What is Gynecomastia (Enlarged Male Breast)?
Gynecomastia refers to a condition where the male breast size increases because of an expansion in ductal tissue, stroma, or fat. The word ‘gynecomastia’ comes from Greek, with ‘gyne’ meaning feminine and ‘masto’ meaning breasts. This condition tends to occur during periods of hormonal change like at birth, during adolescence, and in old age.
There are several causes for gynecomastia. These include severe obesity, use of steroids, certain medications, and medical conditions like hypogonadism, liver failure, and kidney failure. However, many patients have gynecomastia for reasons that cannot be identified, which is called idiopathic gynecomastia.
For treating this condition, the first step is often addressing the underlying cause. Then, lab tests and imaging may be conducted. When necessary, surgical intervention might also be considered.
What Causes Gynecomastia (Enlarged Male Breast)?
Most often, the cause of gynecomastia, which is breast enlargement in males, is unknown. However, it’s linked to hormone imbalances, specifically estrogen and testosterone.
Newborns may temporarily exhibit this condition due to high levels of their mother’s estrogen in their bloodstream. Teenage boys can also experience this condition when there is an imbalance between the hormones estradiol and testosterone. In men older than 65 years, the condition can occur due to a drop in testosterone levels and a shift in the balance between testosterone and estrogen. It’s also more likely in older men because they’re more likely to take medicines that can cause gynecomastia.
Several health conditions like breast cancer, obesity, low testosterone levels, adrenal disease, thyroid disease, liver scarring, kidney failure, and malnutrition can lead to gynecomastia. Hormonal imbalances caused by tumors in the adrenal glands, pituitary, lungs, and testes can also result in this condition.
Some medications can contribute to gynecomastia, including digoxin, thiazides, estrogens, phenothiazines, and theophylline. It is also linked to the use of certain recreational drugs, including marijuana. Some chemotherapy drugs, including methotrexate, alkylating agents, imatinib, and vinca alkaloids are known to cause this condition. However, the most common drugs associated with it are those that mimic the activity of estrogen, including cimetidine, spironolactone, ketoconazole, and finasteride.
Risk Factors and Frequency for Gynecomastia (Enlarged Male Breast)
Gynecomastia, which is the enlargement of male breast tissue, is more common in certain age groups of men. Newborn boys can experience this due to hormonal changes until their hormones balance out.
There is also a surge in cases around the age of 13, which can last into early adult years. Lastly, incidence goes up again in men who are 65 years and older.
- Newborn boys can have gynecomastia until their hormones stabilize.
- Starting around the age of 13, teenage boys can experience breast enlargement that can continue into early adulthood.
- Men aged 65 and older also face an increased risk of developing gynecomastia.
Signs and Symptoms of Gynecomastia (Enlarged Male Breast)
When a patient shows possible signs of gynecomastia, which is breast enlargement in a male, there are several factors that the doctor should look into. These factors include how long the patient has had gynecomastia, any symptoms that came along with it, or issues with the liver, kidney, adrenal glands, prostate, lungs, testicles, or thyroid.
In certain instances, gynecomastia could be discovered when the patient undergoes a chest MRI or CT scan for unrelated reasons. Along with this, the doctor should also investigate the patient’s family and genetic history, their use of medications and recreation drugs.
As part of the investigation, a comprehensive physical examination is required. This includes a head and neck examination to check for irregular masses or thyroid issues. The doctor will also examine the patient’s breasts to look for changes in the tissue, masses, alterations to the skin, discharge from the nipple, unevenness, and sensitivity. The armpits and testicles will also be checked for any irregularities, such as uneven size, masses, swelling, or shrinkage. If the patient is showing signs of feminization, they will need to have endocrine and genetic tests. Any other findings during the physical examination will need to be handled appropriately.
It’s important not to confuse gynecomastia with another condition, pseudogynecomastia. In pseudogynecomastia, there’s only fat around the nipple area, and this condition tends to be found on both sides of the chest. In most instances, the amount of fat remains the same over several years. In cases like these, it’s generally best to monitor the patient rather than taking immediate action.
Testing for Gynecomastia (Enlarged Male Breast)
If a man has had “man-boobs” or gynecomastia for more than a year and there are no other troubling signs or symptoms, then he’s generally in the clear and doesn’t need further tests. But if other symptoms or signs from a physical examination are present, they need further investigation.
For example, if there’s a lump in the testicles, doctors will order a testicular ultrasound and blood tests for different hormone levels. If there’s a growth on the thyroid, that would require tests to judge how the thyroid is functioning, an ultrasound of the thyroid, and a check by an endocrinologist (a hormone specialist).
If a lump is felt in the breast, the patient would need a mammogram or ultrasound, a biopsy (taking a small sample of tissue to examine under a microscope), and might need to talk to a surgeon.
If a man has low sex hormone (hypogonadism), then he will need blood tests for various hormones, an examination of his genetic blueprint (karyotype), and possibly a scan of his adrenal glands (small glands that sit on top of the kidneys and make hormones), plus a meeting with an endocrinologist.
If there are lumps felt in the abdomen or if the liver feels enlarged, the following tests will be ordered: blood tests for liver function and for various hormones, possibly a CT scan (a type of detailed X-ray) of the abdomen, and a referral to an endocrinologist. If the kidneys or liver aren’t working properly, there will be blood tests for that. If an overactive thyroid (hyperthyroidism) is suspected, then the doctor will order thyroid tests.
Treatment Options for Gynecomastia (Enlarged Male Breast)
Gynecomastia is a condition involving the enlargement of male breasts and can be grouped into three grades based on the severity of the enlargement and the presence of excess skin and droopiness. Here’s what each grade looks like:
* Grade I: A slight increase in breast size, no excess skin.
* Grade II: A moderate increase in breast size, no excess skin.
* Grade IIb: A moderate increase in breast size with some extra skin.
* Grade III: A significant increase in breast size with a lot of extra skin.
Treatment for gynecomastia can vary depending on the cause. If an underlying medical condition is causing the breast enlargement, the first treatment step is to address that condition. In cases where the condition has been present for less than a year and shows no signs of abnormal growth, doctors may recommend a wait-and-see approach with regular check-ups. If a medication is identified as a potential cause, it should be stopped. If the condition persists for more than a year, even after treating the underlying cause, surgical treatment may be advised.
It’s worth noting that medical treatments, like certain medications, typically don’t work well in cases that have been ongoing for a long time. Drugs like clomiphene, danazol, and tamoxifen have seen some success in acute cases, but they also come with side effects that some patients find hard to handle.
Surgical treatment options can vary depending on the severity of the condition. Patients with grade I or IIa gynecomastia may be treated with liposuction and surgical removal of the breast tissue.
In cases of grade IIb gynecomastia, a more extensive surgical approach may be needed. This could include open surgical removal of the breast tissue and excess skin, particularly if there’s significant droopiness.
What else can Gynecomastia (Enlarged Male Breast) be?
When a doctor suspects a condition, they often need to consider and rule out other possible diseases that might show similar symptoms. In the case of breast cancer, they would also consider conditions like:
- Lymphoma (a cancer of the lymph nodes and lymph system)
- Dermoid cysts (benign tumors that usually occur in the ovaries)
This process helps to ensure that the diagnosis is accurate and appropriate for the patient’s condition.
What to expect with Gynecomastia (Enlarged Male Breast)
Gynecomastia, or enlargement of male breast tissue, isn’t life-threatening, but it can lead to substantial emotional stress. In most cases, it can take months, or even years, to improve. Moreover, men with a condition known as Klinefelter syndrome may also face an increased risk of developing male breast cancer.
Young individuals dealing with gynecomastia often experience depression, isolation, avoid activities where they must remove their shirts and struggle with low self-esteem.