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:

Obesity

Lack of proper nutrition

Tumors in the testicles or adrenal glands

Liver disease

Hyperthyroidism

Hypoandrogenism

Hypogonadism

Kidney failure

Some drugs can also cause Gynecomastia, including:

Anabolic steroids for improved athletic performance

Estrogens

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).

Frequently Asked Questions (FAQs)

Is gynecomastia a common issue in Nigeria?

Yes, gynecomastia is relatively common in Nigeria, as it is in many parts of the world. It can affect males of all ages, from infants to adults.

Can gynecomastia go away on its own?

In some cases, gynecomastia may resolve on its own, especially if it is related to hormonal changes during puberty. However, in many cases, treatment may be necessary to address the condition.

What are the treatment options for gynecomastia in Nigeria?

Treatment options for gynecomastia may include surgery (liposuction or glandular tissue removal), medications, or lifestyle changes, depending on the underlying cause and severity of the condition.

Is gynecomastia surgery safe and readily available in Nigeria?

Gynecomastia surgery is generally safe when performed by a skilled surgeon. Reputable hospitals and clinics in major Nigerian cities, such as Lagos and Abuja, offer this procedure.

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