Reviewed on 2/9/2022

What Do I Need to Know About Gynecomastia?

Figure 1: Picture of the anatomy of the nail
Picture of male on the left with no gynecomastia and the male on the right with gynecomastia

What Is Gynecomastia? How Common Is It?

Gynocomastia is an enlargement of breast tissue in males as the result of an imbanalce of the hormones in the body, with somewhat of an excess of female horomones called estrogens, when comparted to male hormones calld androgens.Gynecomastia 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 Gynecomastia?

Many medications, diseases, and conditions can cause gynecomastia, for example, drugs like corticosteroids; antibiotics; herbs like lavender, dong quai, and tee tree oil; drugs like opioids, heartburn and anti-anxiety drugs. Gynecoastia is associated with conditions and treatments for obestiy, low testosterone, cirrhosis, and hyperthyroidism.

What Are the Signs and Symptoms of Gynecomastia?

Enalrged male breasts is the primary symptom of gynecomastia. Othe signs and symptoms are rubbery or firm nipples, tenderness, sensitivity, but typically, the condition is painless.

What Is the Treatment for Gynecomastia?

Usually, gynecomastia goes away on its own within about 6 months. If it doesn't go away, talk to your doctor.

What Causes Gynecomastia?

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 Should You Call a Doctor for Gynecomastia?

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 Pain Caused by Gynecomastia?

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.

Can You Treat Gynecomastia at Home?

A variety of chest compression garments and vests are available to help minimize discomfort and/or improve cosmetic appearance if desired.

What Medications Treat Gynecomastia?

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. Moreover, 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.

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.

What Is the Outlook for a Male With Gynecomastia?

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.

Is It Possible to Prevent Gynecomastia?

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.

Half of boys experience gynecomastia during puberty.

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 6-18 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.

Reviewed on 2/9/2022
Ladizinski, B., et al. "Gynecomastia; Etiologies, Clinical Presentations, Diagnosis, and Management." South Med J 107.1 (2014): 44-49.