Gynecomastia: Information, Treatment, and Support.
Gynecomastia: Information, Treatment, and Support.
Helping men learn about support and treatment options for gynecomastia. Our expert doctors are here to help.
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Gynecomastia Specialist Michael Law MD
What is Gynecomastia (Enlarged Breasts in Men)?
Gynecomastia is a medical condition where men and boys experience enlarged breast gland tissue. It may occur when one or both of the hormones in your body are imbalanced. If you suffer from enlarged breasts caused by fatty tissue accumulation, you have a condition called “pseudogynecomastia.” In men, breast gland tissue does not develop as it does in women. It is common for newborn babies to be born with a small amount of breast enlargement due to the mother’s estrogen. Newborn males that develop gynecomastia most always return to normal. Adolescent boys produce a male hormone known as testosterone during puberty, which is pivotal in guiding sexual development. Males, however, also have male estrogen levels — the female hormone that directs female characteristics.
As boys go through puberty and older men experience reduced testosterone levels, hormone imbalance can occur with the female hormones estrogen.
If this occurs, the male breast glands may swell due to increased levels of estrogen. As a result, two-thirds of adults over 50 years old and half of adolescent boys will suffer from gynecomastia to some degree. Seventy percent of boys lose their breast buds after a year, and ninety percent within two years.
Do I have Gynecomastia?
The most common types of gynecomastia are adolescent, adult, anabolic steroid-induced gynecomastia, and pseudogynecomastia.
Gynecomastia can first be identified by a lump of fat beneath your nipple or breast enlargement. In addition, there may be some breast pain, soreness, or breast tenderness associated with the swelling. The gynecomastia breast tissue in men may be moveable and fibrous beneath the nipple in one or both breasts. The enlarged breast may feel firm and distinct from the softer fat tissue. Nipple discharge is noticed in some males. Breast pain and tenderness is common.
There is a possibility that this might make you worry that you are at risk of breast cancer, which affects a small number of men. Typically, signs of gynecomastia do not indicate breast cancer, but your doctor may run some tests to exclude the possibility.
Occasionally, the appearance of true gynecomastia may display swollen glandular tissue that may be uneven, with one becoming more prominent than the other. Gynecomastia may affect one or both breasts.
Gynecomastia tissue is may be tender or painful, or if there is discharge from the nipple of one or both breasts, you should consult a physician.
Gynecomastia caused by breast cancer is extremely rare. There is a low incidence of male breast cancer in the United States. The number of new cases and deaths in 2017 was approximately 2,300. About 1% of all breast cancers are males. Men are less likely than women to be diagnosed with cancer and to die from it.
What Causes Gynecomastia?
The hormone imbalance responsible for male breast growth can be caused by several factors, many of which are unknown. However, it is pretty clear that estrogen controls female traits and testosterone controls male traits, and the balance between these hormone levels plays a significant role in enlarged breast tissue (gynecomastia) development.
In addition to regular changes in the body like puberty and aging, the following risk factors can lead to gynecomastia:
- The testicles, which produce testosterone, can be damaged or afflicted by disease or injury.
- Thyroid gland disorders can alter thyroid function
- Obesity can lead to increased estrogen production.
- The illegal use of anabolic steroids causing enlarged breasts in men with pain and tenderness
- Cannabis | marijuana
- Drug Heroin
- Kidney failure or kidney disease
- Adrenal Glands or pituitary gland tumor or malfunction of hormone production
- Overindulgence to drink alcohol
- Anti-androgens drugs. These drugs are used to treat an enlarged prostate or prostate cancer. Gynecomastia is a common side effect of hormone therapy for prostate cancer patients.
- Androgens and anabolic steroids: To improve their athletic performance, athletes sometimes use these illegal drugs. In addition, a healthcare professional can treat some medical conditions with these drugs.
- Drugs that treat HIV: Gynecomastia is occasionally caused by HIV treatment called “highly active antiretroviral therapy.”
- Anxiety-reducing medications. There are some medicines, such as diazepam ( Valium ), which may cause gynecomastia.
- Heart Medications. Gynecomastia can be caused by several medications, including digoxin (Lanoxin) and calcium channel blockers.
- Medications are used to empty the stomach. In particular, metoclopramide (Reglan ) can cause gynecomastia as a side effect.
- Anti-ulcer drugs. Cimetidine, Tagamet antibiotics, and some over-the-counter medicines for ulcers can lead to gynecomastia.
- Also, some cancer treatments and tricyclic antidepressants can be effective in treating depression can result in gynecomastia.
Approximately 10–25% of cases of gynecomastia are believed to be caused by certain drugs. Illegal drug use of anabolic steroids is the #1 drug.
Male Breast Anatomy
A normal male breast contains some glandular, or breast tissue and fat.
The breasts of men and women are both composed of breast tissue, fatty tissue, and connective tissue. Women have a larger amount of glandular (breast) tissue than men, with the amount of tissue present fluctuating throughout the woman’s life.
Men with gynecomastia have more breast tissue present, due to changes in hormone levels. Because glandular tissue is located at the front of the breast, an increase in glandular tissue causes a noticeable protrusion on the male breast. This causes the breasts to take on a more feminine appearance.
Normal Male Breast
Ninety percent of cases of gynecomastia are resolved by the time a child reaches adulthood. However, in later life, the incidence of these enlarged breasts increases again as one gets older.
Gynecomastia will prompt your doctor to refer you to an expert known as an endocrinologist, who deals with hormones and their effects on the body. The endocrinologist will conduct the evaluation which consist of blood test and physical exam as described below.
The examination will begin with a comprehensive physical evaluation, and medical history is obtained. An important aspect of the physical exam is the evaluation of the following:
- Examination of the breast for cancer and determine if pseudogynecomastia (enlargement of the male chest by excess fat deposits) is the problem. Both breasts must be evaluated because gynecomastia can affect one or both breasts. The “pinch test” is a good self-diagnosis test.
- Measurement of penile size and development,
- Detection of masses in the testicles, which raise suspicions of testicular cancer
- Primary sex characteristics such as pubic body hair are adequately developed.
- Most cases of gynecomastia occur bilaterally, but they can also be unilateral.
It may be possible to determine the cause of gynecomastia by reviewing the medications and illegal substances that an individual consumes.
Recommended blood tests that can cause gynecomastia includes :
- Evaluate liver disease, aspartate transaminase, and alanine transaminase blood tests levels should be performed.
- Blood levels to test for kidney disease by measuring serum creatinine.
- Thyroid disease is evaluated by measuring thyroid-stimulating hormone levels. Adrenal gland evaluation.
If these initial laboratory blood tests do not reveal the cause of gynecomastia, then further tests are required. In addition, you should undergo a thorough evaluation and lab testing to identify any underlying hormonal changes caused by hypogonadism or a testicular tumor, including:
- Sex hormones testosterone and estrogen levels. Since testosterone controls male traits and estrogen controls female traits. These blood test should also include both total and free testosterone levels
- Follicle-stimulating hormone or luteinizing hormone
- Hormones estrogen levels
- A serum level of human chorionic gonadotropin beta
- The presence of high levels of prolactin is uncommon in people with gynecomastia. The pituitary gland can produce hormonally active tumors such as prolactinoma, which produces hormones like prolactin that causes gynecomastia.
- Breast imaging is sometimes used to evaluate cancer of the breast, or breast imaging can quantify glandular components of the male breast tissue. These tests can often rule out breast cancer.
- The female hormone estrogen
A testicular ultrasound should be performed to determine whether there is a hormone-secreting testicular tumor if *-hCG levels are abnormally high.
The urinary 17-ketosteroid dehydroepiandrosterone can be examined for markers of testicular, adrenal, or other tumors if physical examination indicates that hormone balance is disturbed. Gynecomastia (unclear cause) is considered idiopathic when this evaluation results show no reason for the condition.
Once the medical conditions of gynecomastia are evaluated, your American family physician can provide medical advice.
Treatment of Gynecomastia
The treatment of enlarged breasts in men (gynecomastia) may differ depending on your age, health, duration of the disease, and response to certain drugs.
When it occurs during puberty, gynecomastia usually disappears by itself. However, the process might take between 6 months and two years. Resolution of man boobs occurs in over 80% of pubertal gynecomastia cases.
Gynecomastia that develops in puberty and persists beyond two years is referred to as persistent pubertal gynecomastia.
Moreover, if your hormonal levels are unbalanced due to another health condition, you will need to treat the underlying condition as well.
A hormone imbalance that is contributing to breast enlargement may be addressed by medication or tissue hormone treatment.
In some cases, you might need to treat gynecomastia by breast reduction procedure.
Gynecomastia Treatment: Non-invasive Options
|What effect does it have?||Gynecomastia||Pseudogynecomastia|
|Exercise||Minor. May help with excess fat, but will not affect glandular tissue||Minor to significant. Diet and exercise may help reduce the amount of fatty tissue.|
|Non-Invasive Fat Reduction||Minor. May help reduce excess fat, no impact on glandular tissue||Minor to significant. It will depend on individual anatomy and responsiveness.|
|Liposuction||Minor to moderate. Excellent for fat removal, but will not affect the glandular tissue||Significant. Liposuction can remove excess pockets of fat|
|(tissue excision)||Significant. Can help reshape the breast||Unnecessary.|
Gynecomastia Surgical techniques
In breast reduction surgery or gynecomastia surgery, surgical techniques differ according to the degree of gynecomastia
Severity or “Grades of Gynecomastia”?
Gynecomastia does not occur equally among male teens and adults. Different cases may differ based on certain factors. Enlarged breasts in men can vary in size and what causes it, and the quality of the skin. Some features include:
- mammary size
- mammary ptosis (droopiness)
- excess skin
- puffiness in the nipples
- skin elasticity
- chest shape
The American Society of Plastic Surgery developed a classification system or “grades of gynecomastia,” allowing plastic surgeons to evaluate the condition in a standard way.
Gynecomastia Surgical techniques
When deciding which reconstructive surgery method is most appropriate, it is crucial to consider the size of the glandular tissue and the laxity of the skin. The various techniques are as follows:
Pull-Through Technique. A small incision is made of approximately 4-5 mm, in which the swollen gland tissue is pulled through the skin incision.
Gland excision and liposuction. This is the most common gynecomastia surgery technique. An areola skin incision is made at the bottom from the 4 to 8 o’clock location. Liposuction is performed first, and the fatty breast tissue is removed surgically using a lighted retractor.
Two-stage procedure. The technique is used when there is mild to moderate skin laxity. The first stage is gland excision and liposuction. The second stage is performed four later months when a donut shape of skin is cut out around the areola, and the outer circle is purse-stringed closed around the smaller ring, which tightens the skin.
Mastectomy | Double incision mastectomy with a free nipple graft
Gynecomastia treatment with this technique is for patients with grade 3 or 4 enlarged breasts, which is characterized by an excess of skin. These are the more severe cases. Excess skin and gland tissue are removed, which results in a tight, firm, and contoured chest. In addition, the nipple and areola complex is resized and repositioned for a more masculine appearance. The fat deposition in the upper chest is reduced using liposuction for a better contour.
The best surgeon for these specialized techniques is a plastic surgeon who is a specialist as opposed to an average general surgeon. A plastic surgeon is an aesthetic surgeon with special training in breast enlargement reduction procedures.
With all of these, the extra tissue is permanently removed and rarely recurs. The gland tissue can be seen in one but more commonly both.
* There are different types of sedation used in Breast Reduction surgery, including local and general anesthesia. Your plastic surgeon will provide medical advice and details regarding his surgical preferences prior to surgery.
Prevention of Gynecomastia
To reduce manboobs, patients can take certain precautions. Among them are:
- llicit drugs use is not recommended, such as steroids, androgens, amphetamines, marijuana, or heroin.
- Don’t drink alcohol or drink moderately.
- Diet management and adequate nutrition, which is high in testosterone and low in estrogen
- Talk to your internal medicine doctor about your medicine list. If any of your medications can cause enlarged male mammary tissue, ask if there are alternatives.
- Weight management and an exercise routine to build up the chest muscles.
non-invasive procedures help improve the shape of the male chest?
If the breasts are enlarged due to an accumulation of adipose tissue (fat), non-surgical methods are options. This is pseudogynecomastia rather than true gynecomastia.
Cryotherapy is used to freeze and destroy unwanted fat (which is then excreted by the body). CoolSculpting can be a practical choice for treating mild cases of pseudogynecomastia. CoolSculpting is a procedure that can be used to permanently reduce mild to moderate amounts of unwanted chest fat and produce a more masculine look in the patient’s upper body.
Diet and exercise can reduce the fat content in the chest and build muscle mass to create an overall masculine chest. This is a great comprehensive health solutions for man boobs and a healthy lifestyle.
Gynecomastia: Is it harmful?
By itself, gynecomastia is unlikely to harm. However, during puberty, it may even disappear on its own in boys. In 70% of boys, this swollen mammary bud and fat deposit go away in a year, and in 90%, it goes away in two years.
Sometimes some individuals may choose therapy to discuss the shame and embarrassment of the female traits of breast tissue enlargement. In some cases, the medical treatment is surgical removal by plastic surgery. In other patients, hormone therapy blocks the female hormone or estrogen level to better balance with testosterone level. Every male is different, and a customized plan for dealing with man boobs is critical.
In growing boys, this could help prevent psychological issues, improve self-esteem and prevent bullying and other problems at school.
Should I be concerned about breast cancer?
An enlarged chest characterizes the condition known as gynecomastia. Man boobs caused by breast cancer are incredibly uncommon or even rare. However, even with man boobs, the chances of developing breast cancer cells are very low. Man boobs usually go away by themselves with minimal treatment, and there is little risk of long-term complications.
Do Anabolic steroids cause Gynecomastia?
Our bodies convert steroids into estrogen (within fat cells). For example, the unwanted mammary gland is caused by a rise in estrogen levels in males. Despite the highly competitive standards in today’s sport, male bodybuilders are very body-conscious and highly value their appearance. In response, male bodybuilders frequently experiment with or use steroids to enhance their physique.
Is Gynecomastia a breast tissue?
Gynecomastia is an overdevelopment or enlargement of the breast tissue in men or boys. Breast tissue is formed when the hormones testosterone and estrogen are out of balance.
How can I help my son cope has gynecomastia?
Dealing with gynecomastia is one of the most challenging issues for a parent or loved one. The first question a male asks himself is, “do I have gynecomastia.” This usually occurs as soon as he realizes he is different from other males, and teasing begins. It can lead to a roller coaster of guilt and shame, impairing psychological functioning. One is often prompted to hide one’s chest in public and become socially isolated as a result. Sometimes parents do not understand what a young boy is experiencing, and some great discussion is found on the forum here.
The first step in determining the diagnosis is to consult with a pediatrician and an endocrinologist. Additionally, a psychologist may be of assistance. The problem is unlikely to resolve after two years if the enlarged chest persists. He may want to talk to a plastic surgeon when the issue significantly impacts his well-being. Additionally, Gynecomastia.org has a comprehensive referral network, a wealth of information, and support for men with this condition.
Gynecomastia.org does not provide medical advice, treatment, or diagnosis.
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