Gynecomastia is the enlargement of male breast tissue, caused by an increase in glandular components. While benign, it can lead to discomfort or self-consciousness.
How Common is Gynecomastia?
Gynecomastia is a widespread condition. Studies suggest that 32% to 65% of males experience it. Its prevalence fluctuates during specific life stages when hormonal shifts are most pronounced.
In male newborns, 60% to 90% exhibit enlarged breast tissue due to maternal estrogen exposure, typically resolving within weeks.
During adolescence, gynecomastia is common, with estimates ranging from 4% to 69% of boys experiencing breast enlargement. Most cases resolve within six months to two years, with only about 10% persisting by age 17.
Among men aged 50 to 80, prevalence ranges from 24% to 65%.
What Causes Gynecomastia?
The primary cause of gynecomastia is an imbalance between estrogen and testosterone. Estrogen stimulates breast tissue growth, while testosterone inhibits it. This imbalance can be physiological or result from other factors.
Physiological changes include hormonal fluctuations during infancy, puberty, and aging. In older men, declining testosterone combined with increased body fat, which converts testosterone to estrogen, contributes to the condition. Certain medications can also induce gynecomastia by altering hormone levels, including some anti-androgens, heart medications, specific antibiotics, and some antidepressants.
Underlying health conditions can disrupt hormone balance. Liver disease, kidney failure, hyperthyroidism, and certain tumors affecting the testes, adrenal glands, or pituitary gland can lead to gynecomastia. Substance use, such as alcohol, marijuana, and certain illicit drugs, can also contribute to enlarged breast tissue.
When to Seek Medical Advice
If you notice breast enlargement, seek medical advice to determine the cause. It is important to differentiate between true gynecomastia, involving glandular tissue growth, and pseudogynecomastia, characterized by fat accumulation. A healthcare provider can distinguish between the two by physical examination, feeling for a firm tissue mass under the nipple.
Symptoms that warrant medical attention include pain, tenderness, or swelling in the breast area. Nipple discharge, rapid enlargement, or growth on only one side can also be signs that require evaluation. While often harmless, these symptoms could indicate other underlying conditions.
Addressing Gynecomastia
Management of gynecomastia often begins with observation, especially in adolescents, as it often resolves on its own. If an underlying cause, such as medication or a health condition, is identified, addressing that cause is the primary approach. This might involve adjusting medications or treating the specific illness.
For cases that do not resolve or are causing distress, medical treatments can be considered. Certain medications, such as selective estrogen receptor modulators (SERMs) like tamoxifen, can help balance hormones and reduce breast tissue. These are typically used for recent-onset and tender gynecomastia.
When non-surgical options are insufficient, surgical intervention may be an option. The two main techniques are liposuction and excision. Liposuction removes excess fatty tissue, while excision directly removes glandular tissue and can address excess skin. A combination of both is often used for optimal results, especially when both fat and glandular tissue are present.