Symptoms of gynecomastia include breast pain, tenderness, and a rubbery disc of breast tissue underneath the nipple. Enlarged male breasts can be removed permanently with gynecomastia surgery. If you are concerned about gynecomastia symptoms, the first step is to have a gynecomastia diagnosis.
Consult With Dr. Delgado
Gynecomastia Medical History | 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 and is enough to diagnose true gynecomastia vs. fat, which is the cause of pseudogynecomastia. During the exam, you will lie flat, with your hands supporting 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 your:
- testicles for size or asymmetry
- neck for a goiter (a small lump in the front of the neck that moves up and down when you swallow)
- 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. A sample of the tissue removed during gynecomastia surgery is sent to pathology for evaluation to check for breast cancer. Breast cancer is rare in men and is found in only 0.02% of males. 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 that may explain gynecomastia symptoms.
Following a gynecomastia diagnosis in most cases gynecomastia surgery will be the most effective way to resolve gynecomastia symptoms. Gynecomastia surgery removes the glandular tissue and is often combined with liposuction which removes fatty tissue and contours the chest.
Gynecomastia vs Fat
Liposuction on its own is only appropriate for grade 1 and 2 pseudogynecomastia which is only caused by fatty tissue. If liposuction is performed to resolve gynecomastia the breast glandular tissue remains. This can cause uneven chest contours and the glandular tissue may continue to grow.
1. 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.
2. How do you fix gynecomastia?
Gynecomastia surgery is the most successful option to eliminate male breast enlargement. Men who have received gynecomastia surgery report an extremely high rate of patient satisfaction.
3. 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 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.
4. How do you test for gynecomastia?
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.
5. 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 specialist gynecomastia plastic surgeon can also diagnose gynecomastia.
6. Do I have gynecomastia or pseudogynecomastia?
The difference between gynecomastia vs. fat is 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 will usually occur 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.
7. 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”.
Gynecomastia.org does not provide medical advice, treatment, or diagnosis.
©Copyright 2020 Gynecomastia.org. All rights reserved. Use and access to this site are subject to the terms and conditions as set out in our Legal Statement and Privacy Statement.
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.