Gynaecomastia is the enlargement of breast gland tissue in males, a condition distinct from the accumulation of fat in the chest area. It is a common occurrence that can affect males at different life stages, from infancy to old age. This condition affects over half of males at some point in their lives and is benign, meaning it is not cancerous.
Identifying Gynaecomastia
The primary sign of gynaecomastia is the development of a firm, rubbery mass of tissue located directly beneath the nipple. This growth can feel like a small, button-sized lump and may be tender or sensitive. The enlargement can happen in one or both breasts, and they may grow unevenly.
It is important to differentiate gynaecomastia from pseudogynaecomastia. Pseudogynaecomastia is caused by an increase in fat deposits in the chest area, often associated with being overweight, and lacks the firm, concentrated glandular lump under the nipple. The breast enlargement feels softer and more generalized. While gynaecomastia is not physically harmful, it can cause self-consciousness.
Underlying Causes
The cause of gynaecomastia is an imbalance between the hormones testosterone and estrogen. While estrogen is known as a female hormone, males produce it in small amounts. If testosterone levels decrease in relation to estrogen, or if estrogen levels rise, it can lead to the growth of male breast tissue.
Natural hormonal fluctuations are a primary driver of gynaecomastia at three specific life stages. It is seen in male newborns due to exposure to the mother’s estrogen, which resolves within a few weeks after birth. During puberty, hormonal changes frequently cause temporary breast enlargement that disappears on its own within six months to two years. The condition also becomes more common in men over the age of 50, as testosterone production naturally declines.
Certain medications can disrupt hormonal balance and lead to breast tissue growth. These include:
- Specific diuretics
- Heart medications
- Anti-ulcer drugs
- Antibiotics
- Some antidepressants
Various health conditions are also associated with gynaecomastia, especially those that affect hormone production. These include:
- Hypogonadism (low testosterone)
- Kidney or liver disease
- Hyperthyroidism
- Tumors of the testes, adrenal glands, or pituitary gland
The use of certain substances is also a contributing factor. Heavy alcohol use can impact liver function and hormone levels. The use of marijuana and anabolic steroids is also linked to the condition, as steroids can significantly alter the body’s natural hormonal environment.
The Diagnostic Process
A physician will start with a physical examination of the chest area. The doctor will feel the breast tissue to assess its consistency and determine if a firm glandular lump is present under the nipple, which helps to distinguish it from fatty tissue.
A thorough review of the patient’s medical history and current medication use is also performed. This helps the doctor identify any potential underlying health conditions or medications that could be causing the hormonal imbalance. Be prepared to discuss any prescription drugs, over-the-counter products, or other substances you may be taking.
Blood tests are frequently ordered. These tests measure the levels of hormones like testosterone and estrogen and can also check liver and kidney function to rule out related diseases. In some cases, imaging tests may be necessary. A mammogram or a breast ultrasound might be used to examine the tissue more closely and to exclude the rare possibility of male breast cancer.
Available Treatment Paths
For many, particularly adolescents experiencing gynaecomastia due to puberty, the recommended approach is observation. The condition frequently resolves on its own without intervention within six months to two years. During this time, a doctor will monitor the situation in a strategy called “watchful waiting.”
If an underlying cause is identified, treatment focuses on addressing it directly. This could mean treating a medical condition like hyperthyroidism or kidney disease. If a medication is the trigger, a doctor may recommend stopping it or switching to an alternative. Resolving the root issue often leads to a reduction in breast tissue.
Certain medications may be prescribed off-label to manage gynaecomastia. Drugs like tamoxifen, used in breast cancer treatment, can sometimes be used to reduce the enlarged gland. This approach is considered when observation is not sufficient or if the condition is causing significant discomfort.
When breast enlargement is significant or does not resolve with other methods, surgery becomes an option. There are two main surgical techniques: liposuction, which removes excess fat tissue, and mastectomy, which involves the direct removal of the breast gland tissue. Often, a surgeon will use a combination of both procedures for the best cosmetic result.