Symptoms of gynecomastia include breast pain, tenderness, and a rubbery disc of breast tissue underneath the nipple. Enlarged male breasts can be treated permanently with gynecomastia surgery. If you are concerned about gynecomastia symptoms, the first step is to obtain a gynecomastia diagnosis.
Gynecomastia Medical History | How to Diagnose Gynecomastia
To accurately diagnose gynecomastia, a review of your medical history is required. This is important to check if there could be any underlying medical conditions or medications causing your gynecomastia symptoms.
It is common for the medical history to determine that your gynecomastia symptoms have no apparent cause. When this is the case, blood tests will be requested to check for any underlying medical issues. If the tests come back as normal, the diagnosis is of idiopathic or unknown etiology (cause). This gynecomastia diagnosis accounts for approximately 25% of cases.
Gynecomastia Physical Exam
In most circumstances, a gynecomastia pinch test will be done during a physical examination to diagnose true gynecomastia vs. fat buildup, which is the cause of pseudogynecomastia. During the exam, you will lie flat on your back with your hands behind your head. The surgeon uses their thumb and forefinger to palpate the breast tissue, looking for a specific feature to diagnose gynecomastia.
If you suffer from gynecomastia, the surgeon will conduct a physical examination which will include a gynecomastia pinch test to check if there is a rubbery mound or disc of tissue beneath the nipple. This tissue can be of various sizes and may be tender to the touch. Men with pseudogynecomastia will lack this disc of tissue, and the area beneath the nipple will feel like soft, spongy fat.
To diagnose gynecomastia your physician may also inspect:
- The testicles for size or asymmetry
- Your neck for a goiter (a small lump in the front of the neck that moves up and down when you swallow)
- Your abdomen for any abnormal growth
Is a Gynecomastia Mammogram Needed to Diagnose Gynecomastia?
Men with gynecomastia do not need a mammogram (X-ray picture of the breast) to diagnose gynecomastia prior to gynecomastia surgery. If you undergo male breast reduction surgery, a sample of the tissue removed during the surgery is sent to pathology for evaluation to check for breast cancer. Male breast cancer is rare and is found in only 0.02% of men. In order to check for early signs of breast cancer, a mammogram is only required for men over 60 who do not want to have gynecomastia surgery.
Gynecomastia Blood Tests
Blood tests such as an endocrine hormone test can evaluate the levels and balance of hormones to determine the cause of gynecomastia. In cases where a direct reason is not identified, hormone testing is essential to rule out pathological gynecomastia or tumors that discharge hormones that can cause male breast enlargement. In around 25% of cases, no cause is determined, leading to a diagnosis of unknown etiology.
In some instances, additional blood testing may be required to determine liver, kidney, and thyroid function. Gynecomastia blood tests are used to investigate if there is any other medical condition, such as prostate cancer or testicular tumors that may explain gynecomastia symptoms.
Following a gynecomastia diagnosis, gynecomastia surgery will usually be the most effective way to resolve gynecomastia symptoms. Male breast reduction surgery removes the glandular tissue causing abnormal breast tissue growth and is often combined with liposuction to remove fatty tissue and further contour the chest.
Gynecomastia vs Fat
Liposuction on its own is only appropriate for grade 1 and 2 pseudogynecomastia, which is caused by fatty tissue alone, rather than glandular tissue. If liposuction is performed to resolve true gynecomastia, the breast glandular tissue remains. This can cause uneven chest contours and the glandular tissue may continue to grow.
What causes gynecomastia?
The most common cause of male breast enlargement is hormone imbalance between estrogen (a female hormone) and testosterone (a male hormone). When the balance is tipped more toward estrogen, it can cause gynecomastia symptoms. Young males experience this imbalance during puberty, and older men experience it during male menopause. Gynecomastia can also be triggered by the injection or ingestion of anabolic steroids, which bodybuilders may use.
How do you fix gynecomastia?
Gynecomastia surgery is usually the most successful option to eliminate male breast enlargement. Men who have received gynecomastia surgery report an extremely high rate of patient satisfaction.
What is the best drug for gynecomastia?
The most common medication that may be prescribed for gynecomastia is Tamoxifen (Nolvadex). This drug is a selective estrogen receptor modulator (SERM) and can reduce breast tissue. The issue with using medication to treat gynecomastia is that symptoms often return when the medication is discontinued. Another reason gynecomastia surgery is the preferred solution for gynecomastia is due to the unpleasant side effects of gynecomastia medication.
The FDA has not approved any medications to treat gynecomastia symptoms. FDA approval will only be issued when sufficient evidence-based research and data prove that a drug produces consistent and reliable results, for the condition being treated. All gynecomastia medications are therefore prescribed as “off-label” use.
How is gynecomastia diagnosed?
To diagnose gynecomastia a patient’s medical history is evaluated and a physical exam is performed. Occasionally additional blood tests may be requested to rule out any other underlying medical causes.
What kind of doctor can provide a gynecomastia diagnosis?
A family doctor may be able to diagnose gynecomastia or send you to an endocrinologist (hormone doctor). A gynecomastia plastic surgeon can also diagnose gynecomastia.
Do I have gynecomastia or pseudogynecomastia?
The difference between gynecomastia vs. fat is that the breast tissue will feel softer and more pliable when there is no breast glandular tissue. Pseudogynecomastia can be determined during a physical exam with a gynecomastia pinch test.
Pseudogynecomastia usually occurs in men who are overweight. Another symptom of pseudogynecomastia is when male breasts change with weight gain or loss. When true gynecomastia symptoms are present, weight loss will not get rid of male breast enlargement.
Is there an alternative to gynecomastia surgery?
Several non-surgical approaches to gynecomastia may help to reduce gynecomastia symptoms. However, with true gynecomastia, surgery is the only recognized way to eliminate male breast enlargement.
For personalized information about gynecomastia plastic surgery procedures, please complete Dr. Delgado’s inquiry form.
Miguel Delgado, M.D., F.A.C.S is a world-renowned Board-Certified Plastic Surgeon granted by the American Board of Plastic and Reconstructive Surgery and a member of the American Society of Plastic Surgery and Aesthetic Society. Dr. Delgado has a surgical practice solely dedicated to cosmetic plastic surgery. He specializes in gynecomastia surgery and is the medical director of Gynecomastia.org, the oldest and largest gynecomastia forum dedicated to supporting, educating, and providing solutions for men with breast enlargement. Dr. Delgado celebrates 30 years of practice in San Francisco, California. He was voted the “Best Plastic Surgeon of 2017-2021”.
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The content on Gynecomastia.org is for educational purposes only. It is not intended as medical advice. It does not replace the need to meet with a physician who will accurately diagnose your condition and suggest treatment options.