Gynecomastia

What is gynecomastia?

Gynecomastia is a condition of breast enlargement in men. The glandular enlargement arises from hormonal imbalances. It could be confused with pseudogynecomastia caused by fatty depositions in the pectoral area of the chest, where the breasts are located. Physiological gynecomastia occurs primarily in infants and pubertal boys where the hormonal imbalance rectifies on its own within 6 months. If the condition persists for longer periods as a person ages then it is classified under persistent pubertal gynecomastia and requires medical intervention.

What are the symptoms of gynecomastia?

The breast is made up of fat and glandular tissue. Fat is in larger quantities in women giving the female breast its shape and size. The glandular tissue also contributes to the physical characteristics but is mainly for the production of milk to nourish an infant. The enlargement of the glandular tissue in the breasts of men is the major symptom of gynecomastia.

The enlargement is symmetrically localized around the nipple giving it a firm, rubbery feel. It is often observed on both the breasts. However, the extent of enlargement may differ between the two sides. This condition is generally not associated with any pain and sensitivity may be occasionally present.

Sometimes a hardened lump may be felt unilaterally (only on one side) which could be accompanied by nipple discharges. These are symptoms of the rare cases of male breast cancer.

What causes gynecomastia?

Gynecomastia occurs in a state where the body produces excess of estrogen as compared to androgens (male hormones). This is likely to happen in cases of :

  • Natural hormonal changes during infancy (may be mother’s hormones), onset of puberty and advancing age (between 50 to 80 years).
  • Hypogonadism where there is diminished activity of testes in males.
  • Anti-androgenic medications : diuretics (spironolactone), anti-hypertensive (calcium channel blockers and angiotensin inhibitors), antibiotics (ketoconazole, metronidazole) and ulcer drugs (ranitidine, cimetidine, omeprazole).
  • Highly active antiretroviral therapy (HAART) in HIV/AIDS patients generally causes pseudogynecomastia due to fat remobilization and subsequent deposition on the breasts’ region.
  • Hyperthyroidism – overactive thyroid gland.
  • Severe malnutrition and starvation.
  • Chronic kidney disease.
  • Liver cirrhosis.
  • Testicular diseases.
  • Chest trauma.
  • Cancers.
  • Klinefelter’s syndrome which is a genetic condition causing hypogonadism (reduced activity of the gonads).
  • Alcoholism and drug abuse (marijuana , heroin).

How is gynecomastia treated?

A physical examination of the enlarged breasts is the first step in diagnosis. The patient’s medical history and the drugs administered are evaluated. Additional tests for medical conditions associated with gynecomastia may be performed for diagnosis of the condition. If the enlargement is suspected to be cancerous, a mammogram is necessary.

If gynecomastia does not resolve on its own within 6 months, drugs are administered and these are effective in early stages (6 to 12 months). However, it must be noted that there no FDA-approved medication specifically for gynecomastia. Hypogonadism is treated by testosterone replacement therapy. The drugs used to effect regression of the enlarged breasts generally, inhibit the various stages of estrogen synthesis. Examples include the selective estrogen receptor modulators (SERMs) such as clomiphene and tamoxifen. Synthetic, modified variants of testosterone such as danazol decrease estrogen synthesis in the testicles.

If untreated, the enlarged tissue may undergo scarring (fibrosis) after 12 months and medication are then not very effective. In such cases, mastectomy or the removal of the breast tissue may be adopted. If it is a case of pseudogynecomastia, fat in the tissue can be removed by liposuction.

 

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