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Mammograms of males with gynecomastia might occasionally reveal a lipoma , with a thin capsule surrounding radiolucent lipomatous tissue. The relationship between AAS use and depression is inconclusive. Pharmacy and Pharmacology portal. Houglum J, Harrelson GL, eds. A controversy McMahon 'doesn't need ' ".
What is gynecomastia?
Favors muscle function, memory formation, testosterone synthesis and energy expenditure . Prevent apoptosis of germ cells . Least androgenic progestin component preferred. AAS use in adolescence is also correlated with poorer attitudes related to health. It also may occur after severe head injury, be present at sites of skin trauma, or be drug induced Table 1. Retrieved December 5, Epithelial hyperplasia is also typical at this stage.
Levels of serum testosterone greater than ng per dL 6. Selective venous catheterization may be necessary whenever imaging has not identified a tumor but strong clinical suspicion remains. Treatment options for patients who have hirsutism can be divided into those measures targeting local manifestations of hirsutism and pharmacologic therapy aimed at the underlying causes.
Therapy that targets local manifestations includes physical methods of hair removal ranging from shaving to laser therapy, topical treatment, and weight loss. For patients with mild hirsutism, local measures such as shaving, bleaching, depilatories, and electrolysis may suffice.
Shaving is the easiest and safest method, but is often unacceptable to patients. Bleaching products are often ineffective for dark hair growth, and skin irritation may occur.
Chemical depilatories produce results similar to shaving, but skin irritation is common. Electrolysis is one of the most effective and permanent methods of hair removal, and may be an adjunct to hormonal treatment. Algorithm showing the evaluation of hirsutism. Clinical gynecologic endocrinology and infertility. The need for rapid methods of hair removal has led to the development of laser therapy for hirsutism.
Several different lasers exist, including ruby, alexandrite, pulsed diode, and Q-switched yttrium-aluminum-garnet YAG lasers. Pulsed diode lasers are generally less expensive and more reliable than other laser sources for hair removal. Laser therapy works best on dark hair, although post-treatment hyperpigmentation may occur.
Weight loss should be encouraged for obese patients, because this increases SHBG levels and decreases insulin resistance and the levels of serum androgens and luteinizing hormones. Women who are overweight, hyperandrogenic, or hyperinsulinemic should be counseled regarding future risk of diabetes mellitus and cardiovascular disease.
Pharmacologic treatment for hirsutism should be aimed at blocking androgen action at hair follicles or suppression of androgen production Table 6. Response to pharmacologic agents is slow, occurring over many months.
When medical therapy is unacceptable to patients, combining local measures with medical therapy may be appropriate. Eflornithine Vaniqa topical cream has been shown to slow rates of terminal hair growth significantly in up to 32 percent of patients and can be used adjunctively with usual methods of hair removal. For women with idiopathic hirsutism, PCOS, or late-onset CAH, appropriate treatment decisions depend on each patient's desires and childbearing plans.
Women who do not wish to become pregnant should use low-dose OCs. OCs containing less androgenic progestins, such as norgestimate, gestodene not available in the United States , and desogestrel, seem to be the best choice, but some maintain that all preparations are comparable in efficacy. Antiandrogens may be combined with OCs for the treatment of hirsutism. Up to 75 percent of women report clinical improvement with combination therapy, 27 but data have shown that combined therapy is not significantly better than single agents alone.
Patients who use antiandrogens alone may experience irregular uterine bleeding and ovulation. The most commonly used antiandrogens are spironolactone Aldactone and flutamide Eulexin.
However, no antiandrogens are approved by the U. Food and Drug Administration for the treatment of hirsutism. Spironolactone is most commonly used because of its safety, availability, and low cost.
Flutamide has been shown to be as effective as spironolactone; however, hepatic function must be monitored. Duration of therapy is unclear, but treatment cessation generally is followed by recurrent hair growth. Gonadotropin-releasing hormone Gn-RH analogs such as leuprolide Lupron should be reserved for use in women who do not respond to combination hormonal therapy or those who cannot tolerate OCs.
Gn-RH analogs should be used cautiously with particular attention to possible long-term consequences e. For patients whose terminal hair growth does not decrease significantly, treatment with insulin-sensitizing agents may be useful.
Metformin Glucophage has been shown to improve insulin sensitivity and decrease testosterone levels in patients with PCOS. Increased androgen production from nonspecific hyper-secretion or adult-onset adrenal hyperplasia responds to glucocorticoid suppression with dexamethasone.
Because of side effects, long-term use of glucocorticoids should be limited to patients with infertility or unresponsiveness to other antiandrogen therapy. Ethinyl estradiol with norgestimate, desogestrel, norethindrone, ethynodiol diacetate.
Contraindicated with hepatic dysfunction, renal insufficiency, adrenal disease. May be combined with oral contraceptives or Gn-RH agonists for severe hirsutism. Use with caution for short periods because of hypoestrogenic effect. Scalp hair loss, dry skin, abdominal pain, fatigue, headache, vaginal spotting, hepatotoxicity. GI distress, lactic acidosis rare with mortality nearly 50 percent , numerous drug interactions. Monitor liver function, confirm normal renal function before starting, and monitor.
Medical Economics Data, Cost to the patient will be higher, depending on prescription filling fee. Ketoconazole Nizoral , an antifungal agent, has proved effective in the treatment of hirsutism. Severe side effects, including alopecia, dry skin, abdominal pain, and hepatotoxicity, can occur, and use should be reserved for patients with severe hirsutism that has not responded to other therapeutic options.
Already a member or subscriber? He received his medical degree from the Medical University of South Carolina College of Medicine, where he also served a residency in family medicine. Carek completed a sports medicine fellowship and obtained a master's degree in exercise physiology at the University of Tennessee, Memphis, College of Medicine.
Address correspondence to Melissa H. Charleston, SC [e-mail: Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: J Clin Endocrinol Metab. Diagnostic approach to androgen disorders in women: Cleve Clin J Med. Clinical relevance of testosterone and dihydrotestosterone metabolism in women.
Hirsutism, virilization, and androgen excess. Medicine for the practicing physician. Carmina E, Lobo RA. Peripheral androgen blockade versus glandular androgen suppression in the treatment of hirsutism.
Hirsutism causes and treatments. Of course men do not develop milk-producing breasts, but they still have a small amount of breast tissue. Thus, anyone who has breast tissue is at a small risk for breast cancer development. Men who ultimately have a breast cancer diagnosis tend to have tumors of a more advanced stage than women.
Essentially, gynecomastia is abnormally large breast development in males. More specifically medics may define gynecomastia as an abnormal increase in the ductal and stromal elements of the male breast. The development of gynecomastia will be unique for each patient, depending on the patterns and sizes of the glandular tissues involved. Well this page is getting a little old. We have recently created a new page with more up-to-date information on Gynecomastia.
Gynecomastia can be bilateral or unilateral and symmetrical or asymmetrical. Puffy nipples result from the accumulation of glandular tissue under and confined to the areola. Since the level of body fat adipose tissue is so low , the abnormal growth is purely of glandular tissues and not mixed with fat tissues.
Normally, the male breast has only major mammory ducts which almost never branch. As the condition progresses, the breast ducts involved dilate and lengthen, and increase in the number of branches. Epithelial hyperplasia is also typical at this stage. Collagen surrounds the breast ducts and becomes more and more densely packed, which essentially destroys the ducts.
In advance stages, such as in the image below , collagen becomes densely packed around the breast ducts, constricting them and eventually blocking them entirely. Suprisingly, gynecomastia actually affects about one third of males at some point in their lives. But generally speaking, gynecomastia occurs most commonly with men in their mid sixties. However, the condition may also arise as a result of breast tumor development, and this is why a full examination by your doctors is necessary.
In elderly men, one of the main causes of gynecomastia is thought to be decreasing testosterone production. Enter a compound, synonym, CAS , compound class, column name, or keyword below. Statins on Raptor ARC 1. Bisphenols on Raptor Biphenyl 1. Combination Run of U. Phenols and Benzidines by U. Phthalate Esters by U. Alcoholic Beverages Acids and Esters:
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This article is about androgens as medications. Proceedings of the Society for Experimental Biology and Medicine.
No FDA labeling for treatment of hirsutism. Helvetica Chimica Acta in German.
Carek completed a sports medicine fellowship and obtained a master's degree in exercise physiology at the University of Tennessee, Memphis, College of Medicine. Table 3 8 outlines consideration for these causes, along with laboratory findings. AAS were synthesized in the s, and are now used therapeutically gn anabolic mass 2 medicine to stimulate muscle growth and appetiteinduce male puberty and treat chronic wasting conditions, such as cancer and AIDS. Reprints are not available from the authors. Stop taking all recreational drugs, such as marijuana, and stop gn anabolic mass 2 all nutritional supplements or any other bodybuilding drugs. How gynecomastia can be reduced? Principles of Pharmacology for Athletic Trainers 2nd ed.
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