Hello and welcome to the Zero to Finals podcast.

My name is Tom, and in this episode I'm going to be talking to you about Gynacomastia.

And you can find written notes on this topic at zero definals.com slash gynacomastia

or in the breast surgery section of the Zero definals surgery book. So let's get straight

into it. Gynacomastia refers to enlargement of the glandular breast tissue in males. Male breast

enlargement is relatively common, particularly in adolescents and older men over the age of 50.

It may also be present in newborns due to circulating maternal hormones or hormones from the

mother, and this resolves as the maternal hormones are cleared.

Let's start by talking about the causes.

Gynecumastia is generally caused by a hormonal imbalance between estrogen and the androgen

hormones, for example testosterone, with higher estrogen and lower androgen levels.

Raised estrogen stimulates breast development, while androgens have an inhibitory effect on breast development.

Prolactin is a hormone that also stimulates the glandular tissue development, as well as breast milk

production. Therefore, a raised prolactin, or hyperprolactinemia, can cause gynecomastia.

It's worth remembering that dopamine has an inhibitory effect on prolactin. So dopamine blocks the effects of prolactin. Dopamine antagonists, for example,

antipsychotic medications, block dopamine production, which allows prolactin levels to rise, because

the blocked dopamine doesn't have the inhibitory effect on prolactin. So the prolactin levels rise,

and this can cause gynecomastia and galactaria, or breastmilk production. Therefore, in male patients

on antipsychotic medications, they may develop

a high prolactin level and also gynecomastia or galactaria. Gynchamastia is idiopathic in many cases,

meaning that no cause is found. Gynacamastia can be physiological in adolescence,

where there is a proportionately higher level of estrogen around puberty,

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