Gynecomastia in Elderly Males: Understanding Male Boobs

Introduction:

Sexual characteristics are important for proper human growth and development. Development of primary and secondary sexual characteristics is seen in the adolescent period. During this phase, the growth and development of sexual organs are noted. The development of breasts is one of the important phenomena for girls. However, in certain cases, the development of breasts is observed in males also. This is particularly seen in elderly males.

What Is Gynecomastia?

Gynecomastia is known as male boobs or male breasts. The breast is a glandular organ located in the chest. It is made up of glands, connective tissue, and fat. Contrary to the idea that only females have breasts, the breast is present in both males and females. Anatomically and structurally, both breasts are almost similar in composition. The only difference between male and female breasts is the absence of lobules, which are important for milk production in males. The natural size and the growth of the female breast are attributed to the action of several female sex hormones. The hormones that are important for the growth and development of female breasts are estrogen and progesterone. Other than this, hormones like growth hormone, follicular stimulating hormone, and luteinizing hormone play important roles in the growth and development of this hormone. The absence of the hormone in higher amounts in the male body is associated with the non-development of boobs in males.

Enlargement of the glandular and fat tissues in the male body is known as gynecomastia. This type of growth of the breast is benign in nature. In most cases, it is seen in neonates and adolescents. However, those changes are temporary and caused by ongoing hormonal development due to physiological changes. Hormonal imbalance in the males is responsible for this condition.

In most cases, these hormonal changes are caused by age-related changes or due to other pathological conditions. Pathological conditions are tumors in the glands, such as the adrenal, pituitary, and testes. Apart from this, several drugs like Risperidone, Verapamil, Nifedipine, and HIV drugs are responsible for this, along with this, chemotherapy, radiation therapy, and diseases like hyperthyroidism, liver disorder, and Kallmann’s syndrome (a disorder characterized by the absence of puberty).

What Is Gynecomastia in the Elderly?

Gynecomastia in elderly males is very common. Almost 70 percent of males show the development of breast tissues.

1) Pathophysiology:

Gynecomastia in elderly males is mainly caused by andropause. This is also known as male menopause. Technically, this is a misnomer as a menstrual cycle is absent in males. However, a sudden change in the male hormone level is responsible for this. Testosterone, the main male sex hormone, plays a crucial role in regulating various male sexual functions such as sex drive, muscle mass, bone density, and the functionality of male sex organs. Almost 45 percent of testosterone is bound to sex hormone-binding globulin (SHBG), which lacks androgenic potential. Only 2 percent of testosterone remains unbound.

Meanwhile, around 43 percent of testosterone is bound to albumin, which does have androgenic potential. Bioavailable testosterone, which is responsible for androgenic functions, includes albumin-bound and free testosterone. In elderly people, the level of free testosterone decreases by less than 1.2 percent per year after the age of 40. The reduction in albumin-bound testosterone and free testosterone is approximately one percent and 0.4 percent, respectively. Additionally, aging leads to a decrease in Leydig cell mass in the testicles, contributing to lower testosterone levels. In some cases, dysfunction in hypothalamic-pituitary homeostatic control is observed. These factors collectively result in an overall reduction in testosterone levels. Such changes are primarily seen in the sixties and seventies.

These changes are responsible for a shift in the estrogen and testosterone ratio. Along with this increased rate of metabolic product from dehydroepiandrosterone and DHEAS-androstenediol (a precursor of sex hormones) is seen. These metabolic byproducts also have estrogenic action. The higher serum concentration of estrogen in the elderly is associated with the deposition of fat and overgrowth of the glandular tissue.

2) Risk Factors:

Apart from increasing age, several other factors are associated with high levels of estrogen in elderly males. These factors are;

1. Obesity is one of the main risk factors for higher levels of estrogen in elderly males. Due to metabolic slowdown and altered lifestyle, increased fat deposition is seen in elderly males. This deposition is mainly seen around the abdomen and the buttocks. Increased fat levels are associated with increased levels of aromatization and estrogen in the body.

2. Consumption of excessive amounts of alcohol and smoking is responsible for decreased amounts of testosterone in the body. This is responsible for altering the testosterone and estrogen ratio in the body.

3. Chronic hypertension, which is very common in elderly males, is associated with the development of male boobs. Calcium channel blockers like Verapamil and Nifedipine cause decreased levels of testosterone. This action is attributed to a decreased level of gonadotropin hormone-releasing hormone (GnRH) and an increased level of prolactin in the body. Also, these drugs are responsible for increased levels of estrogen due to the inhibitory function of cytochrome P450 3A.

4. High levels of thyroid hormone or thyrotoxicosis are another important factor for low levels of testosterone in the blood. The liver produces a high amount of SHBG when there are high levels of thyroid hormones in the body. This causes low levels of testosterone in the blood.

What Are the Treatments for Gynecomastia in the Elderly?

As this is an age-related hormonal change, treatment is not usually necessary. Certain precautions are sufficient enough to address the issue. These are;

1. Stoppage of destructive habits like smoking and consumption of alcohol.

2. Maintain a healthy lifestyle and maintain proper body weight.

3. Regular exercises and weight training are beneficial in improving testosterone levels in the body.

4. Drugs responsible for hormonal changes need to be altered.

5. In severe cases, surgical correction and removal of glandular tissue can be done.

6. Estrogen modifiers like Tamoxifen or Raloxifene are beneficial in reducing the level of estrogen in the blood.

Conclusion:

Gynecomastia is very common in elderly people. It is seen due to hormonal changes in the body. Aging is one of the main causes of reduced testosterone in the body. Apart from this, obesity, hypertension, thyroid disorder, and smoking may cause gynecomastia in males. Severe cases can be treated by surgical correction.