Gynecomastia refers to abnormal male breast enlargement, due to mainly hormonal imbalance or other factors. Male breast enlargement is not a serious condition but rather an annoying condition that highly affects self-confidence.
The severity of Gynecomastia varies from being very simple which could improve without treatment to being very problematic which requires surgical removal in addition to treatment.
What is meant by gynecomastia?
It is the condition of benign enlarged male breasts due to an increase in the breast gland tissue size as a result of an imbalance between the female sex hormone- estrogen and the male sex hormone- testosterone within the men’s body.
Gynecomastia might affect one or both breasts and sometimes breasts are enlarged unevenly.
How serious is gynecomastia?
Whereas male breast enlargement is not a serious condition that might be gone on its own, it is a very annoying condition that is tough to cope with.
Gynecomastia vs Pseudogynecomastia
Both are male breast engagements whereas the main difference between them lies in the cause behind the enlargement. In gynecomastia, breast engagement is due to the growth of the actual breast tissue. While in pseudo gynecomastia, breast enlargement is due to excess fat tissue deposition.
Physiologic vs Non-Physiologic breast enlargement
Physiologic breast enlargement is a common condition that might occur in three stages in men’s life: newborns, adolescents, and older men. It is usually self-limited and requires no treatment except if its appearance causes emotional distress or physical discomfort.
While non-physiologic condition occurs as a result of a selected cause, this type of breast enlargement must be treated with either medications or surgery.
Symptoms of gynecomastia
In addition to the abnormal increase in breast size in men, this condition includes the following symptoms:
- Pain and breast tenderness particularly appear in adolescents.
- Swelling in the breast tissue.
- Increase in nipple sensitivity.
- Nipple discharge either from one or both breasts.
Causes of breast enlargement in male
Male breast enlargement is mainly triggered by the imbalance between both testosterone and estrogen.
Most people think that estrogen is uniquely a female hormone that is secreted only in a female’s body, while it’s also normally secreted in the male body but in a very small amount in comparison to testosterone.
The hormonal imbalance rises from:
- Decrease testosterone production.
- Conditions that block the testosterone effect.
- Increase in estrogen production.
Physiological hormonal imbalance
During the man’s life the inequality between male and female sex hormones might occur physiologically as the following;
In newborns
About half of male infants are born with swollen breast tissue as a result of the effects of their mother’s estrogen. This enlargement usually goes away within the first three weeks of birth.
During puberty
Sex hormone production increases during puberty in males, rate of increase in both hormones might be unbalanced In most cases, which leads to swollen breast tissue that is usually self-limited within months.
Older males
Men between 50 to 80 years old and up to 65% of them will develop gynecomastia, and in most cases will experience no symptoms.
Nonphysiologic hormonal imbalance
This type of imbalance is triggered by a specific cause and seldom relieves it on its own but requires certain interventions to relieve it.
Causes that might trigger this imbalance:
Drug-induced gynecomastia
Some drugs, either within rational or irrational use, induce hormonal imbalance in males that lead to breast tissue proliferation, the most common drugs are:
Anti-androgens
These medications are used to treat benign prostatic enlargement and prostate cancer.
Anabolic steroids
That is used to treat hormonal deficiencies in males and delayed puberty, and in some cases to increase muscle mass and enhance athletic performance.
AIDS medications
These antivirals carry estrogen-like properties and their chronic use induces a pseudo-hormonal imbalance between male-female sex hormones
ADHD medications
Especially those that contain amphetamines.
Alcohol and Some illicit drugs
Such as Amphetamines, Marijuana, and Heroin.
Health conditions induce hormonal imbalance
Several health conditions can affect the balance of sex hormones in males causing
male breast enlargement, such as:
Hypogonadism
Includes any Condition that lowers the production of testosterone, such as pituitary insufficiency, which can lead to breast enlargement.
Kidney failure
Most cases treated with dialysis experience hormonal imbalance.
Tumors
Particularly those involving the pituitary gland, the testes, or adrenal glands, which can cause male-female hormone balance.
Hyperthyroidism
Excess thyroxine hormone production negatively affects hormonal balance.
Liver failure and cirrhosis
Both conditions affect hormone production and breakdown
Malnutrition and starvation
When the body is deprived of sufficient nutrition, testosterone levels decline while estrogen levels are usually not affected.
Complications associated with gynecomastia
Male breast tissue proliferation, if benign, is not a serious condition and is associated with few physical complications, but an annoying condition that is associated with psychological and emotional problems.
Diagnosis of the enlarged breast in men
Once you feel an abnormal increase in your breasts size you should refer to a specialist to detect the cause of gynecomastia, and to rule out other conditions, these tests include:
- Blood tests.
- Mammograms.
- CT scan or MRI.
- Testicular ultrasounds.
- In some cases, doctors might order tissue biopsies to exclude malignant causes.
Treatment of gynecomastia
Whenever an enlarged breast doesn’t improve on its own or is associated with significant pain, tenderness, embarrassment, or emotional problems, treatment is necessary.
Treatment of breast tissue proliferation depends on the cause that lies behind its development, if it’s due to a specific health condition — such as hypogonadism, Kidney failure, or cirrhosis — treat the underlying condition.
If it’s drug-induced, stop the medication or substitute it with another one if available.
Medications used for gynecomastia treatment
After dealing with the underlying cause, some medications used mainly for female breast cancer show some effect on male breast tissue proliferation, such as:
- Tamoxifen.
- Anastrozole.
Surgical treatment for breast enlargement
Surgical removal of excess breast tissue is an available option in case enlarged breasts are significant or bothersome even after medical treatment and managing the possible cause.
Surgical options available are:
Liposuction
This procedure removes excess breast fat only and does not deal with the breast gland tissue.
It’s the best option for breast enlargement due to excess fat accumulation, not breast tissue proliferation.
Mastectomy
This procedure removes the breast gland tissue through small incisions performed Mastectomy is a less invasive type of procedure that requires less recovery time.
