Gynecomastia (Enlarged Male Breasts)

Picture of the male on the left with no gynecomastia and the male on the right with gynecomastia.

Gynecomastia is an enlargement of the glandular tissue of the male breast. During infancy, puberty, and in middle-aged to older men, gynecomastia can be common. Gynecomastia is different from pseudogynecomastia or lipomastia, which refers to the presence of fat deposits in the breast area of obese men. True gynecomastia disease results from the growth of the glandular breast tissue, which is present in very small amounts in men. The condition is the most common reason for medical evaluation of the male breast.

Who gets gynecomastia?

Normally developing pubertal males may be at risk for gynecomastia, which is part of the normal developmental process. Normal male infants also may have the condition.

Other risk factors include:

• Aging, since aging may promote decreases in testosterone production that can cause the problem.
• The risk factors for developing enlarged male breasts related to specific diseases and conditions (such as cirrhosis of the liver) are the same as those that predispose men to those conditions.
• Taking certain medications may increase the risk of developing the problem.

What causes gynecomastia during puberty? How long does it last?

Gynecomastia results from an imbalance in hormone levels in which levels of estrogen (female hormones) are increased relative to levels of androgens (male hormones). Gynecomastia that occurs in normally growing infants and pubertal boys and resolves on its own over time is known as physiologic gynecomastia.

All individuals, whether male or female, possess both female hormones (estrogens) and male hormones (androgens). During puberty, levels of these hormones may fluctuate and rise at different levels, resulting in a temporary state in which estrogen concentration is relatively high. Studies regarding the prevalence of gynecomastia in normal adolescents have yielded widely varying results, with prevalence estimates as low as 4% and as high as 69% of adolescent boys. These differences probably result from variations in what is perceived to be normal and the ages of boys examined in the studies.

Gynecomastia caused by transient changes in hormone levels with growth usually disappears on its own within six months to two years. Occasionally, when the condition develops in puberty and persists beyond two years, it is referred to as persistent pubertal gynecomastia.

What diseases and conditions cause gynecomastia?

A number of medical conditions may also result in gynecomastia:

• Malnutrition and re-feeding (recovery from malnutrition) have both been shown to create a hormonal environment that may lead to gynecomastia. Similarly, cirrhosis of the liver alters normal hormone metabolism and may lead to the condition.
• Disorders of the male sex organs (testes) can result in decreased testosterone production and relatively high estrogen levels, leading to gynecomastia. These disorders may be genetic, such as Klinefelter's syndrome, or acquired due to trauma, infection, reduced blood flow, or aging. Testicular cancers may also secrete hormones that cause the condition.
• Other conditions associated with an altered hormonal environment in the body and may be associated with gynecomastia are chronic renal failure and hyperthyroidism. Rarely, cancers other than testicular tumors may produce hormones that can cause the condition.

What medications cause gynecomastia?

Gynecomastia can be a side effect of many medications, for example:

• Spironolactone, a diuretic that has anti-androgenic activity
• Calcium channel blockers used to treat hypertension (such as nifedipine)
• ACE inhibitor drugs for hypertension (captopril, enalapril)
• Some antibiotics (for example, isoniazid, ketoconazole, and metronidazole)
• Anti-ulcer drugs (such as ranitidine, cimetidine, and omeprazole)
• Anti-androgen or estrogen therapies for prostate cancer
• Methyldopa
• Highly active antiretroviral therapy (HAART) for HIV disease, which may cause fat redistribution, leading to pseudogynecomastia or, in some cases, true gynecomastia
• Digitoxin
• Diazepam
• Drugs of abuse (for example, alcohol, marijuana, heroin)
• Lavender oil and tea tree oil, when used in skin-care products, have been associated with the condition

Consult a doctor or other health care professional if you think you may be developing or have the condition.

The primary symptom of gynecomastia is an enlargement of the male breasts, which involves enlargement of glandular tissue rather than fatty tissue. It is typically symmetrical in a location concerning the nipple and may have a rubbery or firm feel. The condition usually occurs on both sides but can be unilateral in some cases. The enlargement may be greater on one side even if both sides are involved. Tenderness and sensitivity may be present, although there is typically no severe pain.

The most important distinction with gynecomastia is differentiation from male breast cancer, which accounts for about 1% of overall cases of breast cancer. Usually, cancer is confined to one side, is not necessarily centered around the nipple, feels hard or firm, and can be associated with dimpling of the skin, retraction of the nipple, nipple discharge, and enlargement of the underarm (axillary) lymph nodes. See your doctor right away if you have any of these symptoms that may be signs of breast cancer in males.

The definition of gynecomastia is the presence of breast tissue greater than 0.5 cm in diameter in a male. Gynecomastia is the presence of true breast (glandular) tissue, generally located around the nipple. Fat deposition is not considered true gynecomastia.

In most cases, the condition can be diagnosed by a physical examination. A careful medical history is also important, including medication and drug use. If there is a suspicion of cancer, a mammogram may be ordered. Further tests may be recommended to help establish the cause of gynecomastia in certain cases. These can include blood tests to examine liver, kidney, and thyroid function. Measurement of hormone levels in the bloodstream may also be recommended in some cases.

What drugs are used for the treatment of gynecomastia?

Gynecomastia, especially in pubertal males, often goes away on its own within about six months, so observation is preferred over specific treatment in many cases. Stopping medications and treatment of existing medical problems or health conditions that cause enlarged breasts in men also are mainstays of gynecomastia treatment.

• Medical treatments are available to treat the condition, but data on their effectiveness are limited. No drugs have been approved by the Food and Drug Administration (FDA) for the treatment of gynecomastia; however, medications that have been used to treat the condition include:
  • Testosterone replacement has been effective in older men with low levels of testosterone, but it is not effective for men who have normal levels of the male hormone.
  • Clomiphene can be used to treat gynecomastia. It can be taken for up to six months.
  • The selective estrogen receptor modulator (SERM) tamoxifen has been shown to reduce breast volume in gynecomastia, but it was not able to eliminate all of the breast tissue. This type of therapy often is used for severe or painful gynecomastia in adolescents.

What about surgery for the treatment of gynecomastia? Can it be cured?

Medications are more effective in reducing gynecomastia in the early stages since scarring often occurs after about 12 months. After the tissue has become scarred, medications are not likely to be effective, and surgical removal is the only possible treatment.

Reduction mammoplasty (breast reduction surgery) has been used in severe cases of the condition, long-term gynecomastia, and in cases in which drug therapies have not been effective to help restore a normal breast appearance.

Typically, gynecomastia is not associated with long-term problems.

Although pubertal gynecomastia typically regresses on its own, in rare cases it may persist, requiring treatment. Gynecomastia that has been present for 12 months or more (long term) may undergo scarring (fibrosis), which makes treatment with medications much more difficult, if not impossible to achieve a response.

Psychological consequences can occur if the breast enlargement is pronounced or is a source of embarrassment.

Men with gynecomastia have about a fivefold greater risk of developing male breast cancer when compared with the general population. It is believed that gynecomastia itself is not a precancerous condition, but the hormonal changes (relative increase in estrogens, lower levels of androgens) that produce gynecomastia in adult men also increase their risk of developing breast cancer.

Gynecomastia that occurs because of hormonal fluctuations with growth or aging cannot be prevented. Gynecomastia related to medical conditions can only be prevented to the extent that the underlying or responsible condition can be prevented.

• How to fix gynecomastia. To fix gynecomastia, identify and address any underlying conditions or medications causing it. Implement lifestyle changes, including weight loss through diet and exercise. In some conditions, specific medications used in the treatment of breast cancer may be prescribed by a doctor. For more persistent cases, consult a plastic surgeon for surgical options such as liposuction or mastectomy. It is important to consult with a health care provider for personalized advice.
• How can I reduce gynecomastia naturally? To reduce gynecomastia naturally, maintain a balanced diet, engage in regular physical activity (including strength training and cardio), and manage a healthy weight. Limit alcohol intake, avoid recreational drugs, and be cautious with medications known to cause gynecomastia. Also, manage stress and get adequate sleep to support hormonal balance. Consult a health care provider before making significant lifestyle changes.
• Can gynecomastia go away? While gynecomastia often resolves on its own in adolescents, it rarely goes away without medical or surgical intervention in adults. Consulting with a doctor is recommended for persistent gynecomastia.
• What happens if gynecomastia is not treated? If gynecomastia is not treated, it may lead to persistent breast enlargement, discomfort, tenderness, and potential psychological distress. In some cases, it might resolve on its own, but in others, it may require medical or surgical intervention for relief.
• Can I remove gynecomastia myself? You cannot get rid of gynecomastia yourself. Treatment typically requires professional medical intervention, which may include medication or surgery. Consult a health care provider for proper diagnosis and treatment options.