Gynecomastia: Causes and Treatments

Gynecomastia (also known as “man boobs” or “enlarged male breast tissue”) is a condition in which male breasts swell and grow excessively. There are mainly two hormones in the body that regulate breast growth: testosterone, which decreases breast growth, and estrogen, which increases breast growth. Therefore, an imbalance between testosterone and estrogen is usually what causes the enlargement of breasts. Gynecomastia especially happens during puberty due to the fluctuations in hormone levels. Of course, it can happen in newborns and old people as well.

The Causes of Gynecomastia

As we mentioned earlier, hormonal imbalance is the main cause of male breast enlargement. However, there are also other causes:

• Alcohol
• Obesity
• Some medications/drugs: anabolic steroids, antibiotics, antidepressants, cardiovascular medications, some HIV medications, ulcer drugs, chemotherapy, marijuana, amphetamines, and heroin.
• Certain illnesses: liver disease, thyroid problems, adrenal tumors, kidney disease, klinefelter syndrome.
• Since newborns still have some of the estrogen from their mother’s blood, they may temporarily have gynecomastia.
• Older individuals tend to have lower levels of testosterone and more body fat. These two are contributing factors to gynecomastia.

Symptoms of Gynecomastia

• Lumps or extra fatty tissue around/under the nipple.
• The breasts often grow unevenly.
• Nipple discharge.
• At times, the breast tissue may feel itchy, painful, or tender.

Remember, Gynecomastia can exist in just one nipple or both. Thus, if such symptoms appear in just one breast, it would not rule out the possibility of gynecomastia.

Diagnosis of Gynecomastia

You will talk to your doctor about your symptoms. They will examine your medical history and may ask for lab tests or blood tests to measure hormone levels. Lab tests may also include a tissue biopsy, breast or testicles ultrasound, mammogram, and an MRI. Such tests help the health provider clarify whether your condition has any relation to breast cancer or other possible disorders. If you are currently on medication or have been in the past, let your doctor know. You will also undergo a physical examination of the breast tissue.

Treatment

Gynecomastia usually goes away without treatment. In adolescents, for example, it may take several months to several years. If you have had the condition for a long time now, or you are worried about its being breast cancer, you can visit a doctor. They will first identify the cause through lab tests and an examination.

After the doctor has identified the cause, they will describe the most suitable procedures for your treatment. Then they will ask you about your preferred procedure. Here we look at different means of treatment, which always correlate with the cause:

• If there is a disease/disorder acting as the underlying condition, the disease/disorder has to be dealt with. For instance, in cases where obesity is the underlying condition, gynecomastia will go away after the patient has lost enough weight.
• If certain medications/drugs/substances are the cause, the doctor will advise you to stop using them. If these are medications prescribed previously for another condition that you have, you should talk to your doctor about effective substitutes.
• In case hormonal imbalance is causing gynecomastia, you may have to take medication that balances your hormone levels.
• Sometimes there may be no apparent cause or condition. In such cases, you may need frequent examinations to determine the cause.

In some rare cases, your health provider may recommend surgery in order to remove extra breast tissue.

Medications for gynecomastia

• Testosterone replacement therapy may be required to increase levels of testosterone. This therapy can include pills, gels, and injections.
• Tamoxifen limits the effects of estrogen in the body. Ttamoxifen is mainly used to prevent breast cancer, but research has shown that it can also be an effective cure for enlarged breasts.
• Aromatase inhibitors are also mostly used to treat breast cancer, but they help with gynecomastia as well.

Surgery for gynecomastia

There are various techniques for gynecomastia surgery:

• Liposuction: Generally, this surgery is performed to remove fatty tissues from stubborn parts of the body. In the case of a gynecomastia, the surgeon removes excess fatty tissues from the breast section by using suction.
• Excision: In this procedure, the surgeon has to remove glandular breast tissue. This technique is specifically useful for repositioning the nipple and also reducing the areola.

It usually takes six months to see the final results.

Gynecomastia counseling

Gynecomastia usually does not need treatment. However, it can cause embarrassment, especially in teenage boys. It is difficult to deal with such cases alone. We recommend that you explain your situation to the people you trust, for example, family and close friends. They can provide you with moral support and help you with your decision. Similarly, speaking to a counselor might help you decide how to deal with the situation. You can also talk to people who have had this condition on the internet.

If you decide to go to the doctor, explain your situation thoroughly and try not to be shy. By writing down any questions that you have well before the consultation, you can help yourself recall things you wanted to mention.

FAQ

• What happens if gynecomastia is not treated?  

Men with enlarged male breast tissue may face a slightly higher risk of breast cancer.

• How long does it take for me to recover from male breast reduction surgery?

Most people recover after a week or two. However, this is only for regular activities. It can take 6 weeks before you can go back to vigorous activities.

• Can gynecomastia return after surgery?

Although statistics demonstrate gynecomastia surgery often has lasting results, there are cases in which the condition may return. Nonetheless, since the surgeon deals with the cause of gynecomastia during surgery, it rarely comes back.  

• Does gaining weight cause gynecomastia to come back?

Depends on the underlying cause of your condition. If being overweight had caused gynecomastia, then gaining weight may again cause breast enlargement.

• Are there any questions I should ask my doctor?

Yes, here is a list of questions you might want to ask during your consultation:

• What is the cause of my gynecomastia?
  • Can I be treated without surgery?
  • How long will my treatment take?
  • How long will my breasts be enlarged?
  • Can I prevent getting enlarged breasts again?
  • Is there a chance that I have breast cancer?