Gynecomastia Types
Gynecomastia can be classified into two types. This classification helps in assessment of the condition clinically. Classifying a presenting case of gynecomastia in either of the two types helps the physician in devising strategy to deal with the case.
Physiological gynecomastia
This type accounts for the ways in which the normal physiological mechanisms lead to hormonal fluctuations and gynecomastia. This type includes:
- Neonatal mastauxe: is the term for breast enlargement in neonates, as a result of influence of maternal estrogen transferred during the fetal life to the baby, through the placental barrier. It is mostly a temporary condition, and tends to go away by the second or third week. In some cases, where the pectoral swelling does not regress, it can be due to other pathological causes, which do not come under the heading of physiological gynecomastia.
- Pubertal gynecomastia: is the term used for the incidence of gynecomastia in preteens and teenage boys. It has an average onset at 10-12 years of age, and tends to persist for a span of 18 months, after which it normally regresses. Gynecomastia in this age group may be due to transient increase in functioning of the aromatase enzyme, increased concentration of estradiol, or delay in achieving the pubertal peak of testosterone.
- Involutional gynecomastia: is the term used for gynecomastia seen in elderly males, due to decreased testosterone production with advancing age. The breast enlargement in this age is also due to increased stores of accumulated fat over time. The condition is not reversible on its own. However, as the presentation is due to normal physiological lagging of testosterone, it comes under this heading.
Non-physiological gynecomastia
Gynecomastia, resulting as a pathology of other organs, or conditions that are not physiological in nature, is classified under this heading. There may be multiple causes of pathological gynecomastia. The medicinal side-effect is top of the chart. A number of drugs as discussed above can cause disruption in the normal regulatory mechanisms of testosterone levels, and result in gynecomastia.
Klinefelter syndrome is an example of congenital condition that comes with a compromised testicular function, and has a high incidence of presenting with gynecomastia.
Similarly, liver and kidney disease can also cause abnormality in the metabolism of testosterone. Some of the causes of non-physiological gynecomastia are:
- Tumors
- Congenital conditions
- Hypogonadism
- Chronic illnesses
- Endocrine abnormalities.
All these cases can result in gynecomastia by different mechanisms. Decreased production of testosterone, surge of estrogen and increased binding of serum testosterone, all result in decreased effects on target organs, including breast tissue. Non-physiological gynecomastia can occur at any age. It may be reversible by curing the underlying cause, and in some cases like steroid use, the change in the appearance of the breast tissue may be permanent. Other, less important causes can be testicular injury in mumps, and malabsorption disorders.
Most of the treatment plans are sought in this type of gynecomastia. Non-physiological gynecomastia can be a serious challenge to the mental and psychological health of the patients.