Gynecomastia - Treatment and Psychological Impact

Introduction:

Gynecomastia surgery appears to be helpful in several psychological areas. Vitality, emotional distress, physical restrictions, and pain-related limitations are some of these. Both psychological well-being and quality of life are on the rise. However, the results are not indicative of all males affected with gynecomastia because they are based on data for a patient population in their mid-twenties.

The evidence is of quite low quality. Hence, further research is desperately needed to determine how the surgical gynecomastia intervention affects psychological domains. The current research has not taken into account the older patients who are impacted by the condition. More information on this topic may help identify the patients who will benefit from treatment and enhance the pre-operative assessment of these individuals.

What Is Gynecomastia?

The benign growth of glandular tissue in the breast in men is known as gynecomastia. It is typically brought on by high estrogen activity, low testosterone activity, or a combination of medications. The breasts enlarge. They could develop unevenly. According to reports, it typically appears in adolescence and affects as many as 65 percent of males. Gynecomastia frequently occurs with the hormonal shifts associated with puberty in boys who are preteens or teens. However, it can also affect males as they mature and newborns.

What Are the Psychological Effects of Breast Assessment and Disease in Men?

Male mental health is linked to traits like control, invulnerability, strength (both physical and emotional), and muscular growth. Even the BRCA2 gene is linked to male breast problems, as are feelings of shame, perceived stigma, vulnerability, melancholy, anxiety, injustice, loneliness, and fear of being marginalized or subjugated within gender hierarchies. According to research, 43 percent of men stated they would doubt their masculinity if they were given an MBC diagnosis; publications from all over the world support this opinion. Because of the psycho-sexual side effects of Tamoxifen, males with breast problems experience much more disturbances in their body image.

Persistently suppressing emotions is perceived as a trait associated with men that may have detrimental effects on one's health. The hypothalamic-pituitary-adrenal axis can become disrupted in severe cases, which can result in emotional and endocrine dysfunction as well as the emergence of psychosomatic illness. Prolonged emotional repression can result in headaches, persistent fatigue, obesity, and hypertension.

What Are the Causes of Gynecomastia?

1. Hormonal changes.

2. Antidepressants.

3. Chemotherapy.

4. Antibiotics.

5. Obesity.

6. Trauma.

7. Disorders of the thyroid.

8. Congenital disorders.

9. Tumor (lungs, testicular, adrenal gland, or pituitary gland).

10. Liver disorder.

11. Kidney disorder.

What Are the Psychological Effects of Gynecomastia in Adolescent Males?

Adolescents in this category frequently reported believing that their parents had "wanted a girl" when they were born or that their breast augmentation was their fault. Parental relationship problems were frequently associated with rejection because of one's "disfigurement." All of these individuals shunned chest exposure, and 68 percent of them said they identified in some way with the female sex, adopting submissive and passive behaviors. In the group under study, depression and even suicidal thoughts were prevalent, primarily in patients with pendulous gynecomastia.

Here is a list of problems one suffers from:

1. Depression.

2. Anxiety.

3. Low self-esteem.

4. Underconfident.

5. Avoidance of social gatherings.

How Is Gynecomastia Treated?

Medical Treatment:

Gynecomastia is treated medically with three groups of drugs:

• Aromatase: While randomized, double-blind, placebo-controlled trials have not demonstrated the effectiveness of these newer aromatase inhibitors, such as Letrozole and Anastrozole, they may have therapeutic value. Inhibitors like Letrozole and Anastrozole.

• Anti-estrogens:

  1. Clomiphene: Clomiphene at lower doses has produced inconsistent results; therefore, greater doses might be required if Clomiphene is to be tried.

  2. Tamoxifen: The strongest evidence supports Tamoxifen as an effective medical treatment for idiopathic acute gynecomastia.

• Androgens:

  1. Testosterone: When testosterone therapy is administered to hypogonadal men with gynecomastia, breast regression frequently does not occur once gynecomastia has developed. Gynecomastia is a rare and temporary adverse effect of testosterone therapy that can theoretically be caused by aromatization to estradiol.

  2. Dihydrotestosterone: Although not commercially available, dihydrotestosterone, a non-aromatizable androgen, has been administered with good response rates in patients with protracted pubertal gynecomastia.

  3. Danazol: In a planned placebo-controlled experiment, danazol, a weak androgen that suppresses gonadotropin secretion and lowers serum testosterone levels, was evaluated. Of the patients, 23 percent saw a resolution of gynecomastia, compared to 12 percent who received a placebo.

Surgical Treatment:

Surgical therapy is indicated when medical therapy proves to be ineffective, especially in situations of persistent gynecomastia, when the condition impedes the patient's everyday activities, or when there is a suspicion of breast cancer. In contrast, to reduce the risk of recurrent gynecomastia following surgery, surgical treatment for pubertal gynecomastia should be delayed until beyond puberty. Additionally, surgery ought to be postponed until the root cause of gynecomastia has been addressed. In surgical treatment, glandular tissue is removed together with liposuction if necessary, ideally using a customized strategy. These days, minimally invasive surgery is an option, and it may come with few side effects and a quick recovery. Histological testing is required if cancer is suspected.

What Is the Psychological Management of Gynecomastia?

One could argue that treating the psychological issue alone is the best course of action because gynecomastia is a benign condition. A few scientists countered this claim by arguing that lifetime therapy is necessary because no amount of therapy could resolve the underlying anatomic problem. It would not be in the patient's best interest to continue to enable these individuals to suffer from the psychological weight of depression and anxiety, with the associated risk of suicide and various self-harming behaviors. Gynecomastia and psychological dimensions appear to be strongly correlated; consequently, when treating these individuals, both the physical and mental components should be taken into account.

How Can Gynecomastia Be Prevented?

• Because it treats prostate cancer by blocking androgens, Tamoxifen is the most efficient preventive medication for gynecomastia. In individuals taking Bicalutamide for prostate cancer, Tamoxifen is more effective than radiation in avoiding gynecomastia. This was demonstrated in a randomized controlled study. To avoid gynecomastia in patients with prostate cancer, Tamoxifen is preferable over aromatase inhibitors.

• Abiraterone acetate, Enzalutamide, Apalutamide, and Darolutamide are examples of the new generation of anti-androgen medications that may be linked to a decrease in gynecomastia.

Conclusion:

Gynecomastia surgery is helpful in many psychological areas. Vitality, emotional distress, physical restrictions, and pain-related limitations are some of these. Both psychological well-being and quality of life are on the rise. However, the results are not indicative of all males affected with gynecomastia because they are based on information from patients in their mid-twenties.