Gynecomastia is enlargement of the breasts in men. It is relatively common, occurring in about one third of adult men.
About 65% of boys develop some degree of breast enlargement during puberty. This is normal and usually goes away by age 18.
The breast tissue is firm in men with gynecomastia. In contrast, the breast tissue is soft in men with fat on their chests, hence looking like enlarged breasts (fatty enlargement of the breasts).
Causes
Men normally produce much more male hormones (androgens) than female hormones (estrogens). Gynecomastia is caused by an imbalance in the female and male hormones. The hormone imbalance can be caused by:
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Aging
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Testosterone deficiency
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Certain medications, such as digoxin (a heart medication), spironolactone (a diuretic), cimetidine (a medication for stomach conditions), and many others
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Anabolic steroids used to enhance athletic performance in sports
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Marijuana use
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Liver or kidney failure
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Chronic kidney disease
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Hyperthyroidism (overactive thyroid gland)
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Tumors of the testicles, lung, stomach, liver, kidney, or pituitary gland
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
By definition, only adult men can get gynecomastia.
Risk factors:
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Age: >50
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Obesity
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Excess alcohol consumption leading to liver cirrhosis
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Chronic liver or kidney disease
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Presence of a condition or medication that decreases androgen or estrogen production
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Family history
Symptoms
Symptoms of gynecomastia include:
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may need to be referred to a doctor who specializes in hormone disorders (an endocrinologist).
Your doctor will be especially interested in other symptoms you have had and your use of medications. He or she will focus their attention on your weight, breast exam, testicular exam, and any other signs of a hormone problem.
Diagnostic tests may include:
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Blood Sample–to check the function of your liver, thyroid, and kidneys, as well as other hormone levels
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Ultrasound–a test that uses sound waves to examine the breasts
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CT Scan–a test that uses x-rays and computers to examine the breasts
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Biopsy–if the diagnosis or cause remains unclear, a sample of breast tissue may be removed and sent to a pathology laboratory for evaluation
Treatment
Usually treatment of gynecomastia is not needed. However, it is important to find and treat the underlying cause of the gynecomastia. For example, if you are taking a medication that causes gynecomastia, your doctor will ask you to discontinue it or change to a different medication if possible. It is particularly important to exclude tumors as a cause of gynecomastia, and, if one is found to be present, to treat it.
If treatment of gynecomastia is needed, medications are sometimes used, though they can produce unwanted side effects. On rare occasions, surgery is used to remove breast tissue.
Prevention
Prevention of gynecomastia requires avoiding those things which are known to cause it. Thus, avoiding excessive alcohol consumption, avoiding steroids and refraining from marijuana use will prevent gynecomastia from those sources.
RESOURCES:
American Academy of Family Physicians
http://www.aafp.org
Mayo Clinic
http://www.mayoclinic.com
CANADIAN RESOURCES:
AboutKidsHealth
http://www.aboutkidshealth.ca
BC Health Guide
http://www.bchealthguide.org
References:
Enlarged breasts in men (gynecomastia). Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=HO00063. Accessed August 12. 2005.
Gynecomastia. DynaMed website. Available at: http://www.dynamicmedical.com/dynamed.nsf?opendatabase. Accessed August 14, 2005.
Gynecomastia: when breasts form in males. American Academy of Family Physicians website. Available at: http://www.familydoctor.org/080.xml?printxml. Accessed August 14, 2005.
Modest GA. Gynecomastia. In: Noble JN, ed. Textbook of Primary Care Medicine, 3rd ed. St. Louis, MO: Mosby, Inc.; 2001: 185-187.
Wise GJ. Male breast disease. Am Coll Surg. 2005;200:255-269.
