What is Gynecomastia?
- Gynecomastia is enlargement of the male breast tissue.
- It is common in men and boys at various stages of development and in association with certain medical conditions.
- True gynecomastia refers to enlarged glandular tissue rather than fat (adipose) tissue.
- The presence of fat tissue that appears in the breast area is known as pseudogynecomastia.
What Causes Enlarged Breast in Males?
In general, gynecomastia results from a hormonal imbalance in the body. All normal humans have both male and female hormones to a certain extent. Gynecomastia occurs when male hormones (androgens) are relatively low compared to the level of female hormones (estrogens) in the body. This can transiently occur during normal development of boys, resulting in gynecomastia in infants or during puberty. In these cases, gynecomastia usually resolves on its own as hormone levels return to normal.
In other cases, medical conditions or medical treatments can create the hormonal environment in the body that allows gynecomastia to develop. Examples of conditions that may be associated with gynecomastia include:
A wide range of medications have also been associated with the development of gynecomastia. Examples include the diuretic spironolactone (Aldactone), some calcium channel blockers and ACE inhibitor drugs used to treat hypertension (high blood pressure), some antibiotics, anti-ulcer drugs, and highly active anti-retroviral therapy (HAART) for HIV disease, which may cause fat redistribution leading to pseudogynecomastia or, in some cases, true gynecomastia.
Finally, alcohol and some drugs of abuse (for example, marijuana, and heroin) are known causes of gynecomastia. Lavender oil and tea tree oil, when used in skin-care products, have also been associated with gynecomastia.
What Are the Signs and Symptoms of Gynecomastia?
The breast enlargement of gynecomastia is usually symmetrical in location with regard to the nipple and has a rubbery or firm feel. Both sides are typically affected, although it can develop on only one side. The enlargement may be greater on one side even if both sides are involved. Gynecomastia is not accompanied by severe pain, although the enlarged area may be sensitive or tender.
In contrast to gynecomastia, male breast cancer is usually located only on one side and is not necessarily centered around the nipple. Other symptoms suggestive of cancer include a hard or firm feeling to the tissue, dimpling of the skin, retraction of the nipple, nipple discharge, and enlargement of the underarm (axillary) lymph nodes.
When to Seek Medical Care
If a male develops gynecomastia, it is appropriate to contact a health care practitioner. He or she may order tests to help determine the cause of gynecomastia. It is important to rule out any serious medical conditions that may be the cause of gynecomastia.
What Tests Diagnose the Cause of the Pain?
Gynecomastia is usually diagnosed by a physical examination. The presence of breast tissue greater than 0.5 cm in diameter is characteristic of gynecomastia. In addition to a physical examination, a careful medical history is also important to help assess the cause of gynecomastia.
The doctor may order tests, such as blood tests or imaging studies, to help establish the reason for gynecomastia. Mammography is indicated if there is any suspicion of male breast cancer.
How Is Gynecomastia Treated?
Treatment of gynecomastia is not always necessary since transient gynecomastia, such as occurs during puberty, generally resolves on its own without treatment within three years. If medications are the cause of gynecomastia, stopping the offending drug can be effective in reducing gynecomastia. Treatment of any underlying medical conditions is also important. Both medications (see below) and surgery have been successfully used to treat gynecomastia.
Can the Condition Be Treated At Home?
A variety of chest compression garments and vests are available to help minimize discomfort and/or improve cosmetic appearance if desired.
What Is the Medical Treatment for Gynecomastia?
Medications are most effective when used in the early stages of gynecomastia, because the enlarged breast tissue often becomes scarred after about 12 months. Medications are not likely to be effective at reducing scar tissue, and surgical removal is the only possible treatment.
What Medications Treat the Condition?
Treatments for gynecomastia have not been extensively studied, so data showing their effectiveness are limited. No drugs have yet been approved by the U.S. Food and Drug Administration (FDA) for treatment of gynecomastia. In general, two types of medications have shown promise for the management of gynecomastia:
- Testosterone replacement: This therapy has been effective in older men with low levels of testosterone, but it was not proved to be effective for men who have normal levels of the male hormone.
- SERMs: The selective estrogen receptor modulators (SERMs) tamoxifen (Soltamox) and raloxifene (Evista) can help reduce the amount of breast tissue, although they are not able to entirely eliminate the problem. These medications are most often used for severe or painful gynecomastia.
Male Breast Enlargement During Puberty; Should You Be Concerned?
Approximately half of all boys going through puberty will experience either one-sided or bilateral breast tissue swelling. The average age the condition occurs is around 13, and it may last for six to 18 months. The size of breast tissue swelling is generally about 2 cm (.78 inches) in diameter. While the underlying cause is generally benign and self-resolving, other causes should be explored.
Will Surgery Cure Gynecomastia?
When medical treatment is not effective, surgical removal of breast tissue has been used to treat gynecomastia. Both liposuction and direct excision techniques may be used. Gynecomastia surgery is generally safe, but as with any type of surgery, risks and complications can include infection, bleeding, and complications of anesthesia.
Can Gynecomastia Be Prevented?
Gynecomastia related to medical conditions can only be prevented to the extent that the underlying or responsible medical condition can be prevented.
Gynecomastia due to hormonal fluctuations that occur during growth or aging can generally not be prevented.
What's the Outlook for a Male with This Problem?
Fortunately, in many cases, gynecomastia goes away on its own without the need for specific treatment. Medical and surgical treatments can be effective for persistent gynecomastia. Typically, gynecomastia is not associated with long-term problems, but men with gynecomastia have an increased risk (about five-fold) for developing male breast cancer when compared with the general population. It is likely that the hormonal changes that produce gynecomastia in adult men also increase their risk of developing breast cancer.
What Does Gynecomastia Look Like?
Picture of male on the left with no gynecomastia and the male on the right with gynecomastia
Reviewed on 9/11/2017
Ladizinski, B., MD., et al. "Gynecomastia; Etiologies, Clinical Presentations, Diagnosis, and Management." South Med J. 2014;107(1):44-49.