What Is Gynecomastia? Symptoms, Causes, Treatment

Gynecomastia "Man boob"

Male breast enlargement, clinically referred to as gynecomastia and anecdotally called “man-boobs,” affects up to 65% of men between the ages of 27-92. Gynecomastia can develop at any age, from infancy through your golden years. While the condition is common, there’s a significant amount of social stigma and shame around gynecomastia. Fortunately, treatment is available.

Gynecomastia isn’t usually a serious health problem, but it does contribute to self-confidence issues, mental health problems, and social functioning. In addition to swelling and tenderness in your breast tissue, you might also notice that your areolas increase in size. Your chest might also look unbalanced or asymmetrical. 

What causes gynecomastia?

Many factors can contribute to gynecomastia. In most cases, the condition is due to a hormonal imbalance, particularly between your testosterone and estrogen. Some medications can cause gynecomastia, including:

  • Anabolic steroids
  • Cancer treatments like chemotherapy and hormone therapy
  • Estrogens
  • Finasteride (benign prostatic hyperplasia (BPH) treatment)
  • Calcium channel blockers
  • Proton pump inhibitors for heartburn
  • Diazepam anxiety drugs
  • Antifungal medicines like ketoconazole
  • Antibiotics like metronidazole
  • Human chorionic gonadotropin for fertility
  • Street drugs
  • Alcohol 

Other conditions can also cause enlarged breast tissue. Your physician might order tests like ultrasound or biopsies to rule out conditions like:

  • Cysts
  • Abscess or furuncle
  • Lipoma
  • Mastitis (breast tissue inflammation)
  • Fat necrosis
  • Hematoma (swollen blood clot)
  • Cancer 

If you have signs of gynecomastia, talk to your physician. You should make an appointment right away if your breasts are extremely tender, if you have hard lumps, or nipple discharge.

The role of testosterone in gynecomastia

Your endocrine system includes several glands that work together to produce and regulate your hormones. Many factors can upset that balance and lead to abnormal testosterone levels, which can cause gynecomastia as well as a variety of other distressing symptoms. 

Some of the conditions that can contribute to abnormal hormone levels and gynecomastia include:

Obesity

Obesity interferes with your hormone production and use. While obesity is closely linked to insulin resistance in the form of pre-diabetes and Type 2 diabetes, when you carry too much weight, your entire endocrine system suffers, including the production and use of testosterone and estrogen. 

Deficient nutrition

A nutritionally balanced diet is critical to your overall health. Some studies[1] show that vitamin D deficiencies can contribute to gynecomastia. Approximately 42% of Americans are deficient in vitamin D. While this isn’t the only factor that contributes to your risk of enlarged breast tissue, your overall health will benefit from ensuring you get all the vitamins, minerals, and other nutrients your body needs for optimal functionality. 

Hyperthyroidism

A hyperactive thyroid can reduce the free testosterone in your body[2], which often causes an imbalance between testosterone and estrogen. 

Hypogonadism

Hypogonadism is the clinical term for low testosterone[3]. The condition could be due to damage to your testes, or it could be a secondary condition caused by a problem elsewhere in your body. Hypogonadism also contributes to androgen deficiencies, known as hypoandrogenism, another hormonal factor that can contribute to your risk of gynecomastia.

Tumors in the testes or adrenal glands

Tumors in glands like your testes or adrenals interfere with hormone production. This contributes to low testosterone and hormonal imbalances. 

Liver disease

Liver problems interfere with the breakdown of estrogen[4], which can cause elevated estrogen levels. This contributes to the testosterone-estrogen imbalance that causes gynecomastia. 

Kidney failure

Renal failure can interfere with your endocrine system functionality[5]. There are close links between kidney disease and changes in your androgen synthesis and metabolism. It can also disrupt your hypothalamic-pituitary axis, which can lead to low testosterone levels. 

When does gynecomastia usually develop?

Gynecomastia develops at different ages. Newborn boys sometimes have temporary gynecomastia because they are still affected by their mother’s estrogen. Gynecomastia in infants usually goes away within two or three weeks.[6]
 

Adolescence is another typical time to develop gynecomastia. Your testosterone levels spike during puberty, which can result in abnormally high levels of free testosterone. This contributes to increased estradiol levels and hormonal imbalances. Pubescent gynecomastia usually goes away within 6-24 months from the start of puberty.

Adult men are most likely to experience hormonal imbalances in middle age, although it can happen at any time. Your genetics, medical history, and lifestyle factors contribute to your risk of hormonal problems and gynecomastia.[7]

 

Gynecomastia treatments

The first step in treating gynecomastia is diagnosis. Your physician should screen for other conditions that can cause enlarged breast tissue. They should also evaluate your hormone levels. Depending on your condition and how gynecomastia is affecting your overall well-being, you can choose from a few treatment options. 

HRT for gynecomastia

If your enlarged breasts are due to a hormonal imbalance or low testosterone, you should consider hormone replacement therapy. Testosterone replacement therapy can restore your hormonal balance, reduce your breast size, and relieve other troubling symptoms like weight gain, libido loss, and erectile dysfunction. 

Medication

Your physician might also recommend medication to address gynecomastia. For example, tamoxifen blocks estrogen action and is a standard treatment for breast cancer. However, it also reduces breast pain and enlargement in men. Additionally, aromatase inhibitors, another cancer treatment, are sometimes prescribed for off-label use for gynecomastia. 

Surgery

In severe cases, when other treatments haven’t reduced your gynecomastia, and your enlarged breasts are harming your overall wellness, you might benefit from surgery. In some cases, a liposuction procedure can extract the extra fatty tissue. Depending on your condition, your doctor might also recommend an excision surgery to cut away the enlarged breast tissue. 

Gynecomastia prevention

You can take steps to optimize your health and hormone levels and reduce your risk of gynecomastia. Following a balanced diet with plenty of fish that are rich in omega-3 fatty acids like salmon and tuna and sources of vitamin D like fortified plant milk can keep your body healthy. 

You should avoid excessive soy products and dairy products. Starchy, sugary carbs, like bread and pastries, and alcohol can also have a detrimental effect on your testosterone levels. 

You can also talk to your doctor about supplements. Some patients find that ginger, ashwagandha, and zinc can help optimize your testosterone levels and overall hormone health. 

It’s also important to include physical activity in your daily routine. Both cardiovascular exercises and weight-bearing resistance movements help keep your body strong and healthy. They don’t necessarily increase your testosterone production, but maintaining good health overall supports efficient endocrine function. 

If you’re concerned about gynecomastia and other signs of low testosterone, contact HRT Wellness. After your initial screening, they send you for extensive blood work and hormonal screenings to assess your hormonal needs. This information allows the physicians to create a customized hormone replacement program to restore your health and wellness. 

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