
Take fish oil supplements. You can also take
omega-3 supplements. Consult your doctor for
the correct dosage and usage.
Eat cold-water fish like salmon, tuna and
mackerel that are rich in omega-3 fatty acids

26. 3. Cold Compress
 Gynecomastia often causes the breasts to become
tender and even painful at times. For tender breasts,
you can apply cold compresses.
The cold temperature will cause the tissues to
contract. This in turn will reduce swelling and pain
1.Wrap a few ice cubes in a thin towel.
2.Put this cold compress on each of the breasts for 1
minute only.
3.Follow this treatment as needed.
Note: Do not apply ice directly on the skin as it can
cause frostbite

27. Due to its testosterone-boosting properties, passionflower
may help in the natural treatment of gynecomastia.
It contains a compound called chrysin that keeps the body
from breaking down testosterone.
This herb can also help with withdrawal from alcohol as
well as certain drugs.
•Steep 1 teaspoon of dried passion flower in 1 cup of water
for 10 minutes. Strain and drink this herbal tea a few times a
day.
•Another option is to take this herb in supplement form. For
proper dosage consult your doctor.
Passion Flower

28. Consuming zinc-based foods also helps in the
treatment of gynecomastia, especially when it is caused
by low testosterone.
It has been found that zinc increases testosterone
naturally. Several studies have shown that zinc
deficiency can lead to decreased levels of testosterone.
Low testosterone is one of the leading causes of
gynecomastia.
Eat foods that are high in zinc like oysters, fortified
breakfast cereal, lobster, cashews, yogurt, raisins and
chickpeas.
You can also take zinc supplements after
consulting your doctor.
5. Zinc supplements:

29. If your breast enlargement is due to liver disease,
milk thistle is a good treatment. The active
constituent silymarin in milk thistle is known
to improve liver functioning.
Add 1 tablespoon of crushed milk thistle seeds to
3 cups of water. Heat until boiling, remove from
heat and steep for 20 minutes. Strain and add a
little honey. Drink this tea 2 times a day for a few
weeks.
You can also take this herb in supplement form.
For proper dosage, consult your doctor.
6. Milk Thistle

30. Flaxseeds also contain omega-3
fatty acids that help raise
testosterone and reduce
estrogen levels. Plus, they contain
higher concentrations of lignans
that balance estrogen activity and
have antiestrogenic qualities.
Flaxseeds also aid in the removal of harmful toxins from the
body.
•Add 1 tablespoon of ground flaxseed to a glass of hot water and
consume it daily until you see improvement.
•Another option is to take 1 or 2 tablespoons of flaxseed oil daily
for a few weeks.
•You can also add ground flaxseed to smoothies and baked goods
such as breads and muffins.
7. Flaxseed :

31. Prevention
Consult the doctor if swelling,pain,tendeerness,nipple
discharge in one or both breasts.
Don’t use illegal drugs: steroids
androgens,amphetamine,heroine,marijuana.
Avoid alcohol.
Review your medication.
Reference
Niewoehner CB, Schorer AE;Gynaecomastia and breast cancer in men.
Breast cancer incidence statistics;cancer research UK.
www.who.com/gynaecomastia
Essentials of medical pharmacology by KD Tripathi/hormones and related
drugs
Essential of pharmacology by Padhmaja
udhaykumar/eastogens,progestins and contraceptives.
www.top10homeremidies.com/gynaecomastia