1 What is Gynecomastia?

Gynecomastia is the medical term for enlargement of breasts in men. This is caused by a problem in the hormones.

One or both breasts may be affected by gynecomastia, and it occurs in males at any age, from newborns, teenagers, adults and older adults.

Other than causing pain, gynecomastia does not cause other medical conditions. However, men tend to view gynecomastia a source of body-image issues and so suffer from low self-esteem.

Gynecomastia can go away on its own and can be treated with medications and surgery.

2 Symptoms

Gynecomastia may cause the following symptoms:

  • Breast pain or tenderness
  • Swollen or enlarged breasts

You need to see a doctor immediately if you see discharge coming out of the nipple, swelling, pain or tenderness.

3 Causes

In most cases, gynecomastia is caused by natural hormone changes that happen throughout life:

  • Newborn babies and infants tend to have gynecomastia due to effects of their mother’s estrogen. This usually goes away in two to three weeks after birth.
  • Children undergoing puberty may experience gynecomastia as the body starts to produce adult hormones. This usually goes away in six months to two years.
  • Older men may experience gynecomastia when they reach ages 50 to 80, especially if they are overweight.

In men, breasts tend to swell when there are too low levels of testosterone while estrogen levels remain stable.

Testosterone promotes male sexual characteristics while estrogen promotes feminine characteristics.

Testosterone promotes burning of fats and buildup of muscles while estrogen does the opposite and promote the growth of breasts.

Healthy men have more testosterone and smaller quantities of estrogen. If estrogen levels rise and testosterone plummets, it can result to gynecomastia.

Certain medications can cause gynecomastia. Here are common medications that have gynecomastia as an adverse effect:

  • Heart medications including digoxin and calcium channel blockers
  • Cimetidine (Tagamet) and other medicines used for treating stomach ulcers
  • Medicines used to treat AIDS, including highly active antiretroviral therapy (HAART), especially the drug efavirenz (Sustiva)
  • Tricyclic antidepressants are known to cause gynecomastia
  • Certain antibiotics
  • Anabolic steroids and androgens like injectable testosterone cause gynecomastia as a side effect
  • Anti-androgens used in treating enlarged prostate and prostate cancer, like flutamide, finasteride (Proscar, Propecia) and spironolactone (Aldactone)
  • Herbal products like tea tree oils and lavender in lotions, shampoos and soaps can increase estrogen levels that increase the risk of gynecomastia. Note that most brands containing these herbal products omit this significant side effect.

You can also have gynecomastia by abusing alcohol and marijuana, and using substances like heroin, methadone, and amphetamines.

Certain medical conditions affecting hormones in the body may also cause gynecomastia. Here are those diseases:

  • Aging causes natural drop in testosterone, especially if the person is overweight
  • Hypogonadism or too low activity of the testes, and can be caused by pituitary insufficiency and Klinefelter syndrome
  • Tumors in the pituitary or adrenal glands
  • Hyperthyroidism
  • Kidney failure tends to cause gynecomastia
  • Liver failure and cirrhosis
  • Malnutrition and starvation

4 Making a Diagnosis

Gynecomastia has several causes so the doctor might start obtaining your medical and drug history, and determine the health problems common in your family to make a diagnosis.

You will have to undergo a physical examination, which will require an evaluation of swollen breasts, abdomen, and genitals. Your doctor may order the following procedures:

  • Blood tests
  • Mammograms
  • Ultrasound of your testicles
  • CT or computerized tomography scans
  • Magnetic resonance or (MRI) scans
  • Biopsies of your organs or testicles

Note that breast swelling in men might be a symptom of conditions other than gynecomastia. The breasts may simply grow due to deposits of fat, called false gynecomastia, even though there is nothing wrong with the hormones.

However, the growth of breasts may be caused by inflammation of the breast tissue (mastitis). There is also a minor possibility of breast cancer, which affects both men and women.

5 Treatment

Gynecomastia may resolve on its own without treatment. Most cases of gynecomastia, especially in adolescents, tend to improve in six months to two years.

The doctor may only recommend scheduled checkups. However, gynecomastia may need treatment if it causes embarrassment and significant discomfort.

However, gynecomastia with medical causes often persists until the cause has been treated. Conditions like hypogonadism, problems in the pituitary gland, malnutrition and cirrhosis must be addressed to treat gynecomastia. If medications cause gynecomastia, the doctor may look for alternatives or stop the prescription.

There are medications that may work for gynecomastia, though they have not been approved exactly for this use. Such drugs include tamoxifen (Soltamox) and raloxifene (Evista), used for treating breast cancer, may work for some men with gynecomastia. The doctor will carefully consider benefits and risks before prescribing these drugs for you.

If medicines fail or the breast enlargement is particularly huge, the doctor may recommend liposuction or mastectomy. Liposuction involves removal of fat tissues in the breasts, but leaving breast tissue intact, to reduce gynecomastia. A mastectomy removes both the fat and breast tissue. Surgeons may use an endoscope to do the mastectomy, which only requires small incisions for faster recovery.

6 Prevention

You can prevent gynecomastia by avoiding factors that cause it, like using heroin, bodybuilding steroids, testosterone injections, amphetamines, heroin, and marijuana.

Do not abuse alcohol, or try to control your intake.

You can also review your medicines. If you suspect that one or more cause gynecomastia, call your doctor to check for alternatives.

7 Lifestyle and Coping

As gynecomastia is particularly embarrassing, it can drastically affect one's lifestyle, and coping can be difficult.

Gynecomastia has a significant effect on self-esteem and body image. Swollen breasts can be difficult to hide, especially if they are relatively large. Things like swimming or changing in the locker room can be a nightmare. Teenage boys are often highly vulnerable to bullying or teasing due to gynecomastia.

Emotional and self-confidence issues caused by gynecomastia require urgent treatment. A talk with a psychologist or counselor can help increase understanding of the condition and deal with negative feelings. In most cases, the whole family also needs psychological therapy as well.

8 Risks and Complications

The following are at risk for gynecomastia:

  • Use of bodybuilding steroids and androgens like testosterone
  • Having conditions in the liver, kidneys and thyroid glands, which can cause problems in hormones
  • Having tumors that themselves secrete hormones
  • Having Klinefelter syndrome
  • Adolescence and old age

9 Related Clinical Trials