Gynecomastia is a condition in boys or men where the amount of breast gland tissue is increased because of an imbalance between the estrogen and testosterone hormones. It can affect one or both breasts. In this article, we will be discussing the symptoms, causes, diagnosis, and treatment of this condition.
Symptoms
Here are a few symptoms of gynecomastia:
- Breast tenderness
- Swollen breast tissue
- Pain
- Nipple discharge from one or both breasts
Causes
Gynecomastia is a condition that is triggered when the amount of testosterone decreases in comparison to the estrogen. There are several conditions that can be responsible for blocking the effects of testosterone, increasing the estrogen, or reducing the testosterone level. Here are a few things that can upset the hormone balance:
- Natural hormone changes
The hormones estrogen and testosterone control sex characteristics in women and men. Estrogen controls female traits like the growth of breasts while testosterone controls male traits like body hair and muscle mass. Some people believe that estrogen is an exclusively female hormone, but it is produced by men as well, usually in small quantities. If the male estrogen levels get out of balance with the testosterone levels or too high, it can lead to gynecomastia.
- Medications
There are several medications that can lead to gynecomastia:
- Anti-androgens for treating prostate cancer, enlarged prostate, or other conditions.
- Anabolic steroids and androgens are sometimes illegally used by athletes for enhancing performance and building muscle.
- AIDS medications
- Anti-anxiety medications
- Antibiotics
- Tricyclic antidepressants
- Ulcer medications
- Cancer treatment
- Stomach-emptying medications
- Heart medications
- Alcohol and street drugs
Here are a few substances that can lead to gynecomastia:
- Alcohol
- Marijuana
- Heroin
- Amphetamines used for treating attention-deficit/hyperactivity disorder
- Methadone
- Health conditions
- Hypogonadism – Conditions in which the normal testosterone production is interfered with like pituitary insufficiency or Klinefelter syndrome.
- Tumors – Some tumors, especially the ones involving adrenal glands, pituitary gland, and testes can change the male-female hormone balance.
- Hyperthyroidism – In this condition, too much thyroxine is produced by the thyroid gland.
- Liver failure and cirrhosis – Any changes in the hormone levels related to cirrhosis medications and liver problems can be associated with gynecomastia.
Diagnosis
The diagnosis will begin with the doctor asking you about the health conditions that run in your family and your drug and medical history. This will be followed by a physical examination that includes an evaluation of your breast tissue, genitals, and abdomen.
Here are some diagnostic tests used for determining the cause of gynecomastia:
- Mammograms
- Blood tests
Depending on the initial test results, you might have to go through the following tests as well:
- Magnetic resonance imaging (MRI) scans
- Computerized tomography (CT) scans
- Tissue biopsies
- Testicular ultrasounds
The doctor will make sure that your breast swelling is due to gland enlargement and not some other condition. Here are some examples of such conditions that have similar symptoms:
- Fatty breast tissue – Some boys and men have breast fat resembling gynecomastia. It doesn’t need any further evaluation.
- Breast cancer – Even though it is uncommon among men, it can occur. The presence of a firm nodule or enlargement of one breast can be a concern for breast cancer.
- Breast abscess – This is a breast tissue infection.
Treatment
In most cases, you won’t need any treatment for gynecomastia and it will resolve itself over time. However, if it is caused by another underlying condition like malnutrition, hypogonadism, or cirrhosis, it might need treatment.
In case your gynecomastia is caused by taking some medications, the doctor will recommend either stopping them or substituting them. In adolescents with no definite cause other than normal hormonal changes, the doctor will recommend periodic reevaluations in every 3 to 6 months to check if the condition is improving on its own or not. Usually, it will go away without any treatment in less than 2 years. However, if it doesn’t, here are some treatment options:
- Medications
Medications that are used for treating breast cancer and other conditions can be helpful with gynecomastia as well.
- Surgery
If the medications don’t work and the enlarged breasts are becoming significant and bothersome, the doctor might advise surgery. Here are two surgery options for treating gynecomastia:
- Liposuction – Through this procedure, breast fat is removed, but not the breast gland tissue.
- Mastectomy – In this surgery, the breast gland tissue is removed. It is often performed through small incisions that ensures less recovery time.
Make sure that you talk to your doctor before going through the surgery to understand everything there is to know about the procedure.
Blog written by:
Dr. Sasikumar
Consultant Cosmetic Surgery
Apollo Cosmetic Clinics, MRC Nagar
