Gynecomastia is swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly. Newborns, boys going through puberty and older men may develop gynecomastia as a result of normal changes in hormone levels, though other causes also exist.
Generally, gynecomastia isn’t a serious problem, but it can be tough to cope with the condition. Men and boys with gynecomastia sometimes have pain in their breasts and may feel embarrassed.
Gynecomastia may go away on its own. If it persists, medication or surgery may help.
It’s normal. Seventy percent of boys get it during puberty. It’s caused by natural changes in estrogen (a “female hormone” that men also have) and testosterone. Newborn babies sometimes have short-term gynecomastia, too. That’s because some of their mothers’ estrogen stays in their blood for a while after birth.
Middle-aged and older men can also have the condition. It could be due to aging (which also shifts hormone levels) or because of certain medicines, including some:
- Heart medicines
- Anti-anxiety drugs
- AIDS treatments
- Tricyclic antidepressants
- Drugs that treat heartburn
Marijuana and drugs like heroin, amphetamines, and steroids can cause it. So can drinking too much alcohol.
Herbal products that contain tea tree oil or lavender oil can also increase breast size. That’s because they have natural estrogen that can upset your body’s normal hormone levels.
Sometimes it happens because of another health problem, like anoveractive thyroid, kidney disease, or a tumor on one of the glands that controls your hormones.
Gynecomastia is a benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast (see the image below). Gynecomastia is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples. Although the condition is usually bilateral, it can be unilateral. The condition known as pseudogynecomastia, or lipomastia, is characterized by fat deposition without glandular proliferation.
Signs and symptoms of gynecomastia include:
- Swollen breast gland tissue
- Breast tenderness
The cause of gynecomastia isn’t always clear. So it’s a good idea to check in with your regular doctor or an endocrinologist, a doctor who specializes in hormone imbalances. During your appointment he may ask you:
- How old were you when you noticed a change in your breast size?
- Does the condition run in your family?
- Have you noticed a difference in your nipple size?
- Have you had any discharge or pain?
- How’s your overall health?
- Do you drink alcohol, use drugs, or have you had infertility problems?
Most cases of gynecomastia regress over time without treatment. However, if gynecomastia is caused by an underlying condition, such as hypogonadism, malnutrition or cirrhosis, that condition may need treatment. If you’re taking medications that can cause gynecomastia, your doctor may recommend stopping them or substituting another medication.
In adolescents with no apparent cause of gynecomastia, the doctor may recommend periodic re-evaluations every three to six months to see if the condition improves on its own. Gynecomastia often goes away without treatment in less than two years. However, treatment may be necessary if gynecomastia doesn’t improve on its own or if it causes significant pain, tenderness or embarrassment.
Medications used to treat breast cancer and other conditions, such as tamoxifen (Soltamox) and raloxifene (Evista), may be helpful for some men with gynecomastia. Although these medications are approved by the Food and Drug Administration, they have not been approved specifically for this use.
Surgery to remove excess breast tissue
If you still have significant bothersome breast enlargement despite initial treatment or observation, your doctor may advise surgery. Two gynecomastia surgery options are:
- Liposuction. This surgery removes breast fat, but not the breast gland tissue itself.
- Mastectomy. This type of surgery removes the breast gland tissue. The surgery is often done endoscopically, meaning only small incisions are used. This less invasive type of surgery involves less recovery time.