Introduction:
Gynecomastia is enlarged breasts in men. The condition is often due to an imbalance of estrogen and testosterone hormones in the body. It occurs in older adulthood, puberty, and the newborn period in men. The person can feel the breast lump under their nipples. It is tender and moves within the breast tissue. Gynecomastia is an uncommon disorder where a button-sized growth is seen below the nipple. A breast lump is felt when pressed over the area. It is found in either one breast or both breasts. This article describes the causes of gynecomastia and its treatment.
How Does Liver Function Cause Gynecomastia?
Gynecomastia is mainly due to estrogen imbalance. It affects teenagers and adults. These men have a drop in testosterone and a rise in estrogen hormone which is the crucial factor for breast development in males. It is more common above the age of 50 in men and when they are more fat it stimulates breast growth and estrogen production.
One of the main reasons for hepatic cirrhosis is gynecomastia. The liver is responsible for:
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Breaking down the hormones after use by the body.
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It metabolizes the drugs.
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Produces blood clotting factors and proteins.
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Processes food nutrients.
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Regulates the balance of sex hormones, cortisone, thyroid, and adrenal hormones.
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Removes excess hormones from the body.
How Does the Liver Cause Hormone Imbalance?
Hormonal imbalance is when there is too less or high of a hormone.
The symptoms of hormone imbalance include fatigue, loss of libido, and mood symptoms. The symptoms include:
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Unexplained weight gain or weight loss.
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Irritability, anxiety, difficulty sleeping, fatigue.
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Excessive sweating, changes in sensitivity to cold and heat.
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Dry skin, rashes.
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Changes in heart rate and blood pressure.
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Weak or brittle bones.
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Digestive issues.
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Reduced sex drive.
The liver is the site of the biosynthesis of estrogen. The estrogens are further biotransformed in the liver. They are synthesized by aromatase in the peripheral tissues of the liver and are released into the bloodstream. The liver takes up the estrogen and is biotransformed into various metabolites. Estrogens affect many organs and contribute to the regulation of liver lipid metabolism and serum lipoprotein levels. More than 40 percent of the metabolism of estrogen takes place in the liver. The liver is the main site for the metabolism of estrogen. After the methylation of estrogen, they are excreted easily. Animal protein is an important form of sulfur. Glucuronidation is a process by which estrogens are conjugated. The breakdown of estrogen is a complicated process and is influenced by many factors.
How Does Estrogen Cause Gynecomastia?
Estrogen is not exclusively a female hormone. Men also produce it. When males' estrogen levels are too high along with high testosterone it causes gynecomastia. Changes in the hormonal levels because of the liver problem are associated with gynecomastia. There is increased production of estrogen hormones (estrone and estradiol) in liver patients. The estrogen concentration increases fourfold in live cirrhosis patients than in normal patients. If the liver is not functioning properly, it cannot eliminate the high estrogen levels in the blood. The liver gets poorly metabolized and gets reabsorbed in the body which leads to hormonal imbalance. The liver is the organ that eliminates the estrogen from the body. When the liver does not function at its best, the estrogen starts accumulating in the body.
How Does Cirrhosis of the Liver Cause Gynecomastia?
Cirrhosis of the liver is a form of late-stage liver disease. The scar tissues are formed in place of healthy tissues. There is cell death and inflammation in the liver. It is followed by repairing and scarring. The scar tissue blocks the blood flow to the liver. The liver’s ability to process hormones, nutrients, and drugs does not happen properly. Due to high estrogen levels, the breast tissues start growing. In men, testosterone gets higher and estrogen increases the size of the breast tissues. Gynecomastia is direct with body mass index and with age. Individuals with severe cirrhosis usually are very thin. Gynecomastia causes reduced circulating testosterone, an elevated estrogen resulting in an increased estrogen-testosterone ratio. Men with cirrhosis produce less testosterone and there is an increased conversion of androstenedione to estrone.
What Is the Diagnosis of Gynecomastia?
Breast cancer or lumps are diagnosed by using ultrasound to view breast growths.
Mammogram is used to examine unusual growths in the breast tissues. Physical examination is done on breast tissue that may extend to the abdomen and genitals. Biopsy or blood tests are done to rule out breast cancer. Imaging tests such as MRI (magnetic resonance imaging) scans, mammograms, chest X-rays, and testicle ultrasounds are done.
The conditions that are similar to gynecomastia symptoms are:
- Breast Cancer- It is uncommon in men and enlargement of one of the breasts or the presence of a form nodule can be a sign of male breast cancer.
- Breast Abscess- A breast abscess is an infection of the breast tissue.
What Is the Treatment for Gynecomastia?
The treatment includes:
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Gynecomastia in pubertal males goes away on its own.
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Medication is given to adjust the hormone imbalance.
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Surgery is done to remove the excess tissue in the breast. Male breast reduction surgery is done for the treatment of gynecomastia. Medical treatments are available to treat gynecomastia. Testosterone replacement has been effective in older men.
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Clomiphene is used to treat gynecomastia which is taken for up to 6 months. The drugs such as Tamoxifen and SERM (selective estrogen receptor modulator) reduce the breast volume in gynecomastia. This therapy is used for painful gynecomastia. Reduction mammoplasty (surgery done to modify the shape of the breast) is used in severe cases in cases where drugs do not work effectively.
Conclusion:
Gynecomastia associated with liver problems can be treated by treating the underlying liver problems. Medications reduce the high blood pressure in the veins of the liver that supplies the liver with blood. A doctor can always pinpoint the cause of the condition and if someone finds the breast size abnormal it is always better to seek professional help if the person is embarrassed, talking to mental health can help a great deal.
