What is Gynecomastia?
Gynecomastia is an increase in male glandular breast tissue, usually caused by decreased testosterone and elevated estrogen levels. Certain medication and health conditions can also result in increased breast tissue.
Over 30 percent of males will suffer from this condition at some point in their life. It is most likely to occur in infants, adolescents and older men. (1)
The main sign of gynecomastia is an increase of breast tissue around the nipple, generally forming in a concentric circle. It usually manifests on both breasts, although it can affect just one.
The extra tissue tends to be symmetrically located in relation to the nipple. It will feel rubbery or firm, and might be tender or painful to the touch. (3)
Enlarged breasts in males can also be caused by fat deposits below the nipple in men who are overweight. Called pseudogynecomastia, this is different as the excess is not breast tissue. (4)
Both women and men have male hormones (androgens) and female hormones (estrogens).
On reaching puberty, hormone levels in males fluctuate and estrogen concentration is higher. Teenage boys are more likely to have gynecomastia due to these hormone changes. In fact, it affects between 50 to 60 percent of adolescent males. It usually peaks around 14 to 15 years old.
Gynecomastia is prevalent in infants due to exposure to increased levels of estrogen in the womb. It is present in 60 to 90 percent of newborn males.
As men get older, usually past the age of 50 years, the incidence of gynecomastia increases. It will occur in up to 70 percent of older males, generally due to decreased testosterone levels and testicular shrinkage. (8, 9)
There are other factors which contribute to the development of this condition. Some examples are below.
Many conditions affect the balance of hormones in the body, which can lead to gynecomastia.
Hypogonadism interferes with normal testosterone production. A pituitary gland that does not function properly also affects hormone production.
Klinefelter syndrome, where males are born with one or more extra chromosomes. (10)
Tumors, especially those involving the testes, pituitary or adrenal glands, change the balance of estrogen and testosterone in the male body.
Production of too much thyroxine, due to an overactive thyroid, also has an effect on the balance of male and female hormones in men.
Liver and kidney diseases can cause fluctuations in hormone levels; both are associated with gynecomastia.
Hormone imbalance is also the result of malnutrition, or starvation. It causes a drop in levels of testosterone, but maintains estrogen levels. (11)
There are many treatments linked to the onset of gynecomastia.These include: hormone treatments like anabolic steroids and androgens, as well as androgen antagonists like spironolactone.
Drugs used to treat conditions like ulcers (e.g., cimetidine, ranitidine, omeprazole), psycho active conditions (such as antidepressants or diazepam) and cardiovascular disease (digitoxin) also affect growth of breast tissue.
Many cancer treatments can also predispose a man to gynecomastia.
Use of drugs like marijuana, heroin, methadone and amphetamines, as well as alcohol consumption, increase the risk of developing this condition. (12)
It is natural for men who experience gynecomastia to worry that it might be breast cancer.
While there is a small risk of male breast cancer developing in cases of gynecomastia, the prevalence is low: about 0.18 percent. In fact, male breast cancer represents less than one percent of all male cancers. (13)
There are no stages for this condition. There are however two sets of classifications used by medical professionals when considering breast removal surgery.
The first set has four grades which are applied when assessing suitability for surgery of this nature.
This applies to a small enlargement of the breast tissue which is localized around the nipple and surrounding areola. The breast will not appear to droop. The nipple and areola will be positioned above the line where the lower part of the breast meets the chest.
The breast enlargement is considered moderate but excess tissue will still not cause the breast to droop. The nipple and areola will still be positioned above the line where the lower part of the breast meets the chest.
Breast enlargement is considered severe. It will show minor signs of sagging (ptosis). The nipple and areola extend by no more than one centimeter beyond the line where the lower part of the breast meets the chest.
This final level represents a severe breast enlargement with major ptosis. The nipple and areola extend more than one centimeter beyond the line where the lower part of the breast meets the chest. (14)
The second set of classifications again has four grades, these are:
Enlargement of the breast is considered small, without any excess skin.
Breast enlargement is considered to be moderate, without any excess skin.
The breast enlargement is still considered moderate, but with a minor amount of excess skin
This is a significant enlargement of breast tissue and excess skin. At this stage, the breast will mimic that of a female and display signs of sagging. (15)
Prior to commencing any treatment, a medical professional will establish the patient actually has gynecomastia.There are other conditions which display similar symptoms.
We have already mentioned pseudogynecomastia (false gynecomastia), where chest fat is the cause of the enlargement.
We have also touched on breast cancer. While rare in men, a lump in the breast, especially in the area of the nipple, can mimic gynecomastia.
Once established gynecomastia is present, treatment options available include:
There are many occasions when this condition will regress naturally and spontaneously. Consequently a “wait and watch” approach might be adopted initially, with check ups every six months.
Reassurance may be the only treatment needed. (18)
Apparently, there is no medication which will regress the growth of breast tissue completely. However, some treatments will help to reduce the size of the growth and possibly relieve any associated symptoms.
Drugs used to treat this condition include anti estrogens, androgens and aromatase inhibitors. The aim of these medications is to balance hormone levels.
Anti estrogen medication, like tamoxifen, can reduce the production of estrogen in males and therefore help balance hormone levels. They are able to reduce associated symptoms and prevent the stimulation of breast tissue growth.
This treatment is considered for symptomatic gynecomastia which does not resolve itself naturally. (19)
When gynecomastia is due to hypogonadism, androgens (male hormone replacements) can be effective in its treatment.
Some androgens might worsen the condition and consideration will be given to this.
Danazole is one androgen which has shown to be effective in treating symptoms of gynecomastia, particularly size and pain. However, the drug has several potential side effects, including: acne, edema, muscle cramps, nausea and weight gain. (20)
These inhibitors block the enzyme aromatase, which helps convert the androgen hormone to estrogen in the body.
They have shown some positive results in decreasing estrogen levels in men. In particular, anastrozole and testolactone have been used to treat gynecomastia.
That said, test results indicate use of these drugs in dealing with gynecomastia appear to be inconclusive. (21)
Surgery is generally considered only as a last resort. Patients who display psychological distress, discomfort or have cosmetic issues may be offered surgery when the condition has been present for more than 12 months.
Removal of part or all of the breast, or liposuction, are the options available. 50 percent of patients are reportedly dissatisfied with the cosmetic results following surgery. (22)
What is gynecomastia? Gynecomastia is an increase in male glandular breast tissue, usually caused by decreased testosterone and elevated estrogen levels.
What are the signs of gynecomastia? The signs of this condition are an increase in breast size, usually concentric in relation to the location of the nipple. It will feel rubbery or firm and might be painful. It can affect one or both breasts.
How do you develop gynecomastia? This condition is more prevalent in infants, adolescents and older men. It is usually the result of a hormone imbalance. There are also health conditions and medications which lead to gynecomastia developing.
How are you diagnosed for gynecomastia? An initial physical examination will be conducted by a doctor. Medical history will also be discussed. If necessary, blood tests, a mammogram, imaging scan or tissue analysis might also be carried out. (23)
What is the best treatment for gynecomastia? Often a “wait and watch” approach will be adopted; this condition can rectify itself over time. Other treatment options include medication or, as a last resort, surgery. A doctor will discuss the best options on an individual basis.
What are the long term complications of gynecomastia? This condition can affect a person socially and psychologically; there is also a minimal possibility of breast cancer. (24)
Is gynecomastia considered a disability? This condition is not considered to be a disability.
Is there a cure for gynecomastia? There is no cure for this condition. However, in many cases, especially during adolescence, it will rectify itself.
Is gynecomastia life threatening? Gynecomastia is not considered a life threatening condition.
Gynecomastia is an increase in male glandular breast tissue, resulting in enlarged breasts, particularly in the area of the nipple.
Usually caused by hormone imbalance, some health conditions and medication can contribute to the onset of gynecomastia.
Fortunately, many cases of gynecomastia will rectify themselves. If they don’t, treatment options are available to help manage the symptoms.