Gynecomastia is enlargement of the breast gland in men. It can be physiological at certain stages of life, but in many cases it is a sign of a hormonal disorder or another disease.
What is gynecomastia?
An enlarged chest in men is sometimes attributed to excess weight alone. In fact, there are two different conditions: in true gynecomastia the breast enlarges due to glandular tissue, while in false gynecomastia it enlarges due to fatty tissue.
Along with the enlargement, the tissue may become firm and tender to the touch. Gynecomastia causes considerable physical and psychological discomfort, especially in teenagers.
Who develops gynecomastia?
Physiological gynecomastia occurs in newborns, teenagers and adults and may regress on its own. If gynecomastia has appeared recently in an adult man, its cause should be evaluated.
- Newborn boys: it develops under the influence of placental estrogen and returns to normal size on its own after a few weeks.
- Teenagers (12–15 years): pubertal gynecomastia is often temporary and usually resolves without treatment within 2 years.
- Men over 40: involutional gynecomastia is linked to the age-related decline in testosterone and the rising estrogen-to-testosterone ratio.
Causes
A shift in the balance between testosterone and estrogen plays a role: when testosterone falls or estrogen rises, the breast gland may enlarge. True gynecomastia is associated with high estrogen and hyperprolactinemia (high blood prolactin).
- age-related hormonal changes and testosterone deficiency
- increased estrogen: impaired regulation of the conversion of androgens to estrogen, androgen resistance, estrogen-producing tumours
- increased prolactin (hyperprolactinemia), including pituitary micro- and macroprolactinomas
- certain medications, anabolic steroids, some supplements, uncontrolled use of narcotic substances
- thyroid dysfunction, including hyperthyroidism
- liver disease (viral or alcohol-related) and kidney disease
- adrenal and testicular tumours and, more rarely, other growths
- stress and obesity
Examination and diagnosis
First and foremost, gynecomastia must be distinguished from breast cancer. If there is a hard one-sided lump, skin changes or nipple discharge, it should not simply be put down to hormonal changes and left to wait.
The diagnosis is based on a physical examination, breast ultrasound, mammography and blood levels of certain hormones. Since many medications can cause breast enlargement, be sure to tell your doctor about any medicines you take.
Treatment
In newborns and during adolescence, gynecomastia is not treated, only monitored. When the underlying cause is being treated, gynecomastia is kept under observation. Involutional gynecomastia is managed with hormonal therapy. In false gynecomastia, treatment begins with weight loss.
Surgical removal of the breast gland is performed after the underlying disease has been treated. Surgery, and sometimes radiotherapy, may be recommended when the gland does not regress despite treatment, is large (over 5 cm) or there is a possibility of cancer.
The information on this page is general and does not replace a medical examination.