Enlarged breasts in men (gynecomastia)

Overview

Gynecomastia (guy-nuh-koh-MAS-tee-uh) is an increase in the amount of breast gland tissue in boys or men. An imbalance of the hormones estrogen and testosterone causes it. Gynecomastia can affect one or both breasts, sometimes unevenly.

Pseudogynecomastia is an increase in fat but not gland tissue in male breasts.

Newborns, boys going through puberty and older men may develop gynecomastia due to natural changes in hormone levels. There are other causes too.

Most often, gynecomastia isn't a serious problem. But it can be tough to cope with the condition. People with gynecomastia sometimes have pain in their breasts. And they may feel embarrassed.

Gynecomastia may go away on its own. If it doesn't, medicine or surgery may help.

Symptoms

Gynecomastia symptoms can include:

• Pain, especially in teenagers.
• Swollen breast tissue.
• Tender breasts.
• Sensitive nipples when they rub against clothes.

When to see a doctor

See a member of your health care team if you have:

• Swelling.
• Pain or tenderness.
• Fluid coming out of one or both breast nipples. This is called nipple discharge.
• A firm or hard lump.
• Dimpled skin on the breast.

Causes

In people assigned male at birth, the body mainly makes the sex hormone testosterone. It also makes small amounts of the hormone estrogen. Gynecomastia can happen when the amount of testosterone in the body drops compared with estrogen. The decrease can be caused by conditions that lower testosterone or block its effects. Or it can be caused by conditions that raise the estrogen level.

Some things that can change the body's hormone balance include the following:

Natural hormone changes

The hormones testosterone and estrogen control sex traits. Testosterone controls traits such as muscle mass and body hair. Estrogen controls traits that include the growth of breasts.

Estrogen levels that are too high or are out of balance with testosterone levels can cause gynecomastia.

• Gynecomastia in infants. More than half of male babies are born with enlarged breasts due to the effects of estrogen during pregnancy. The swollen breast tissue usually goes away within 2 to 3 weeks after birth.
• Gynecomastia during puberty. Gynecomastia caused by hormone changes during puberty is somewhat common. Most of the time, the swollen breast tissue goes away without treatment within 6 months to 2 years.
• Gynecomastia in adults. About 24% to 65% of men ages 50 to 80 get gynecomastia. But most adults with the condition have no symptoms.

Medicines

The following medicines can cause gynecomastia:

• Anti-androgens used to treat conditions such as an enlarged prostate and prostate cancer. Examples of these medicines include flutamide, finasteride (Proscar, Propecia) and spironolactone (Aldactone, Carospir).
• Anabolic steroids and androgens to treat delayed puberty or muscle loss from another disease.
• Antiretroviral medicines. The estrogen-like properties of some HIV medicines can cause gynecomastia, especially efavirenz.
• ADHD medicines that contain amphetamines, such as Adderall.
• Anti-anxiety medications, such as diazepam (Valium).
• Tricyclic antidepressants.
• Some antibiotics.
• Opioids to treat chronic pain.
• Ulcer medicines, such as the nonprescription medicines cimetidine (Tagamet HB) and omeprazole (Prilosec).
• Chemotherapy to treat cancer.
• Heart medicines, such as digoxin (Lanoxin) and calcium channel blockers.
• Stomach-emptying medicines, such as metoclopramide

Recreational drugs, illegal drugs and alcohol

Substances that can cause gynecomastia include:

• Alcohol.
• Anabolic steroids used to build muscle and improve athletic performance.
• Amphetamines.
• Marijuana.
• Heroin.
• Methadone (Methadose).

Health conditions

Certain health conditions that affect the balance of hormones can either cause or be linked with gynecomastia. They include:

• Hypogonadism. Conditions that lower the amount of testosterone the body makes can be linked with gynecomastia. Some examples are Klinefelter syndrome and pituitary insufficiency.
• Aging. Hormone changes that happen with aging can cause gynecomastia, especially in people who are overweight.
• Tumors. Some tumors can make hormones that shift the body's hormone balance. These include tumors involving the testes, adrenal glands or pituitary gland.
• Hyperthyroidism. In this condition, the thyroid gland makes too much of the hormone thyroxine.
• Kidney failure. About half the people who receive dialysis treatment develop gynecomastia due to hormone changes.
• Liver failure and cirrhosis. Changes in hormone levels related to liver problems and cirrhosis medicines are linked with gynecomastia.
• Malnutrition and starvation. When the body doesn't get enough nutrition, testosterone levels drop. But estrogen levels stay the same. This causes an imbalance in the hormones.

Herbal products

Some plant oils used in shampoos, soaps or lotions have been associated with gynecomastia. These include tea tree or lavender oil. This likely is due to compounds in the oil that may mimic estrogen or affect testosterone.

Risk factors

Risk factors for gynecomastia include:

• Puberty.
• Older age.
• Obesity.
• Use of anabolic steroids to improve athletic performance.
• Certain health conditions. These include liver and kidney disease, thyroid disease, Klinefelter syndrome and some tumors.

Complications

Gynecomastia has few physical complications. But it may lead to mental health concerns due to changes in how the chest looks.

Prevention

Several factors within your control may lower the risk of gynecomastia:

• Don't use drugs. Examples include anabolic steroids, amphetamines, heroin and marijuana.
• Limit or stay away from alcohol. It helps not to drink alcohol. If you do drink, do so in moderation. That means no more than two drinks a day for men.

Diagnosis

To find out if you have gynecomastia, a member of your health care team starts by asking you some questions. For example, you'll likely be asked about your symptoms and any medicines you take. You're also given a medical exam to check your breast tissue, stomach area and genitals.

Tests

Your health care team likely will order tests. These can help find a possible cause of gynecomastia or look for conditions that can cause similar symptoms. Tests also may be done to check for breast cancer. You may need exams such as:

• Blood tests.
• Mammograms — This is an X-ray of the breast.
• Computerized tomography (CT) scans — This is a series of X-rays taken from different angles.
• Magnetic resonance imaging (MRI) scans — This imaging test uses a magnetic field and radio waves.
• Testicular ultrasounds — This uses sound waves to make images of the testicles and the tissue around them.
• Tissue biopsies — This procedure removes a tiny piece of tissue, which gets checked in a lab.

Conditions that cause similar symptoms

Your health care team will want to be sure that your breast swelling is gynecomastia and not another condition. Other conditions that can cause similar symptoms include:

• Fatty breast tissue. Another name for this is pseudogynecomastia. Some people, especially those with obesity, have breast fat that looks like gynecomastia. But it isn't the same as gynecomastia. For people diagnosed with this condition, more testing isn't needed.
• Breast cancer. Breast cancer is uncommon in men, but it can happen. Enlargement of one breast or the presence of a firm lump raises the concern for male breast cancer.
• Mastitis. This is inflamed breast tissue that sometimes involves an infection.
• Lipoma. This slow-growing, fatty lump is not cancer.

Treatment

Gynecomastia often goes away over time without treatment. But if gynecomastia is caused by a medical condition, that condition may need treatment.

If you take medicine that may be the cause of gynecomastia, ask your health care team about your choices. Your doctor may have you stop the medicine or try a different one.

Often, no treatment is needed for teenagers who have gynecomastia due to natural hormone changes during puberty. A teen's health care team may recommend checkups every 3 to 6 months to see if the condition is getting better on its own. Gynecomastia in teens often goes away without treatment in less than two years.

Treatment may be needed if gynecomastia doesn't get better on its own. Treatment also can help if the condition causes pain, tenderness or embarrassment.

Medications

Medicines used to treat breast cancer and other conditions may be helpful for some adults with gynecomastia. They include:

• Tamoxifen (Soltamox).
• Raloxifene (Evista).
• Aromatase inhibitors, such as anastrozole (Arimidex).

In the United States, these medicines are approved by the Food and Drug Administration. But they have not been approved specifically for use in people with gynecomastia.

Surgery to remove extra breast tissue

You may still have enlarged breasts after waiting for gynecomastia to go away on its own or after taking medicine for it. If your appearance or other symptoms bother you, surgery may be a treatment choice:

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. With smaller amounts of gland tissue, mastectomy can be done using small incisions. This lessens the recovery time. Sometimes liposuction and mastectomy are combined.

Coping and support

For people with gynecomastia, having enlarged breasts can be stressful and embarrassing. The condition can be hard to hide. Sometimes, it can be a challenge to romantic relationships. During puberty, gynecomastia can make teens a target for teasing from peers as well. It can make activities such as swimming or changing in the locker room traumatic.

Whatever your age, if you have gynecomastia, you might feel unhappy with your body. But you can take steps that may help you cope:

• Get a checkup. Some people with gynecomastia worry that their symptoms are due to a more serious condition. It can be a relief to learn that gynecomastia is the cause.
• Get counseling. Talk therapy can help you manage anxiety or depression caused by gynecomastia. It also can help you talk with your partner or family members, so they understand what you're going through.
• Reach out to your family and friends. You may feel embarrassed to talk about gynecomastia with the people you care about. But if you explain your situation and ask for support, that could strengthen your relationships and ease stress.
• Connect with others who have gynecomastia. It might feel good to talk with people who understand what you're going through. Websites such as Gynecomastia.org can help you connect with others who have the condition.