ENLARGED MALE BREAST TISSUE (GYNECOMASTIA)
Gynecomastia is an abnormal enlargement or swelling of breast tissue in males. It is mainly caused by male estrogen levels that are very high or are out of balance with testosterone levels. It can affect any or both breasts.
What causes Gynecomastia?
Gynecomastia is typically caused by an imbalance between the hormones estrogen and testosterone. Estrogen sees to female traits, including breast growth. Testosterone sees to male traits, such as muscle mass and body hair. While each of these hormones forms the normal traits seen in males and females, males produce a little amount of estrogen and females produce a little amount of testosterone. In some cases male estrogen levels that are very high or not in balance with testosterone levels lead to gynecomastia.
Gynecomastia happens naturally at different periods in a male’s life. These phases are:
After birth. Newborn boys are mostly influenced by the effects of the estrogen they get from their mothers while developing in the womb. More than 50% of newborn males are born with enlarged breasts. The gynecomastia goes away in about two to three weeks after birth.
At puberty. Hormone levels are changing at the stage in puberty (usually 12 to 14 years of age). Breast enlargement normally goes away six months to two years after the commencement of puberty.
At mid-life and beyond. Breast enlargement regularly peaks in men between the ages of 50 and 80. Around one in four men in this age range have breast enlargement.
There are many other medical conditions that can bring about Gynecomastia. They include:
Lack of proper nutrition
Tumors in the testicles or adrenal glands
Some drugs can also cause Gynecomastia, including:
Anabolic steroids for improved athletic performance
Finasteride (Proscar®, Propecia®) for enlarged prostate
Spironolactone (Aldactone®), digoxin (Lanoxin®), amiodarone (Cordarone®), and calcium channel blockers
Cimetidine (Tagamet®) and proton pump inhibitors for heartburn
Diazepam (Valium®) for anxiety
Ketoconazole (Nizoral®) for fungal infections
Metronidazole (Flagyl®) for bacterial infections
Human chorionic gonadotropin for fertility problems
Amphetamines, marijuana, heroin, methadone (“street” drugs) and alcohol
How is Gynecomastia diagnosed?
The diagnosis is usually based on physical symptoms, breast exam, medical history and medication review, and other exams. Breast pain and softness are common symptoms. Most times a firm rubbery disk of tissue, located straight beneath the nipple area, is felt during the exam. The lump is simply portable within the breast tissue. Your doctor will assess all the medications, supplements, and herbal products you take. Your doctor will also review your medical history and order tests to verify if other diseases/conditions are the cause of the gynecomastia. Breast imaging tests -- a mammogram and/or breast ultrasound -- may be prearranged. These tests are generally ordered to rule out breast cancer. Your doctor may also order blood tests to test your hormone levels.
What is the treatment for Gynecomastia?
Normally, no treatment is needed. Most cases of gynecomastia reduces with time. However, if a medical issue is causing gynecomastia, medications may need to be given. If a medication is the cause, your doctor may ask you to stop taking it or may prescribe another medication. Your doctor may suggest to you see an endocrinologist (a doctor who specializes in handling hormone-related problems). Surgery is normally not recommended except the gynecomastia is causing serious pain and tenderness or embarrassment.
Counseling may be suggested for boys and men who don’t find it easy to cope with this condition. Gynecomastia can be embarrassing and leads to avoiding situations in which the chest is bare (changing clothes in the locker room, swimming, public showering). This can result to not wanting to be around other people, anxiety, stress, and depression. Discussing with a counselor can help.
Other conditions that have the same look of Gynecomastia, but are not Gynecomastia include:
Breast cancer. Men do get breast cancer, but it is rare. Normally breast cancer affects only one breast. The breast is not soft, feels firm-to-hard to the touch, and might contain a lump that feels like it is joined to the breast tissue. Also, lymph nodes in the breast area are inflamed. The skin on the breast region appears dimpled, and there may be escape of liquid from the nipple.
Fatty breast tissue. This is observed in obese men. It is as a result of an increase in fat deposits in the breast. (Gynecomastia is an enlargement of the glandular tissue of the breast; it is not fat deposits).
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