Doctor's Notes on Gynecomastia Definition, Causes, Pain, Diagnosis, and Surgery
Although gynecomastia may be caused transiently in the normal development boys, it usually resolves on its own. Other causes such as medical conditions or medical treatments may not resolve spontaneously. Causes associated with gynecomastia development include cirrhosis, malnutrition, chronic kidney failure, disorders of the male sex organs, aging, testicular cancer, hyperthyroidism and anti-androgen medical treatments. Other associated causes are alcohol use and some drugs of abuse like heroin.
Male breast cancer usually causes gynecomastia only on one breast and may include a lump or feeling of hard tissue in the breast; other signs and symptoms may be breast skin changes, nipple discharge and enlargement of underarm lymph nodes.
Gynecomastia Definition, Causes, Pain, Diagnosis, and Surgery Symptoms
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.
Gynecomastia Definition, Causes, Pain, Diagnosis, and Surgery Causes
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:
- cirrhosis of the liver,
- chronic kidney failure,
- disorders of the testes (male sex organs) including infection, trauma, or inborn disorders,
- testicular cancer,
- anti-androgen treatments for prostate cancer, and
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.
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.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.