Definition and Overview

Gynecomastia refers to the enlargement of breasts in men, which is generally caused by hormonal imbalance. The condition may affect one or both breasts and in some cases, it is accompanied by breast pain. It can affect men of all ages, from newborn male babies, adolescent males, to adults. Although it is not seriously detrimental to a man’s health, it can have emotional and psychological repercussions, prompting men to seek treatment. Existing treatment options include medication and surgery, although in some cases, the condition may resolve on its own without treatment.

Gynecomastia should not be confused with lipomastia (also known as pseudogynecomastia, which is characterized by breast enlargement caused by fat deposits in the breasts often due to obesity) and with mastitis, which is caused by breast abscess or infection.

Causes of Condition

The most common cause of gynecomastia is an imbalance in the male and female hormones in the body. If the level of the female hormone estrogen is abnormally higher than that of the male hormone androgen, this may result to the enlargement of the glandular tissue in the breasts.

In some cases, the condition may occur as a natural consequence of growth development among infants and boys undergoing puberty. It can be caused by the normal fluctuation of hormones in the male body at stages of significant growth. Such cases are identified as physiologic gynecomastia, which is a form of the condition that resolves on its own over time.

Other possible causes include:

  • Side effects of medications
  • Underlying medical conditions
  • Trauma
  • Infection
  • Aging, which causes decreased testosterone production
  • Recovery from malnutrition
  • Abusive use of recreational drugs such as marijuana and heroin
  • Alcohol abuse
  • Hormonal therapy for the treatment of certain cancers, e.g. prostate cancer
  • Highly active anti-retroviral therapy for the treatment of HIV
  • The use of herbal products such as tea tree and lavender oil


Medications that can possibly cause gynecomastia as a side effect include:

  • Spironolactone, an anti-androgenic diuretic
  • Some types of antibiotics
  • Ranitidine and cimetidine
  • Methyldopa
  • Calcium channel blockers
  • Amphetamines
  • Methadone
  • ACE inhibitor drugs
  • Digitoxin
  • Diazepam


Diseases that have been associated with the condition include:

  • Chronic kidney disease
  • Cirrhosis of the liver
  • Hyperthyroidism
  • Diseases affecting the testes, resulting in altered levels of testosterone production, such as hypogonadism
  • Inherited diseases, such as Klinefelter’s syndrome
  • Testicular cancers
  • Tumors in the testes, adrenal glands, or pituitary glands

Key Symptoms

The main symptom of gynecomastia is the enlargement of male breasts caused by the growing size of the glandular tissue, as opposed to the presence of fat deposits. This makes the breasts feel firm or rubbery instead of fatty. In the majority of cases, the condition affects both breasts, although the growth may not be even at all times. Gynecomastia affecting only one breast is rare, but also possible. The patient may also feel mild to moderate breast pain or tenderness, but severe pain is generally not considered as a symptom of the condition.

Other than those mentioned above, the condition does not cause any other symptoms. If a male patient experiences breast growth in only one breast that is accompanied by other major symptoms such as nipple discharge, nipple retraction, skin dimpling, and enlarged lymph nodes in the underarms, these may be signs of male breast cancer.

Gynecomastia does not cause serious health effects that require treatment, unless it is caused by an underlying medical condition. In most cases, men suffering from this condition seek treatment because it negatively affects their self-esteem and self-confidence. The appearance of their breasts may cause them to become conscious about their bodies, and this may have some effects on the way they live their lives and interact socially. In severe cases, it may lead to depression or social anxiety.

Who to See and Types of Treatments Available

A male patient seeking treatment for gynecomastia will be asked to undergo some tests to determine the cause of the condition and to rule out other possible causes of the condition. These tests may include:

  • Mammogram
  • Blood test
  • CT scan
  • MRI scan
  • Testicular ultrasound
  • Biopsy


Once gynecomastia has been confirmed, the physician will discuss the findings and whether treatment is necessary. In cases wherein gynecomastia is caused by an underlying medical condition, treating the said condition typically resolves the problem. In suspected physiologic gynecomastia affecting infants and adolescent males, doctors typically recommend a re-evaluation after three to six months to see if the condition resolves on its own or not.

For gynecomastia affecting adult males with no known causes, is accompanied by tenderness, and is causing significant embarrassment, treatment options include:

  • Medications – Medications used in treating gynecomastia are those that are used to treat breast cancer, such as tamoxifen and raloxifene. However, patients should be aware that these medications have not been approved for the specific treatment of gynecomastia.
  • Surgery


There are two types of surgical treatment available for gynecomastia. These are:

  • Mastectomy – This is a surgical procedure wherein the breast gland tissue is removed. Nowadays, mastectomies can be performed endoscopically and are therefore minimally invasive so post-surgical pain and recovery time are significantly minimized.

  • Liposuction – This surgical procedure reduces breast size by removing fatty tissues in the breast. However, since it does not remove the breast gland tissue, there is a chance of recurrence.

Men suffering from gynecomastia may also benefit from counseling and group therapy sessions with other patients in the same situation. This may help to relieve the anxiety and embarrassment that they may be feeling because of their condition.

References:

  • Ali O, Donohue PA. Gynecomastia. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 579.

  • Bridenstine M, Bell BK, Rothman MS. Gynecomastia. In: McDermott MT, ed.

  • Endocrine Secrets. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 46.

  • Carlson HE. Approach to the patient with gynecomastia. J Clin Endocrinol Metab. 2011;96:15-21.

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