An Overview of Gynecomastia

Gynecomastia is the enlargement of the glandular tissue in one or both of a male's breasts that's usually due to hormone imbalance, though other causes exist. The condition is benign (noncancerous) and very common: Up to 70% of young and adolescent boys experience gynecomastia, and according to one study, up to 65% of men over 50 have some degree of it.

Males with gynecomastia often consider it embarrassing, and it can take a toll on their self-confidence and body image. The condition often resolves on its own as hormone levels normalize, but treatments—including medication and surgery—are available if it persists and an aesthetic change is desired.

The main symptom of gynecomastia is enlarged breasts. It often begins as a slight bump or lump behind the nipple. This enlargement is usually painless, but some men experience tenderness. One breast may be larger than the other.

There are two types of gynecomastia: physiologic and nonphysiologic, and both must be considered when a male presents with an enlarged breast.

Physiologic gynecomastia results from an increase in the ratio of estrogen (female hormone) to testosterone (male hormone) that occurs naturally at birth, puberty, or as part of aging. Eventually, the exposure to this hormone imbalance can stimulate the growth of glandular tissue.

Birth

Up to 90% of newborn boys have enlarged breasts as a result of the estrogen that's transferred from their mother in the womb. Newborn gynecomastia usually resolves spontaneously after about a month.

Puberty

Half of adolescent boys will experience gynecomastia, usually at around age 13 or 14. It often goes away on its own within six months to two years, but the condition persists into adulthood up to 20% of the time.

Older Adults

Decreasing levels of the hormone testosterone may contribute to the final peak in gynecomastia incidence in men older than 50.

This type of gynecomastia, which can occur at any age as a result of a number of medical conditions, medication use, or substance use, typically takes longer to get to the bottom of, as there are several possibilities for it.

Chronic Conditions

Nonphysiologic gynecomastia may be caused by chronic conditions such as:

• Cirrhosis of the liver
• Hypogonadism (testosterone deficiency)
• Hyperthyroidism
• Poor kidney function
• Testicular or adrenal tumors (rare)

Gynecomastia is also a symptom of Klinefelter syndrome, a condition in which a male has an extra X chromosome. Males usually have one X and one Y chromosome. Some of the other clinical findings associated with Klinefelter's are hypothyroidism, infertility, and testicular cancer. Klinefelter syndrome is associated with an increased risk of developing male breast cancer. But if you have gynecomastia, the condition alone does not increase your risk of breast cancer.

Drugs/Treatments

Use of certain drugs may also lead to enlarged breasts in men. For example:

• Spironolactone (heart medication)
• Ketoconazole (anti-fungal)
• Heartburn and ulcer medications
• Certain supplements
• Illicit drugs (marijuana, heroin, amphetamines)

Anabolic steroid use often causes irreversible gynecomastia as well, according to one report. The injection of external testosterone inhibits the natural production of testosterone, which cannot recover rapidly enough between steroid-injecting cycles to prevent estrogen predominance, explain the authors.

Gynecomastia can also result from tamoxifen or radiation therapy prescribed to men with prostate cancer because the treatment blocks male hormones.

Essential Oils

Gynecomastia in children has been associated with regular use of skin care products (lotions, soaps, and shampoos) containing tea tree oil and lavender oil, according to one study. These oils contain plant estrogens that can affect the body's hormone balance. Gynecomastia usually resolves completely after stopping the products.

To diagnose gynecomastia, a doctor will perform a physical exam of the genitals, liver, lymph nodes, and thyroid, as well as the breasts.

It's important to be sure that a male's large breasts are due to excess growth of glandular tissue, which has a network of ducts that can be felt, and not excess fat tissue. Known as pseudogynecomastia, this occurs when the breasts of overweight boys and men enlarge due to increased fat and not true breast tissue.

Blood tests to check hormone levels may also be performed. Sometimes imaging tests like a mammogram or ultrasound may also be needed to confirm the diagnosis.

If pseudogynecomastia is determined to be the cause, your breast size will not decrease on its own. A combination of diet and exercise can help reduce your total body fat percentage and, likely, your chest size.

In contrast, there are several possible treatment options for gynecomastia, and what is best for your case depends on a few factors.

Because breast growth in newborns and adolescents often goes away on its own, no treatment may be needed at all.

When gynecomastia is the result of an underlying health problem or use of medication that may cause breast growth, treating that problem or discontinuing the medication usually improves the condition. Of course, this should be done under the advisement of your physician.

In cases where the condition is persistent or causing substantial discomfort or mental anguish in boys, a doctor may prescribe a brief (three-to-six-month) course of an estrogen-blocking drug called tamoxifen or raloxifene.

Adult men may also be prescribed a short course of one of these drugs. However, this treatment is only effective in men whose breast tissue is tender and who have had the condition for less than a year.

Medications are more effective if used as early as possible after symptoms are first noted, according to one report.

Surgery is a common treatment for gynecomastia. In 2016, it was the second most common plastic surgery procedure performed on men. Surgery is generally not recommended for adolescents until puberty is completed to be sure the breast tissue has stopped growing.

There are a number of surgical techniques used to reduce breast tissue. Often men are treated with an excision technique to remove glandular tissue and/or excess skin and possibly reduce the areola or reposition the nipple, plus liposuction to remove excess fat. The surgery often deemed to be a success: In one 2016 study, the majority of men who had surgery ranked their satisfaction score as a 9 out 10.

Gynecomastia is a common problem among boys and men, and it's important to see your doctor to rule out any medical cause for the condition. Though it may resolve on its own without treatment, gynecomastia often leads to feelings of anxiety, embarrassment, emasculation, and even depression. If your condition persists and causes you emotional distress, consider meeting with a counselor or mental health professional who can provide support and advice you about how you can learn to accept your body. If you can't accept your breasts or they're causing symptoms, there are treatments—lifestyle changes, medication, and surgical procedures—that can help reduce the size of your breasts.