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Gynecomastia (Enlarged Breasts in Men)

Definition


Disease: Gynecomastia (Enlarged Breasts in Men) Gynecomastia (Enlarged Breasts in Men)
Category: Endocrine and metabolic diseases
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Disease Definition:

An imbalance of the hormones estrogen and testosterone causes swelling of the breast tissue in boys or men, a condition known as gynecomastia. Normal changes in hormone levels, as well as other reasons lead to the development of gynecomastia in newborns, boys going through puberty and older men.

 

Although gynecomastia could be difficult to cope with, however, it's not a serious problem. Boys and men who have gynecomastia could feel pain in their breasts, in addition to feeling embarrassed.

 

Medications that help balance hormone levels could be used to treat gynecomastia. This condition could also go away on its own. Sometimes, an available option could be surgery to remove breast tissue.
 

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Swollen breast glad tissue and breast tenderness may be some of the signs and symptoms of gynecomastia. Someone should see a doctor in case they experience pain, swelling, tenderness or nipple discharge in one or both of the breasts.
 

Causes:

A decrease in the amount of the hormone testosterone compared with estrogen triggers gynecomastia. A condition that increases someone's estrogen level or conditions that block the effects of or reduce testosterone could cause this. Medications, certain health conditions are natural hormone changes are some of the factors that may upset a person's hormone balance. The cause of gynecomastia is not found in about 25% of the cases.

 

THE TESTOSTERONE-ESTROGEN BALANCE:

The development and maintenance of sex characteristics in both men and women are controlled by the hormones testosterone and estrogen. Female traits are controlled by estrogen, such as the growth of breasts, while male traits are controlled by testosterone, such as body hair and muscle mass.

 

Though normally in small amounts, men also produce the hormone estrogen, which is not an exclusively female hormone. Mood, sperm production and bone density is regulated by estrogen. Gynecomastia could be caused when male estrogen levels are too high or are out of balance with testosterone levels.

 

GYNECOMASTIA IN INFANTS:

Because of the effects of the mother's estrogen, more than 50% of male infants are born with enlarged breasts. However, within two to three weeks after birth the swollen breast tissue goes away.

 

GYNECOMASTIA DURING PUBERTY:

This condition is quite common in puberty and is triggered by hormone changes. Usually, within six months to two or three years, swollen breast tissue goes away on its own without any treatment.

 

GYNECOMASTIA IN MEN:

At least 25% of men between the ages of 50 and 80 are affected with gynecomastia.

 

MEDICATIONS:

Some of the medications that could cause gynecomastia include:

 

  • AIDS medications: HIV positive men that are receiving a treatment regimen called HAART (Highly Active Antiretroviral Therapy), may develop gynecomastia. Efavirenz is an HIV medication that is more commonly associated with gynecomastia than others.
  • Antibiotics
  • Tricyclic antidepressants
  • Chemotherapy for cancer treatment
  • Diazepam or other anti-anxiety medications.
  • Cimetidine or other ulcer medications
  • Digitalis, calcium channel blockers or other heart medications.
  • Anti-androgens: These medications include finasteride, cyproterone, spironolactone and flutamide, which are used to treat prostate enlargement and cancer, in addition to some other conditions.

 

STREET DRUGS AND ALCOHOL:

Some of the substances that could cause gynocomastia are:

 

  • Marijuana
  • Heroin
  • Alcohol
  • Amphetamines
  • Androgens and anabolic steroids

 

HEALTH CONDITIONS:

There are several health conditions that could affect the normal balance of hormones and end up causing gynecomastia, such as:

 

  • Kidney failure
  • Starvation and malnutrition
  • Aging: Particularly in men who are overweight, gynecomastia is caused by hormone changes that occur with normal aging.
  • Hyperthyroidism: When the thyroid gland produces too much of the hormone thyroxine, gynecomastia could occur.
  • Hypogonadism: Gynecomastia could be associated with pituitary insufficiency, Klinefelter syndrome, or any other conditions that interfere with normal testosterone production
  • Liver failure and cirrhosis
  • Tumors: The male-female hormone balance may be altered due to hormones that are produced by some tumors, such as those involving the testes, pituitary gland or adrenal glands.

 

HERBAL PRODUCTS:

Due to their weak estrogenic activity, plant oils, such as tea tree or lavender that are used in lotions, shampoos or soaps have been associated with gynecomastia.
 

Complications

Complications:

There are only a few physical complications that are associated with gynecomastia. Psychological or emotional trouble due to physical appearance could be caused by this condition.
 

Treatments:

Without treatment, most cases of gynecomastia go away on their own. However, gynecomastia may need treatment in case it is caused by an underlying condition such as malnutrition, hypogonadism or cirrhosis. In case someone is taking medications that can cause gynecomastia, they may be recommended substituting them with other medications or stopping them altogether.

 

In case adolescents develop gynecomastia with no apparent cause, they may be recommended periodic re-evaluations every three to six months in order to see if the condition will improve on its own. In most cases, in less than three years, gynecomastia goes away without treatment. However, if it causes significant pain, tenderness or embarrassment, or if it doesn't improve on its own, treatment may be necessary.

 

MEDICATIONS:

Some men with gynecomastia may benefit from medications that are used to treat breast cancer and other conditions such as raloxifene and tamoxifen. However, these medications are not approved for this specific condition.

 

SURGERY TO REMOVE EXCESS BREAST TISSUE:

A person may be advised surgery in case they still have significant bothersome breast enlargement in spite of initial treatment or observation. Gynecomastia could be treated with two types of surgery:

 

Liposuction:

This surgery does not remove the breast gland tissue itself, it only removes breast fat.

 

Mastectomy:

Only small incisions are used in this surgery because it is done on an endoscopic basis. This surgery, which is less invasive, needs less recovery time. In this procedure the breast gland tissue is removed.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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