Drugs that cause gynecomastia.
One is H2 receptor antagonists, i.e. cimetidine, ranitidine, etc.
The second is gastrofacial, this drug can make androgen and estrogen ratio imbalance, but also to promote prolactin secretion, thus making male breast enlargement, overflow.
The third is the antipsychotic drugs, mainly chlorpromazine, some statistics can make male breast enlargement up to 80%, but also can cause lactation. Long-term use of such drugs lead to lactation rate of 10% to 57%.
Fourth, antiepileptic drugs, phenytoin sodium makes the body androgen and estrogen ratio imbalance, estrogen levels are relatively high, prompting male breast development; carbamazepine can make prolactin increase, breast enlargement.
Fifth is lisdexamfetamine, the drug can be through the dopamine receptors, causing increased secretion of prolactin, promote male breast enlargement, but also impotence, its effect increases with the dosage, the daily dosage of greater than 400 mg, male breast enlargement rate of almost 100%, impotence rate of 30%.
Sixth is the calcium channel blockers, these drugs, such as nifedipine, isoptin, etc., can interfere with the inhibition of prolactin-releasing factor, so that prolactin increases, resulting in male breast enlargement.
Seventh, anti-arrhythmics, slow heart rhythm, acetaminophen and other drugs can cause an imbalance in the ratio of androgens and estrogens in men, resulting in breast enlargement.
There are other medications, diuretics androstenedione, which can cause gynecomastia and may even cause breast cancer when taken for a long time. Mercaptan prolene, colistin, brain prozac, isoniazid, ethambutol, ketoconazole and other drugs can also cause gynecomastia.
Endocrine diseases: testicular hypofunction (castration, congenital testicular hypoplasia), testicular tumors (Sertoli cell tumor, Leydig cell tumor, etc.), adrenal feminization tumors, hyperthyroidism, anterior pituitary tumors (acromegaly, suspicion of pheochromocytoma, craniopharyngioma), hermaphroditism, drug-induced breast development: gonadotropin preparations, estrogen preparations, testosterone, de Oxycorticosterone, digitalis, isoniazid, alpha-methyldopa, amphetamine, reserpine, chlorpromazine; non-endocrine diseases: leprosy, leukemia, neurological diseases (such as spinal cord injury, spinal cord cavitation, Friedreich’s ataxia), bronchial cancer, osteoarthrosis, liver disease; familial; idiopathic.
Under normal circumstances, the amount of estrogen and androgen secreted in the male body is in a relatively constant state. If the concentration of estrogen and androgen or their action on the mammary gland is not balanced, the mammary gland can be stimulated to overgrow; reduced plasma free testosterone levels may be due to primary testicular disease or due to increased SHBG. Male neonatal mastopexy is associated with high levels of estrogen not being cleared in time during fetal life. In adolescence, it is associated with a momentary imbalance of estrogen secretion in the body. Usually, patients have normal plasma estrogen and testosterone levels, but the ratio of estradiol to kucosterone can be increased, and the symptoms usually disappear on their own within a few months, or can last for as long as 1 to 2 years.
Castration and congenital testicular hypoplasia result in insufficient androgen production, which increases the concentration of estrogen in the male body and stimulates male breast development. Hypergonadotropic hypergonadotropic hypogonadism may overstimulate the mesenchymal cells, altering the hormone biosynthetic pathway in the mesenchymal cells, resulting in the synthesis and secretion of relatively more estrogen and its predecessor substances than testosterone, causing a decrease in the plasma androgen/estrogen ratio, and causing gynecomastia. Adrenocortical tumors and mesenchymal cell carcinomas that cause feminization can directly secrete large amounts of estrogen, both of which can cause a decrease in the androgen/estrogen ratio and result in gynecomastia. With oral or topical estrogen use, areolar hyperpigmentation first occurs, followed by female-pattern breast changes. In addition, shampoos and other products containing estrogen can also cause precocious puberty and lead to the development of female-pattern breasts in boys. Phenothiazine voice, methyldopa and reserpine can cause gynecomastia by increasing PRL. Other drugs such as Ativan, digitalis and Marijuana interact with estrogen receptors on the mammary gland to cause mammary gland development.
In some cases of gynecomastia caused by non-endocrine diseases, it can be due to certain metabolites in the lesion that affect the inactivation of estrogen in the liver in men, and some tumor lesions can be related to the secretion of some estrogen by the tumor itself. Reduced serum gonadotropin levels in patients with malnutrition and chronic diseases and increased gonadotropin levels during disease recovery can cause the secretion of excessive androgens from the testicular interstitial cells and relatively more estrogen than testosterone, causing gynecomastia. Idiopathic and familial gynecomastia may be caused by sensitivity of the milk ducts to low normal serum estrogen levels or by excessive conversion of estrogenic precursor substances to estrogen. In some obese men, breast enlargement is related to obesity itself.
According to its cause, gynecomastia has 2 categories: primary and secondary.
1.Primary gynecomastia
Most often seen in children and adolescents, often due to physiological endocrine disorders, plasma estradiol content is higher than testosterone content, resulting in a transient estrogen/androgen ratio malfunction, or breast tissue sensitivity to estrogen increased and caused, also known as physiological male breast enlargement.
2, secondary gynecomastia can be seen in youth, middle age, and old age, and can be caused by the following reasons
(1) Endocrine diseases.
① Testicular disease: due to hypogonadism, androgen secretion is very low, testosterone in the blood, estrogen ratio changes, causing gynecomastia.
A, congenital testicular hypoplasia (Klinefelter syndrome): oral mucosal chromatin positive, small testes, chromosome 47XXY, low blood testosterone, increased gonadotropins, significant reduction of sperm in semen, abnormal sperm morphology and motility, may appear mental retardation, breast hypertrophy and distension at puberty.
B. Complete testicular feminization: female vulva, testes in labia majora or abdominal cavity, chromosome 46XY, testosterone cannot function due to abnormal androgen receptor quantity and quality, normal or increased testosterone in blood, normal high limit of estradiol, increased gonadotropin, pubertal breast development or hypertrophy, incomplete testicular feminization of vulva can be male, or small penis or pseudohermaphroditism, pubic hair The pubic hair is normal, and pubertal breast development or hypertrophy may also occur.
C. Kallmann syndrome: hypopituitarism and partial hypopituitarism, reduced gonadotropins, hyposmia, poor testicular development, and pubertal breast development.
D. Testicular inflammation, trauma and tumor: testicular inflammation, traumatic testicular atrophy, can cause low androgen secretion, feedback caused by excessive gonadotropins, seminoma, teratoma, chorionic villoma of the testes, all can produce chorionic gonadotropin (HCG), all can cause gynecomastia.
E. Reifenstein’s syndrome: fetal development of testicular mesenchymal cell insufficiency, after birth can appear breast development with hypospadias and other malformations.
②Adrenal gland diseases: such as adrenal cortical hyperplasia, benign tumors, malignant tumors and hypofunction. Such tumors can directly secrete estrogen or produce excessive estrogen precursors (such as androstenedione), which are converted into effective estrogen in the tissues and elevated blood estradiol, causing breast enlargement.
(3) Thyroid disorders: such as hyperthyroidism, increased concentration of sex hormone-binding globulin in plasma, excessive bound androgens, elevated free estradiol (unbound estradiol), elevated estrogen/testosterone ratio, and imbalance of hormone balance, such that it stimulates hyperplasia of breast tissue and leads to gynecomastia.
(2) Other non-endocrine diseases.
(1) Liver diseases: such as hepatitis, cirrhosis, liver cancer, etc., accompanied by decompensated liver function, often cause breast hypertrophy, and in ethanolic cirrhosis, the estrogen in the body is more increased, easily causing breast hypertrophy, the reason is that the liver function decreases in cirrhosis, the ability to inactivate estrogen is weakened, the content of estrogen in the body is relatively increased, the bound steroid globulin in the blood is elevated, so that the free testosterone in the blood is further reduced. The androstane dione and testosterone precursors in the microcirculation are converted to produce a large amount of estrogen, so the concentration of estrogen in the blood increases and acts on the breast tissue, causing mammary gland hyperplasia and hypertrophy.
When malnutrition is corrected, gonadotropin secretion and gonadal function return to normal, resulting in a kind of side-note second puberty phenomenon and breast enlargement, which is called “increased feeding breast enlargement”.
Bronchial lung cancer and chronic lung disease: such as oat cell carcinoma, tuberculosis, abscess chest, etc., often accompanied by testicular atrophy, or secretion of ectopic hormones, resulting in breast enlargement.
④ Chronic renal failure: Patients with uremia caused by chronic renal failure are found to have relatively elevated estrogen and elevated prolactin concentration in the blood, leading to breast development and hypertrophy.
⑤ Neurological diseases: such as paraplegia caused by high spinal cord lesions, spinal cord cavitation, hereditary movement disorders, can be accompanied by breast hypertrophy.
(6) Prostatic hyperplasia or prostate cancer: When patients take estrogen for long-term treatment, it can often cause gynecomastia.
(7) Lymphatic system diseases: lymphoma, malignant histiocytoma, myeloma and other reticuloendothelial system diseases are also rarely seen in gynecomastia.
(8) Pharmacological breast enlargement: gonadotropins, chlorpromazine, metformin (cimetidine), methyldopa, metoclopramide (gastric receptor), metronidazole (methotrexate), isoniazid, reserpine (reserpine), meperidine, methadone, acetone, phenytoin sodium, digitalis, vincristine, thyroid extract, etc., can bind to estrogen receptors and cause endocrine dysfunction in the body, which can cause gynecomastia. It can cause gynecomastia, but the enlarged breast can be restored after stopping the drug.
Other diseases: cardiovascular diseases (hypertension, heart disease), serious skin diseases (leprosy, exfoliative dermatitis), autoimmune diseases (rheumatoid arthritis, rheumatoid arthritis), leptospirosis, ulcerative colitis, etc. can sometimes be associated with gynecomastia.
A number of drugs may also cause gynecomastia, including steroid hormones such as prednisone or dexamethasone, drugs used to treat ulcers (e.g., cimetidine), drugs used to treat epilepsy (e.g., phenytoin sodium [phenytoin sodium]), digitalis and other cardiac drugs, chemotherapy drugs, especially alkylating agents, anticancer drugs that interfere with DNA and inhibit cancer cell growth, anti androgenic drugs (e.g., amino compounds, cyproterone, androstadienone, anti-anxiety and antidepressant drugs (e.g., diazepam [Valium] with tricyclic antidepressants), products containing tea tree oil or lavender oil.