By the term gynecomastia, we mean the accumulation of adipose tissue beneath the mammary gland, leading to breast tenderness and enlargement in the male.
This term is often used by bodybuilders, due to accumulated estrogens under the nipple (areola).
Estrogen levels that are in imbalance with testosterone levels (increased ratio of of estrogens/androgens) are responsible for the development of gynecomastia.
Furthermore, estrogens can increase serum levels of sex hormone binding globulin (SHBG), which binds free testosterone (the active form-FT), leading to decreased levels of FT and testosterone’s action in male mammary gland.
Medications which can cause gynecomastia include:
– Androgenic-anabolic steroids (AAS) converted to estrogens (beta estradiol) by the enzyme aromatase.
Estrogenic AAS are: Nandrolone, Equipose, Testosterone, Methandienone, and Methyltestosterone.
– Finasteride, an anti-androgen used in the treatment of benign prostate hyperplasia (BPH).
– Spironolactone, a diuretic with anti-androgenic property, can produce dose-dependent gynecomastia.
The fact that the adrenal cortex produces a fair amount of dehydroepiandrosterone (DHEA), it is understandable, that abuse of spironolactone will lead to gynecomastia
– Ranitidine-Cimetidine: used in the treatment of duodenal ulcer
– Opioids pain killers: codein
– Marijuana
– Barbiturates: Diazepam
Initially, the problem is addressed by reducing weight and lowering body fat percentage, accompanied by resistance training.
If there is no improvement, the athlete should undergo a hormonal blood panel (beta estradiol, estrone, prolactine), which could reveal any supraphysiological serum levels of these hormones.
Accordingly, he should use an anti-estrogen (tamoxifen with mesterolone, or aromatase inhibitors, such as anastrozole, letrozole and exemestane).
If the problem persists, then the gland should be removed surgically (mastectomy).
Liposuction is a surgical procedure, which removes breast fat, but not the breast gland tissue itself.
It should be noted that, gynecomastia is a purely aesthetic condition.