Patient's question:
I am a man, but my chest is like the breasts of a 15-year-old girl. I want to ask if this is a disease? I want to ask what medicine can be used to treat it.Doctor's answer:
Hello, Gynecomastia in men is divided into physiological and pathological types. Physiological gynecomastia is more common in newborns, adolescents, and menopausal individuals, and it can often resolve on its own. Pathological gynecomastia is referred to as gynecomastia. It is a condition characterized by breast enlargement in men, with single or bilateral lumps, sometimes accompanied by. This disease is more common in middle-aged and elderly men, and it can also occur in boys around the age of 10. Although this condition is not frequently seen in clinical practice, it can cause significant psychological stress to patients and affect their normal lives. Therefore, timely, accurate, and effective diagnosis and treatment of this condition should not be taken lightly.### II. How does gynecomastia occur?
The occurrence of this condition is mainly due to an absolute or relative increase in estrogen levels in the body, or an increased sensitivity of breast tissue to estrogen. Both men and women secrete androgens and estrogens in their bodies, but the difference in their proportions determines the gender differences. Therefore, any factors that lead to high estrogen levels or reduced androgen secretion can trigger this condition. For example:
1. Diseases of the adrenal cortex, the primary site of estrogen secretion, can cause abnormally high estrogen levels.
2. Liver diseases, which impair liver function, can lead to the accumulation of estrogen in the body, resulting in gynecomastia.
3. The testes are the main organs for androgen secretion. Conditions such as testicular tumors or congenital testicular hypoplasia can reduce androgen levels, leading to a relatively higher estrogen level and thus gynecomastia.
4. Other diseases, such as hypothalamic-pituitary disorders, thyroid disorders, diabetes, sexual differentiation abnormalities, and chronic colitis, can also cause gynecomastia. Certain medications, such as progesterone, isoniazid, tricyclic antidepressants, and digitalis, can also affect estrogen metabolism and induce breast enlargement.
### III. How is it treated? What is the prognosis?
Physiological gynecomastia generally does not require treatment. Pathological gynecomastia should be treated by addressing its underlying cause, actively treating the primary disease, regulating the endocrine system, and providing symptomatic relief. More importantly, patients should develop a correct understanding of the condition in terms of their thoughts and emotions. Letting go of psychological burdens and actively cooperating with treatment will help the condition improve more quickly. If conservative treatment is ineffective for a long time, if the breast enlargement is severe with intense, or if there is suspicion of malignancy, surgical removal may be considered.
Traditional Chinese Medicine (TCM) adopts the principle of syndrome differentiation and treatment from a macroscopic and holistic perspective, aiming to comprehensively adjust the body's functions based on the underlying pathogenesis. The main pathogenesis of this condition includes yin deficiency and nourishing failure of the liver and kidneys, stagnation of qi and blood, as well as qi stagnation, phlegm coagulation, and blood stasis obstructing meridians. Therefore, the primary treatment focuses on soothing the liver, resolving depression, resolving phlegm, and dispersing nodules; tonifying the liver and kidneys for deficiency syndromes; and promoting blood circulation to unblock meridians for blood stasis.
Commonly used herbs include:
- For soothing the liver and regulating qi: Chaihu (Bupleurum chinense), Xiangfu (Cyperus rotundus), and Chuanlianzi (Gleditsia sinensis).
- For harmonizing the stomach and resolving phlegm: Fu ling (Poria cocos), Chen pi (Tangerine peel), and Banxia (Pinellia ternata).
- For softening and resolving nodules: Beimu (Fritillaria cirrhosa) and Qiangongcao (Dandelion).
- For tonifying the liver and kidneys: Goji berries.
- For promoting blood circulation: Wangbuluxing (Vaccaria segetalis).
Prescriptions for specific syndromes include:
- For qi stagnation and phlegm coagulation: Qinggan Jieyu Tang (Liver-Clearing and Stasis-Resolving Decoction) and Xiao Yao San (Free and Easy Wanderer Decoction).
- For liver-kidney yin deficiency: Yi Guan Jian (Unani Decoction) and Liu Wei Di Huang Wan (Six-Flavor Rehmannia Pill).
- For qi stagnation and blood stasis: Dan Qi Pian (Salvia Miltiorrhiza Tablet) and Wu Jin Wan (Black Gold Pill).
- For yin deficiency and phlegm coagulation: You Gui Yin (Right Regulating Decoction) and Er Xian Tang (Two Herbs Decoction).
Additionally, topical ointments, auricular acupuncture, and body acupuncture can be used.
The prognosis for this condition is generally good. Mild cases may resolve on their own, moderate cases can be cured with medication, and severe cases that do not respond to conservative treatment may be cured after surgery.