Gynecomastia, often called “gyno,” is the common, non-cancerous enlargement of male breast tissue. This development occurs due to a natural hormonal imbalance where estrogen activity becomes proportionally higher than that of androgens, such as testosterone. Affecting over half of all males at some point, this glandular growth is frequent during periods of significant hormonal fluctuation.
Understanding Tenderness and Pain
The question of whether gynecomastia causes pain is frequently asked, and the answer is that it often does, particularly during the initial stages of development. This discomfort, medically termed mastalgia, is a common symptom reported by individuals with newly forming breast tissue. The pain is typically felt as a dull ache, soreness, or tenderness, especially when the area is touched or compressed.
The physical mechanism behind this tenderness relates to the rapid growth of the glandular tissue beneath the nipple and areola. During this proliferative phase, the tissue is actively expanding, which can lead to inflammation and stretching of the surrounding nerves and skin. This localized swelling pushes against the sensory nerves, causing the sensation of pain.
This pain is mild to moderate and is a temporary symptom that tends to subside naturally. Once the tissue growth stabilizes and enters a more fibrous, less active stage, the pain usually resolves. It is important to distinguish this glandular pain from sensitivity associated with pseudogynecomastia, where enlargement is primarily due to excess fat deposits rather than true glandular growth, and is less likely to be tender.
Common Reasons for Enlargement
The fundamental reason for gynecomastia is an altered ratio of estrogen to androgen activity, which stimulates the growth of breast ducts and stroma. This hormonal shift can occur physiologically at three distinct stages of life: in newborns due to residual maternal estrogen, during puberty when estrogen levels may rise faster than testosterone, and in older age (often after 50) as testosterone naturally declines.
Beyond these natural hormonal fluctuations, many cases are linked to external factors, particularly the use of certain medications. Several drug classes are known to cause this side effect:
- Anti-androgens used for prostate conditions.
- Cardiovascular drugs, such as digoxin.
- Certain chemotherapy agents.
- Spironolactone, a diuretic used for blood pressure or heart failure.
Illicit substance use, such as anabolic steroids (which disrupt natural hormone production), and chronic, excessive alcohol or marijuana use can also contribute to the hormonal imbalance.
Underlying medical conditions that affect hormone metabolism or production are also frequent causes of tissue enlargement. Liver diseases, such as cirrhosis, can impair the breakdown of estrogen, leading to higher circulating levels. Kidney failure and conditions like hyperthyroidism or hypogonadism (low testosterone) similarly disrupt the balance between sex hormones. Excess body fat from obesity also plays a role, as fat cells contain an enzyme called aromatase that converts androgens into estrogen, exacerbating the imbalance.
Signs That Require Immediate Medical Attention
While the majority of gynecomastia cases are benign, certain symptoms warrant immediate evaluation by a healthcare provider. These warning signs are important because they may indicate a rarer, more concerning underlying condition, such as male breast cancer.
A primary sign to watch for is enlargement that is distinctly unilateral (affecting only one breast), especially if the lump feels hard, fixed, or irregular in shape. Benign gynecomastia often affects both sides and is typically soft or rubbery in texture. The absence of tenderness in a newly developed lump also requires attention, as cancerous masses are frequently painless, unlike the mastalgia of early gynecomastia.
Additional symptoms that necessitate prompt medical consultation include any changes to the skin over the breast, such as dimpling, puckering, or redness. Nipple changes are also a serious concern, particularly any discharge (especially if bloody or clear) or if the nipple appears to be pulling inward. Any breast lump accompanied by systemic symptoms like unexplained weight loss, bone pain, or fever should be evaluated without delay.