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Enlarged breasts in men (gynecomastia).

Male Boobs in men (Gynecomastia)

Gynecomastia (guy-nuh-Koh-MAS-tee-uh) is an increase in the amount of breast gland tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly. Newborns, boys going through puberty and older men may develop gynecomastia as a result of normal changes in hormone levels, though other causes also exist.

Generally, gynecomastia isn't a serious problem, but it can be tough to cope with the condition. Men and boys with gynecomastia sometimes have pain in their breasts and may feel embarrassed. Gynecomastia may go away on its own. If it persists, medication or surgery may help.

man boobs

Symptoms of gynecomastia.

Signs and symptoms of gynecomastia include:

  • Swollen breast tissue.
  • Breast tenderness.
  • Swelling.
  • Pain or tenderness.
  • Nipple discharge in one or both breasts.

Man sitting

What causes gynecomastia?

Gynecomastia is triggered by a decrease in the amount of the hormone testosterone compared with estrogen. The decrease can be caused by conditions that block the effects of testosterone, reduce testosterone or increase your estrogen level.

Several things can upset the hormone balance, including the following.

Natural Hormone changes.

The hormones testosterone and estrogen control sex characteristics in both men and women. Testosterone controls male traits, such as muscle mass and body hair. Estrogen controls female traits, including the growth of breasts.

Most people think of estrogen as an exclusively female hormone, but men also produce it though normally in small quantities. Male estrogen levels that are too high or are out of balance with testosterone levels can cause gynecomastia.

Gynecomastia in infants. More than half of male infants are born with enlarged breasts due to the effects of their mother's estrogen. Generally, the swollen breast tissue goes away within two to three weeks after birth.

Gynecomastia during puberty. Gynecomastia caused by hormone changes during puberty is relatively common. In most cases, the swollen breast tissue will go away without treatment within six months to two years.

Gynecomastia in adults. The prevalence of gynecomastia peaks again between the ages of 50 and 69. At least 1 in 4 men in this age group is affected.

man standing

Medications of Gynecomastia.

Several medications can cause gynecomastia. These include:

Anti-androgens are used to treat an enlarged prostate, prostate cancer, and other conditions. Examples include flutamide, finasteride (Proscar, Propecia), and spironolactone (Aldactone, Carospir).
Anabolic steroids and androgens, which are prescribed by doctors for certain conditions or are sometimes used illegally by athletes to build muscle and enhance performance.

AIDS medications. Gynecomastia can develop in men who are HIV-positive and receiving a treatment regimen called highly active antiretroviral therapy. Efavirenz (Sustiva) is more commonly associated with gynecomastia than are other HIV medications.

  • Anti-anxiety medications, such as diazepam (Valium).
  • Tricyclic antidepressants.
  • Antibiotics.
  • Ulcer medications, such as the over-the-counter drug cimetidine (Tagamet HB).
  • Cancer treatment.
  • Heart medications, such as digoxin (Lanoxin) and calcium channel blockers.
  • Stomach-emptying medications, such as metoclopramide (Reglan).
  • Street drugs and alcohol

Substances that can cause gynecomastia to include:

  • Alcohol.
  • Amphetamines are used to treat attention-deficit/hyperactivity disorder.
  • Marijuana.
  • Heroin.
  • Methadone (Methadose, Dolophine).
  • Health conditions.

Several health conditions can cause gynecomastia by affecting the normal balance of hormones. These include:

Hypogonadism. Conditions that interfere with normal testosterone production, such as Klinefelter syndrome or pituitary insufficiency can be associated with gynecomastia.

Aging. Hormone changes that occur with normal aging can cause gynecomastia, especially in men who are overweight.

Tumors. Some tumors, such as those involving the testes, adrenal glands, or pituitary gland, can produce hormones that alter the male-female hormone balance.

Hyperthyroidism. In this condition, the thyroid gland produces too much of the hormone thyroxine.
Kidney failure. About half the people being treated with dialysis experience gynecomastia due to hormonal changes.

Liver failure and Cirrhosis. Changes in hormone levels related to liver problems and cirrhosis medications are associated with gynecomastia.

Malnutrition and Starvation. When your body is deprived of adequate nutrition, testosterone levels drop while estrogen levels remain the same, causing a hormonal imbalance. Gynecomastia can also happen when normal nutrition resumes.

man boob

Risk factors in Gynecomastia.

Risk factors for gynecomastia include:

  • Adolescence
  • Older age
  • Use of anabolic steroids or androgens to enhance athletic performance
  • Certain health conditions, including liver and kidney disease, thyroid disease, hormonally active tumors, and Klinefelter syndrome

Complications in Gynecomastia.

Gynecomastia has few physical complications, but it can cause psychological or emotional problems caused by appearance. Many people face very shame to make a public presence. 

Prevention for Gynecomastia.

There are a few factors you can control that may reduce the risk of gynecomastia:

Don't use drugs. Examples include steroids and androgens, amphetamines, heroin, and marijuana.
Avoid alcohol. Don't drink alcohol. If you do drink, do so in moderation.

Review your medications. If you're taking medication known to cause gynecomastia, ask your doctor if there are other choices.

Diagnosis Gynecomastia.

Your doctor will ask you questions about your medical and drug history and what health conditions run in your family. The doctor will also do a physical examination that may include a careful evaluation of your breast tissue, abdomen, and genitals.

Tests for Gynecomastia.

Initial tests to determine the cause of your gynecomastia may include:
  • Blood tests
  • Mammograms

You may need further testing depending on your initial test results, including:

  • Computerized tomography (CT) scans.
  • Magnetic resonance imaging (MRI) scans.
  • Testicular ultrasounds.
  • Tissue biopsies.
  • Conditions that cause similar symptoms.

Your doctor will want to be sure your breast swelling is gynecomastia and not another condition. Other conditions that can cause similar symptoms to include:

Fatty Breast Tissue. Some men and boys have breast fat that resembles gynecomastia. This isn't the same as gynecomastia and doesn't need additional evaluation.

Breast Cancer. This is uncommon in men but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.

Treatment for Gynecomastia.

Most cases of gynecomastia resolve over time without treatment. However, if gynecomastia is caused by an underlying condition, such as hypogonadism, malnutrition, or cirrhosis, that condition may need treatment.

If you're taking medications that can cause gynecomastia, your doctor may recommend stopping them or substituting another medication.

In adolescents with no apparent cause of gynecomastia other than normal hormone changes during puberty, the doctor may recommend periodically reevaluations every three to six months to see if the condition improves on it's own. Gynecomastia often goes away without treatment in less than two years.

Treatment may be necessary if gynecomastia doesn't improve on its own or if it causes significant pain, tenderness, or embarrassment.

Medications of Gynecomastia.

Medications used to treat breast cancer and other conditions may be helpful for some men with gynecomastia. They include:

  • Tamoxifen (Soltamox).
  • Aromatase inhibitors, such as anastrozole (Arimidex).
  • Although these medications are approved by the Food and Drug Administration, they have not been approved specifically for use in people with gynecomastia.
  • Surgery to remove excess breast tissue.
  • If enlarged breasts are significant and bothersome even after initial treatment or observation, your doctor may advise surgery.

Two gynecomastia surgery options are:

Liposuction. This surgery removes breast fat but not the breast gland tissue itself.

Mastectomy. This type of surgery removes the breast gland tissue. The surgery is often done using only small incisions. This less invasive type of surgery involves less recovery time.

What is the cost of gynecomastia surgery?

In the USA the cost ranges from $4,123-$10700 depending on the amount of fat to be removed, sculpting needed, the technology used, and other miscellaneous expenses.

How to get rid of gynecomastia?

While some non-surgical treatments for gynecomastia are helpful, surgery is often the only way to correct gynecomastia. Gynecomastia surgery offers certain, immediate, and permanent elimination of excess breast tissue and fat and improvement of the appearance of the chest.

How to get rid of gynecomastia during puberty?

If gynecomastia doesn't go away on its own, male breast reduction surgery to remove the extra breast tissue is possible. Men that are suited to, or don't want to undertake surgery, hormone therapy or other medication can reduce the appearance of gynecomastia by using a compression shirt.