Gynecomastia: pathogenesis and approaches to treatment

Gynecomastia is a benign enlargement of the breast glands in men that can be physiologic, pathologic, or idiopathic. Physiologic gynecomastia can occur in children and during puberty. Pathologic gynecomastia is associated with various endocrine, genetic disorders, systemic diseases, paraneoplastic processes, or may be iatrogenic. Common causes of pathologic gynecomastia are hypogonadism, testicular or adrenal tumors producing estrogens, androgen excess syndromes with aromatization, androgen deficiencies, hepatopathy, and nephropathy. Most commonly, the underlying cause of gynecomastia is an imbalance between estrogens and androgens. It is known that the treatment of syndromes causing gynecomastia depends on the etiology and pathogenesis, but gynecomastia itself is eliminated, as a rule, surgically. The use of drug therapy for gynecomastia is debated. It would probably be appropriate in cases of gynecomastia due to an imbalance between estrogens and androgens, given the initial stage of gynecomastia development. The main candidates for drug treatment of gynecomastia are anti-estrogens and aromatase inhibitors. These aspects are discussed in the review.