Gynecomastia is a condition resulting in enlarged breast tissues in men. This is caused when the hormones of the body become imbalanced. Estrogen is the female hormone and androgens are the male hormone. When a male has too much estrogen, it can cause this condition. This is very common in both boys and men during their developmental stages. This condition has also been linked to several medical conditions. The true form of this condition is in reference to an enlargement of the glandular tissue as opposed to the adipose or fat tissue. The fat tissue appearing within the male breast is called pseudogynecomastia. There are numerous conditions, diseases, and medications capable of causing this condition.
Drugs such as antibiotics and corticosteroids, herbs including tea tree oil, Dong Quai, and lavender, and medications like anti-anxiety, heartburn, and opioid drugs can all cause this condition. Gynecomastia has also been linked to obesity treatments, hyperthyroidism, cirrhosis, and low testosterone levels. The main symptom is enlarged breasts in males. The additional symptoms may include firm or rubbery nipples and sensitivity and tenderness in the breasts. In most cases, the condition does not cause any pain. This condition will generally go away by itself in about six months. If the condition has not cleared during this period of time it is important to talk to a medical professional.
This condition is generally triggered when the hormones in the body become unbalanced. Every individual has an extent of both female and male hormones. When the level of estrogen is higher than the level of androgens in the body, the result may be this condition. This can also result in boys during their normal development or during puberty. In most instances, the hormones will naturally revert to a normal level. Medical treatments or conditions can also cause the hormonal imbalance enabling the development of this condition. This includes:
- Chronic kidney failure
- Testes disorders, trauma, or infections
- Testicular cancer
- Cirrhosis of the liver
- The aging process
- Anti-androgen treatments for hyperthyroidism and prostate cancer
There are a wide variety of medications linked to the development of this condition. This includes:
- Some anti-ulcer medications
- Diuretic spironolactone
- HAART for treating HIV
- Specific ACE inhibitors used to treat high blood pressure
- Certain antibiotics
Specific drugs including heroin and alcohol can cause this condition when abused. In most cases, the enlargement of the male breasts is symmetrical regarding the nipple. The nipple often develops a firm or rubbery feel. Although the condition can develop in one breast, both breasts are usually impacted. When both breasts are affected, one breast may enlarge to a greater degree than the other.
The Diagnosis of Gynecomastia
When a male develops this condition, he should consult with a medical professional. Tests are often necessary to find the cause of the condition. It is important any serious medical conditions are eliminated as a potential cause. In most cases, the first step is a complete physical examination. One of the main characteristics of this condition is breast tissues larger than a diameter of 0.5 cm. It is important to ensure the medical profession has a complete medical history to help diagnose the cause of the condition. Numerous medical professionals will order tests including imaging studies or blood tests to help establish the cause. If there is any suspicion or indication of male breast cancer, the medical professional will order mammography.
Treatment is not always required because the condition can resolve by itself. If the cause of the condition is a specific medication, the individual should have the medication replaced with another drug by a physician. Once the medication is discontinued, the condition may be effectively reduced. There are two different medications that have shown the best results for the management and treatment of this condition. The first is testosterone replacement. This therapy is recommended for older males with a low testosterone level.
Selective estrogen receptor modulators are often referred to as SERMs. This includes tamoxifen or Soltamox and Evista for gynecomastia or raloxifene. Both can help decrease the amount of breast tissue. This type of medication is used when the condition is painful or severe. If no medical treatments have been successful, the condition can be treated by removing the breast tissue through surgery. Both direct excision and liposuction techniques have been used for treatment. If the condition does not resolve naturally, medical interception is necessary. When the condition is persistent, both surgical and medical treatments have been effective. Gynecomastia does not usually cause issues in the long term.
The Causes of Gynecomastia
There are numerous causes of this condition including:
- Side effects of medications
- Anabolic steroids and corticosteroids
- Specific herbs
- Drug abuse
- Narcotic drugs including opioids
- Drugs prescribed for heartburn
- Low levels of testosterone
- Cirrhosis of the liver
- Estrogen including soy products
- Chronic kidney failure
- Anti-anxiety medication
- The treatments for hyperthyroidism
Gynecomastia can be effectively treated using either surgical treatments or medications. The condition usually disappears naturally for both normal male infants and males experiencing puberty. One of the most common causes of the condition is the decrease in the production of testosterone in aging males. The risks for developing the condition for men predisposed to this condition are the same as for men with specific conditions and diseases including cirrhosis of the liver. There are specific medications that can increase the individual’s risk of developing this condition. The enlarged breasts result from the glandular tissues.
The cause is usually an imbalance of the male and female hormones. When there is more estrogen than testosterone in the male body, the result can be the development of this condition. When the issue is resolved naturally in either boy going through puberty or growing infants, it is referred to as physiologic gynecomastia. Although men and women both have androgens and estrogen or the male and female hormones, these hormone levels can fluctuate resulting in one or the other increasing. Numerous studies have been conducted regarding this condition. The results found in normal adolescents have produced a wide variety of different results. The belief is these differences were caused by the difference in ages of the participants and perceptions as to what is considered normal.
It is possible for the condition to become persistent and last longer than a period of two years. When this occurs, a physician should be consulted to determine if any medical action is necessary. If the cause is not related to hormones, a specific treatment may be required. If the issue resulted from the medications prescribed for an existing health problem or medical concern, the physician will recommend stopping the medication. This often results in a decrease in breast size.
Testosterone is an effective treatment if the levels of testosterone are low and the man is older. This therapy is not effective for younger males with a normal testosterone level. There are two medications that are used and shown to be effective. These are clomiphene and danazol. Clomiphene is an effective treatment for this condition and may be taken for a maximum of six months. Nolvadex has also been successfully used in the past to reduce the volume of breast tissue. This medication is unable to eliminate all of the excess breast tissue. This medication is used predominantly for men with painful or severe issues. Danazol is a synthetic testosterone derivative created to decrease the synthesis of estrogen in the testes.
This inhibits the pituitary secretion of FSH and LH hormones. The sex organs are directed by these substances to produce hormones. This is not one of the most frequently used medications for treating this condition. When the condition is still in the early stages, the medications are more effective. This is because, after approximately twelve months, scarring will begin to occur. Once there are scars on the tissues, the chances of the medication being effective sharply decrease. In most cases the only possible treatment remaining is surgery. A reduction mammoplasty is a type of surgery to reduce the size of the breasts. This surgery can be used to restore the normal appearance of the breasts if the condition is severe, has been present for a substantial period of time or other therapies have been ineffective.
In most cases, this condition is not precancerous although it can increase the risk of cancer. The most common cause is too much estrogen present and the accompanying hormonal changes. If the man affected with this condition is overweight or obese, ordinary fat tissue can be confused with glandular tissue. In some cases, the condition only affects one breast or there is growth behind the nipple. Boys often experience a breast bud in both or only one breast. The bud is usually equivalent to the size of a nickel or a quarter. One of the reasons seeking the help of a medical professional is critical is to make certain the enlarged breasts are not due to breast cancer. The symptoms of cancer are different and can be easily identified by a medical professional.
A breast abscess will also cause swelling in the male breasts. This condition is rare in males. The abscess may cause the man to develop either chills or a fever. The swelling can be extremely painful. The skin in the area may become red in color and feel hot when touched. It is important to obtain medical assistance to treat this condition. If you are interested in learning more about gynecomastia or require treatment for the condition, please reach out to the educated staff at Dr. Jeneby Plastic Surgery to learn more about your surgical options. We also offer breast augmentation for women who are looking to improve their bust size. We are conveniently located in San Antonio, TX. Contact us today to schedule your consultation!