Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
The appearance of enlarged breast tissue in men can be either due to the true
enlargement of actual breast tissue or a result of deposition of fat in the
pectoral area of the chest. True enlargement of the gland tissue of the breast
is due to hormonal fluctuations or imbalances. Breast enlargement in men due to
this condition is referred to as
gynecomastia. However, especially in obese or
overweight men, there can be an increase in fatty tissue over the breast area.
This condition, which is not the same as true enlargement of male breast tissue,
creates an appearance of enlarged breasts and is known as pseudogynecomastia.
Doctors can usually tell whether or not enlarged breasts in men are due to
true gynecomastia by the physical examination, but sometimes other testing is
required. True gynecomastia (enlargement of breast tissue), in men is not
uncommon and can be seen in normal, healthy boys during puberty or in men as
they age. Medical conditions that interfere with the body's hormonal balance can
also cause breast enlargement in men.
Gynecomastia is enlargement of the gland tissue of the male breast. During
infancy, puberty, and in middle-aged to older men, gynecomastia can be common.
Gynecomastia must be distinguished from pseudogynecomastia, which refers to the
presence of fat deposits in the breast area of obese men. True gynecomastia
results from growth of the glandular, or breast tissue, which is present in very
small amounts in men.
What causes gynecomastia?
Gynecomastia results from an imbalance in hormone levels in which levels
of estrogen (female hormones)
are increased relative to levels of androgens (male hormones). Gynecomastia
that occurs in normally-growing infant and pubertal boys that
resolves on its own with time is known as physiologic gynecomastia.
All individuals, whether male or female, possess both female hormones (estrogens) and male hormones
(androgens). During puberty, levels of these hormones may fluctuate and rise at
different levels, resulting in a temporary state in which estrogen concentration
is relatively high. Studies regarding the prevalence of gynecomastia in
normal adolescents have yielded widely varying results, with prevalence
estimates as low as 4% and as high as 69% of adolescent boys. These differences
probably result from variations in what is perceived to be normal and the
different ages of boys examined in the studies.
Gynecomastia caused by transient changes in hormone levels with growth
usually disappears on its own within six months to two years. Occasionally,
gynecomastia that develops in puberty persists beyond two years and is referred to
as persistent pubertal gynecomastia.
A number of medical conditions may also result in gynecomastia:
Malnutrition and
re-feeding (recovery from malnutrition) have both been shown to create a
hormonal environment that may lead to gynecomastia. Similarly,
cirrhosis of the
liver alters normal hormone metabolism and may lead to
gynecomastia.
Disorders of the male sex organs (testes) can result in decreased
testosterone production and
relatively high estrogen levels, leading to gynecomastia. These disorders may be
genetic, such as Klinefelter's syndrome, or acquired due to
trauma,
infection, reduced blood flow,
or aging.
Testicular cancers
may also secrete hormones that cause gynecomastia.
Other conditions that are associated with an altered hormonal environment
in the body and may be associated with gynecomastia are
chronic renal failure and
hyperthyroidism. Rarely, cancers other than testicular tumors may produce
hormones that can cause gynecomastia.
Gynecomastia can also be a side effect of a number of medications. Examples
of drugs that can be associated with gynecomastia are listed below:
highly active anti-retroviral therapy (HAART) for
HIV disease, which may cause fat
redistribution leading to pseudogynecomastia or, in some cases, true
gynecomastia;
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Low testosterone can affect both men and women. Causes of low testosterone in males include undescended testicles and injury to the scrotum. Low testosterone in females includes ovary conditions. Treatment for low testosterone in men includes testosterone replacement therapy. Currently there is no FDA approved testosterone treatment for women.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Testicular pain, or pain in the testicle or testicles are caused by a variety of diseases or conditions such as testicular trauma, testicular torsion, testicular cancer, epididymitis, and orchitis. Common symptoms of pain in the testicle or testicles are abdominal pain, urinary pain or incontinence, fever, nausea, vomiting, and pain in the scrotum or testicle. Treatment depends on the cause of the testicular pain or pain in the testicles.
Testicular cancer symptoms include a painless lump or swelling in a testicle, testicle or scrotum pain, a dull ache in the abdomen, back, or groin, and a feeling of heaviness in the scrotum. Treatment for cancer of the testicles depends on the type of cancer (seminoma or nonseminoma), the stage of the cancer, and the patient's age and health.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
The time when boys and girls begin the process of sexual maturation is called puberty. During this time, both sexes undergo a series of biological changes that include a rapid increase in height, bone growth, weight increase, the growth of pubic hair, breast development and the onset of menstruation in girls, and testicle, penis, and muscle enlargement in boys.
Klinefelter syndrome, also referred to as XXY condition, is a genetic disease. Klinefelter syndrome affects mostly males. Symptoms include decreased testosterone levels, development of breasts, wider hips, and infertility. Some men with Klinefelter syndrome have no symptoms. Treatment includes educational, therapeutic, and medical therapy.
Men's health is an important component to a happy lifestyle and healthy relationships. Eating healthy, exercise, managing stress, and knowing when to have medical tests for a particular age is key to disease prevention in men.
The average life expectancy of a man born in the United State in 2007 is 75
years and 5 months. The life expectancy for a man has increased dramatically in the past 50 years.
How long we live is important; however, the quality of life is equally
important. The ability to enjoy life to its
fullest requires investing time and effort into health maintenance and disease
prevention. This investment pays dividends almost immediately and it is never
too late to begin. A person who was 65 years old in 2007 could expect to live to
age 82, and a 75 year old could expect 10 more years of life.
Our bodies are incredibly complex machines that require fuel components
(food, water, and air) to grow, function, and repair itself. Like any machine, the body requires routine maintenance to make it last a long
time and to function well throughout a person's life expectancy. Using the body as it
was intended and minimizing abuse also inc...
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