Gynecomastia is a special condition where men develop large breasts which is abnormal. Almost 60% of males worldwide have Gynecomastia to some degree. It can either start showing in the early ages (children) or sometimes later in life. Most of the times, the enlarged breasts don’t show up until the affected person comes to the teenage.
- Metabolic disorders as a side-effect of some medication
- Low-levels or decrease of testosterone naturally
Gynecomastia should not be considered as pseudogynecomastia or lipomastia, which represents the fat presence in the breast area. In reality, Gynecomastia results from growth of breast tissue.
What Causes Gynecomastia?
Men will have both male hormones (Androgens) as well as female hormones (Estrogens). The Androgens are responsible for deciding male characteristics like facial hair, muscle development, baldness, and so on. These male hormones are normally higher in amounts compared to the female hormone count. However, when there is any imbalance between Androgens and Estrogens in men, they may develop female characteristics and one notable feature is the development of enlarged breasts like in females.
There are however many other causes of Gynecomastia which include physiological, age-related, drugs etc.. Let us look at these causes in detail.
i] Physiological Causes of Gynecomastia
You’ll notice physiological causes of Gynecomastia in newborn and pubertal adolescent boys.
Breast enlargement may be accompanied by milk secretion in newborns which is basically due to the influence of estrogens on the boy within the womb. In most of the cases, this physiological gynecomastia goes away in a week or two.
Where as pubertal adolescent boys grow breasts buds that lasts for a year or two and then go away without doing anything. This is due to the hormone imbalances in them at puberty.
ii] Age-Related Gynecomastia
Aged men often get Gynecomastia. By age increasing day by day, the testosterone levels decline in men and philandering characteristics of the female hormone like Gynecomastia thus appears.
iii] Drugs and Gynecomastia
There are a few drugs that are known to cause Gynecomastia. These include:-
- Antifungals (Ketoconazole)
- Antibiotic drug* (metronidazole)
- Antacids (Cimetidine)
- AIDS drugs (Efavirenz)
- Anxiolytic drug (diazepam)
- Heart drugs (Spironolactone)
- Prostatic adenocarcinoma or enlargement drugs (flutamide, finasteride etc.)
- Tricyclic antidepressant drug, heart failure drugs (digoxin)
iv] Other Gynecomastia Causes in Men
- Semipermanent liver disease: Liver disease over long time periods may lead to an increase of estrogen (female hormone) production that may lead to Gynecomastia.
- Kidney failure and need for dialysis
- Deficiency of male hormones
- Vulnerability to female hormones
- Consumption of anabolic steroids or usage of Alcohol, Heroin, Methadone or Marijuana.
- Radiotherapy and cancer chemotherapy particularly for testicular and prostatic adenocarcinoma (cancer).
- Congenital disease: Klinefelter’s syndrome causes deformity and underdevelopment of testes in boys and leads to Gynecomastia.
- Thyroidal disorders – particularly a hyperactive thyroid gland.
- Tumors – specially those that release female hormones.
- Malnutrition or severe diet – On malnutrition the testosterone count drops but estrogen levels stay normal, which may lead to Gynecomastia in some.
- A few herbaceous plant like tea tree or lilac in shampoos and soaps have been affiliated with Gynecomastia due to their supposed powerless estrogen like action.
- Unknown – occasionally the cause of Gynecomastia may be obscure.
v] Breast Cancer and Gynecomastia
At times the real cause behind breast expansion may be an underlying tumor or cancer.
Breast cancer in men is rare but wants to be omitted when Gynecomastia is found. Breast cancer turns up as a lump that is firm or hard with or without pain from the nipples.
Tumors and cancers as well tend to turn up as a single breast enlargement although most hormonal causes of breast enlargement in males normally develop enlargement of both boobs.
Gynecomastia Symptoms in Men
Picture of a Patient with Severe Gynecomastia
The primary symptom seen in Gynecomastia affected males is enlarged breasts which will have a rubbery or firm feel. It mostly occurs on both the sides but can be seen only on one side in some rare cases. There will be no pain but tenderness and sensitivity may be experienced.
- Enlargement of single or both breasts. The breast size may be undifferentiated or mismatched w.r.t the nipple. Your nipple is either rubbery or firm. The increase may appear just behind the nipple.
- Although you won’t feel any pain, there may be a little pain or mild tenderness of your breasts or nipple when touched.
- You can identify breast cancer in men with the symptoms like firm, localized and hard lump.
- The skin over the lump may be uneven from the texture surrounding healthy skin. That means the skin may be warm or reddened. The skin might seem dimpled on the movement of the lump.
- The nipple may discharge blood or colorless liquid. You may notice lymph node enlargement on the same side under the arms along with the lump called the axillary lymph nodes.
- Breast abscess likewise to show up as a breast swelling. These patients might get high fever with shiverings and rigor.
- The breast swelling might be very painful and hot to touch. You may notice redness or yellowish appearance of the skin over the lump. Breast abscess is very rare in men.
Here is how you can differentiate between Gynecomastia and man boobs.
How is Gynecomastia Diagnosed & Available Treatment Options?
In most cases, it can be diagnosed by a physical examination of your breasts. However, the doctor will also consider your medical history that includes the medicines or drugs you’ve taken prior to getting male breasts. If there is a suspicion of breast cancer, the doctor may order a mammogram. Additionally, blood tests may be recommended to examine kidney, thyroid/liver functions and for measurement of hormone levels in your blood.
What is the Treatment for Gynecomastia?
In pubertal males, Gynecomastia often disappears within six months on its own and so only observation is preferred over treatment. The physician will recommend stopping any offending medicines or other problems that have caused large breasts. Whereas in other cases, Gynecomastia surgical removal is the only possible solution.
It is advised to see your physician immediately after you notice any of the above said symptoms and get appropriate treatment based on your condition. In several cases, Gynecomastia doesn’t need urgent treatment. In newborn or pubertal boys the condition settles by itself.
If the same caused due to the consumption of drugs or other inherent disease, it may resolve once the intake of the offending drug is stopped or when the underlying disease is treated.
Whilst complications of Gynecomastia are uncommon, some of the time the breast tissues may go through scarring which makes the treatment hard.
Also the psychological effect of the Gynecomastia condition is great for a lot of patients particularly young men and teenagers.
Additionally, men with Gynecomastia may have a higher risk of getting breast cancer. A few patients so might need drugs that stop the feminizing hormones or Gynecomastia surgery to reduce the breast size.
In general, treatment procedures for Gynecomastia include medications and surgery.
Medications to Treat Gynecomastia Patients
- Right now, no drugs are O.K.ed by the U.S. FDA (Food & Drug Administration) for the treatment of Gynecomastia.
- Doctors may prescribe an anti-estrogen drug called ‘Tamoxifen’ which may be taken as 10mg pills twice daily. This is given mostly to the patients who suffer pain. Tamoxifen may also help patients who develop Gynecomastia by the intake of prostate cancer drugs.
- In case of low levels of male hormones, Testosterone replacement may be tried in some patients.
- Although not seen much success, another most popular drug is Anastrozole. This prevents the formation of Estrogen.
- Male breast removal surgery
Gynecomastia Surgery: Treatment Options
There are 2 types of cosmetic surgery for Gynecomastia.
- The first one is liposuction where only the breast fat tissues are removed but the tissues remain intact.
- The second one is mastectomy where the surgeon operates and removes the breast gland tissues. Small incisions will be made over the breast sides, in the underarm or near the areola.
How Gynecomastia Surgery is Performed? [Video]
Once the surgery is done, the healing process starts and it will take just a few weeks to heal completely.
Since Gynecomastia is caused due to the drugs, medications and diseases, these need to be assessed and appropriate solution needs to be provided.
Lastly, if you’re suffering from severe Gynecomastia, then it is recommended to consult a reputed surgeon and seek his guidance.