madman
Super Moderator
Gynecomastia in boys is breast enlargement due to hormonal imbalances, including androgen-estrogen changes and other hormone effects. Common causes include puberty, obesity, drugs, and hypogonadism. Other conditions like liver/renal problems, thyrotoxicosis, Klinefelter syndrome, tumors, and pollutants can also trigger it. Diagnosis involves history, exams, and focused tests. Treatment addresses underlying issues, like testosterone for hypogonadism. Some cases resolve naturally. Medical management helps with simple cases; tamoxifen works for adolescent gynecomastia. Other drugs like clomiphene, danazol, letrozole, and anastrozole lack consistent success in this age group. Severe, chronic cases might require surgery.
Key Takeaways:
*Pubertal gynecomastia, which refers to breast enlargement in boys during puberty, typically resolves on its own in 85-90% of cases within 6 months to 2 years. This should be explained to both the boy and his parents, especially when the gynecomastia is less severe.
*Treatment for gynecomastia is required for some patients, depending on the underlying cause and severity of the condition. Underlying diseases like thyrotoxicosis, liver, or renal failure should be treated first, and gynecomastia regression often depends on resolving the underlying condition. Tumors causing breast enlargement may require surgical removal.
*If significant gynecomastia is present and underlying diseases are ruled out, medical management is tried before considering surgery. The choice of medication depends on the clinical condition. Treatment initiated within the first year from onset tends to yield better results due to less fibrosis. Treatment may involve testosterone for hypogonadism and drugs like tamoxifen, danazol, raloxifene, letrozole, anastrozole, or clomiphene have been tried with varying success.
*Tamoxifen, an estrogen receptor inhibitor, is effective for idiopathic gynecomastia. A dose of 10-20 mg twice daily for 3-6 months can lead to clinical improvement, with around 80% effectiveness and 60% complete resolution. Other drugs like danazol, raloxifene, letrozole, anastrozole, and clomiphene have been tried with varying success.
*If medical therapy fails or activities of daily living are affected, surgical treatment may be considered. Minimally invasive procedures like subcutaneous mastectomy, ultrasound-assisted liposuction, and suction-assisted lipectomy can provide faster recovery and fewer complications. Surgery is usually deferred until after puberty to avoid recurrence.
*Gynecomastia treatment should be tailored to each patient's condition for optimal outcomes. Some cases of gynecomastia, including those related to obesity and drug-induced causes, can resolve without surgery or medications.
Key Takeaways:
*Pubertal gynecomastia, which refers to breast enlargement in boys during puberty, typically resolves on its own in 85-90% of cases within 6 months to 2 years. This should be explained to both the boy and his parents, especially when the gynecomastia is less severe.
*Treatment for gynecomastia is required for some patients, depending on the underlying cause and severity of the condition. Underlying diseases like thyrotoxicosis, liver, or renal failure should be treated first, and gynecomastia regression often depends on resolving the underlying condition. Tumors causing breast enlargement may require surgical removal.
*If significant gynecomastia is present and underlying diseases are ruled out, medical management is tried before considering surgery. The choice of medication depends on the clinical condition. Treatment initiated within the first year from onset tends to yield better results due to less fibrosis. Treatment may involve testosterone for hypogonadism and drugs like tamoxifen, danazol, raloxifene, letrozole, anastrozole, or clomiphene have been tried with varying success.
*Tamoxifen, an estrogen receptor inhibitor, is effective for idiopathic gynecomastia. A dose of 10-20 mg twice daily for 3-6 months can lead to clinical improvement, with around 80% effectiveness and 60% complete resolution. Other drugs like danazol, raloxifene, letrozole, anastrozole, and clomiphene have been tried with varying success.
*If medical therapy fails or activities of daily living are affected, surgical treatment may be considered. Minimally invasive procedures like subcutaneous mastectomy, ultrasound-assisted liposuction, and suction-assisted lipectomy can provide faster recovery and fewer complications. Surgery is usually deferred until after puberty to avoid recurrence.
*Gynecomastia treatment should be tailored to each patient's condition for optimal outcomes. Some cases of gynecomastia, including those related to obesity and drug-induced causes, can resolve without surgery or medications.
