Bilateral gynecomastia causes. Bilateral Gynecomastia: Causes, Symptoms, and Treatment Options

24.08.202310.06.2023 by alexxlab

What are the main causes of gynecomastia in men. How is gynecomastia diagnosed and treated. Can gynecomastia be prevented. What are the psychological effects of gynecomastia on men. When should you see a doctor for enlarged male breasts.

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Understanding Gynecomastia: An Overview of Male Breast Enlargement

Gynecomastia is a condition characterized by the enlargement of breast tissue in males. This phenomenon can occur at various stages of life and is often a result of hormonal imbalances. While generally benign, gynecomastia can cause significant physical discomfort and emotional distress for those affected.

The development of gynecomastia is closely linked to the delicate balance between androgens (male hormones) and estrogens (female hormones) in the male body. When this balance is disrupted, with estrogen levels becoming relatively higher compared to androgen levels, it can lead to the growth of breast tissue.

Is gynecomastia a common condition?

Gynecomastia is indeed quite common, affecting a significant portion of the male population at different life stages. It’s estimated that up to 60% of adolescent boys may experience some degree of breast enlargement during puberty, while up to 70% of men over 50 may develop gynecomastia due to age-related hormonal changes.

Physiological Causes of Gynecomastia: Natural Hormonal Fluctuations

Gynecomastia can occur naturally at three distinct stages of life due to physiological hormone changes:

Neonatal period: Newborn males may develop temporary breast enlargement due to exposure to maternal hormones during pregnancy.
Puberty: Hormonal fluctuations during adolescence can lead to breast bud development in boys, typically resolving within a year or two.
Older age: Elderly men may experience gynecomastia due to age-related declines in testosterone levels, resulting in a relative increase in estrogen activity.

These physiological instances of gynecomastia are generally considered normal and often resolve without intervention. However, persistent or severe cases may require medical evaluation.

Drug-Induced Gynecomastia: Medications and Substances That Can Trigger Breast Enlargement

Various medications and substances can contribute to the development of gynecomastia through different mechanisms. These may include:

Estrogenic properties
Stimulation of estrogen production
Providing molecules easily converted to estrogen

Some common culprits include:

Estrogen-containing products (vaginal creams, topical sprays)
Certain antifungals, diuretics, and antibiotics
Some cardiac glycosides and antacids
Anti-androgens used in prostate cancer treatment
Certain AIDS medications
Some anxiolytics

It’s crucial for patients to discuss any medications they’re taking with their healthcare provider if they notice breast enlargement.

Can herbal products cause gynecomastia?

Yes, some herbal products have been associated with gynecomastia. Tea tree oil and lavender, for instance, have been linked to breast enlargement in some men due to their weak estrogenic properties. Additionally, herbs containing phytoestrogens may potentially contribute to hormonal imbalances leading to gynecomastia.

Medical Conditions Associated with Gynecomastia: Beyond Hormonal Imbalances

Several medical conditions can disrupt the hormonal balance in men, potentially leading to gynecomastia:

Chronic liver disease: May increase female hormone production
End-stage renal disease: Often associated with testosterone deficiency
Male hypogonadism: Can result from various genetic disorders or acquired testicular diseases
Thyroid disorders: Particularly hyperthyroidism
Hormone-secreting tumors: Including those of the testes, adrenal glands, or pituitary gland
Klinefelter’s syndrome: A genetic condition causing testicular underdevelopment and low testosterone levels

These conditions underscore the importance of a thorough medical evaluation when gynecomastia is detected, as it may be a symptom of an underlying health issue.

How does liver disease contribute to gynecomastia?

Chronic liver disease can lead to gynecomastia through multiple mechanisms. The liver plays a crucial role in hormone metabolism, including the breakdown of estrogen. When liver function is impaired, it can result in increased estrogen levels in the bloodstream. Additionally, liver disease can cause a decrease in the production of sex hormone-binding globulin (SHBG), which normally binds to and inactivates estrogen. This combination of increased estrogen and decreased SHBG can tip the hormonal balance, potentially leading to breast tissue growth in men.

Lifestyle Factors and Gynecomastia: The Impact of Diet, Exercise, and Substance Use

Certain lifestyle choices and environmental factors can influence the development of gynecomastia:

Anabolic steroid use: Often associated with bodybuilding and athletic performance enhancement
Alcohol consumption: Excessive drinking can disrupt hormone balance
Illicit drug use: Some recreational drugs may have estrogenic effects
Malnutrition or severe dieting: Can lower testosterone levels without a corresponding decrease in estrogen
Obesity: Excess body fat can increase estrogen production

Addressing these lifestyle factors can sometimes help manage or prevent gynecomastia. However, it’s important to note that in many cases, the exact cause remains unknown, classified as idiopathic gynecomastia.

Can weight loss help reduce gynecomastia?

Weight loss can potentially help reduce the appearance of gynecomastia, particularly in cases where excess body fat is a contributing factor. Adipose tissue (fat) contains an enzyme called aromatase, which converts testosterone to estrogen. By reducing overall body fat, you may decrease the amount of estrogen produced, potentially helping to balance hormone levels. However, it’s important to note that true glandular gynecomastia tissue will not disappear with weight loss alone. In such cases, medical or surgical intervention may be necessary for complete resolution.

Diagnosing Gynecomastia: Differentiating from Other Breast Conditions

Accurate diagnosis of gynecomastia is crucial, as it can sometimes be confused with other breast conditions, including male breast cancer. While breast cancer in men is rare, accounting for only 0.2% of all male cancers, it’s essential to rule out this possibility.

Key differences between gynecomastia and breast cancer include:

Gynecomastia is typically bilateral (affecting both breasts), while breast cancer often presents as a unilateral lump
Breast cancer lumps tend to be firm or hard, sometimes accompanied by pain or nipple discharge
Gynecomastia usually feels like a rubbery or firm mass extending concentrically from the nipple

A thorough physical examination, medical history review, and potentially imaging studies or biopsy may be necessary to confirm a diagnosis of gynecomastia and rule out other conditions.

What diagnostic tests are used to confirm gynecomastia?

Several diagnostic tests may be employed to confirm gynecomastia and rule out other conditions:

Physical examination: A doctor will palpate the breast tissue to assess its consistency and extent.
Blood tests: Hormone levels, liver function, and thyroid function may be checked to identify underlying causes.
Mammography: This imaging technique can help distinguish between true gynecomastia and pseudogynecomastia (fatty tissue accumulation).
Ultrasound: Can provide detailed images of breast tissue and help identify any suspicious masses.
Biopsy: In rare cases where cancer is suspected, a small tissue sample may be taken for analysis.

The choice of diagnostic tests will depend on the individual’s age, medical history, and physical examination findings.

Treatment Options for Gynecomastia: From Watchful Waiting to Surgical Intervention

The treatment approach for gynecomastia depends on its cause, severity, and impact on the individual’s quality of life. Options may include:

Watchful waiting: For cases of pubertal gynecomastia, which often resolves on its own within two years.
Addressing underlying causes: Discontinuing medications or treating medical conditions contributing to gynecomastia.
Medications: Tamoxifen or raloxifene may be prescribed to block estrogen’s effects on breast tissue.
Surgery: For severe or long-standing cases, surgical removal of breast tissue (mastectomy) or liposuction may be considered.

It’s important to consult with a healthcare provider to determine the most appropriate treatment plan based on individual circumstances.

How effective is medication in treating gynecomastia?

Medication can be effective in treating gynecomastia, particularly in its early stages. Selective estrogen receptor modulators (SERMs) like tamoxifen and raloxifene have shown promise in reducing breast tissue growth. Studies have reported success rates of 80-90% in patients treated with tamoxifen within two years of gynecomastia onset. However, the effectiveness of medication decreases in long-standing cases where fibrosis has developed. It’s important to note that these medications are typically used off-label for gynecomastia and should be prescribed under close medical supervision due to potential side effects.

Living with Gynecomastia: Psychological Impact and Coping Strategies

Gynecomastia can have significant psychological effects on men, potentially leading to:

Decreased self-esteem and body image issues
Anxiety in social situations, particularly those involving shirtless activities
Depression or mood disturbances
Avoidance of intimate relationships

Coping strategies and support options may include:

Counseling or therapy to address body image concerns
Joining support groups to connect with others experiencing similar issues
Wearing compression garments to minimize the appearance of enlarged breasts
Focusing on overall health and fitness to improve body confidence

It’s crucial for men with gynecomastia to seek emotional support and professional help if they’re experiencing significant distress due to their condition.

Are there any non-invasive treatments for gynecomastia?

While surgical intervention remains the most definitive treatment for persistent gynecomastia, several non-invasive options may help manage the condition or improve its appearance:

Compression garments: Special shirts or vests can help flatten the chest appearance.
Cryolipolysis: This FDA-approved fat-freezing technique may reduce fatty tissue in pseudogynecomastia cases.
Radiofrequency therapy: Some studies suggest this method may help tighten skin and reduce the appearance of gynecomastia.
Topical DHT gels: These may help balance hormone levels locally, though more research is needed to confirm efficacy.

It’s important to note that the effectiveness of these non-invasive treatments can vary, and they may not be suitable for all cases of gynecomastia. Consultation with a healthcare provider is essential to determine the most appropriate approach.

Gynecomastia, while often benign, can significantly impact a man’s physical and emotional well-being. Understanding its causes, seeking proper diagnosis, and exploring treatment options are crucial steps in managing this condition. Whether it’s a temporary hormonal fluctuation or a sign of an underlying health issue, addressing gynecomastia proactively can lead to improved quality of life and peace of mind for affected individuals.

Gynecomastia Causes

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By Dr. Liji Thomas, MDReviewed by Dr. Ananya Mandal, MD

Gynecomastia is a condition characterized by the development of enlarged breasts in males. There are many causes of gynecomastia; physiological, age-related, and drug-induced gynecomastia being just a few.

Indy way FOTO | Shutterstock

Both androgens (male hormones) and estrogens (female hormones) are present in males. The male hormones determine masculine characteristics like facial hair, baldness, male gonad development and male pattern of muscle and bone development, among others.

Normally estrogen is present in very low amounts in males. When there is an imbalance between the male and female hormones in men, they may develop feminizing characteristics. Notable among these is gynecomastia.

Is gynecomastia normal?

Gynecomastia may be physiological at three stages of life: in the neonatal period, at puberty, and in aging males. In all three cases it is due to relatively high estrogen levels.

In newborns, breast development may be accompanied by milk secretion. This happens because of high levels of female hormones in the mother during pregnancy that continue to stimulate breast tissue in the newborn. This typically resolves in a week or two.

Adolescent boys develop breast buds that usually reduce to normal size in a year or two. This is also due to the changes in the levels of male and female hormones around the time of puberty.

Estrogens are, in fact, essential for proper bone elongation and growth. A rise of these hormones during puberty is thus normal, and may be accompanied by breast bud development in pubertal boys in up to 60% of cases.

Elderly men often develop gynecomastia because of age-dependent declines in the testosterone levels, which leads to a comparative increase in estrogenic activity on breast tissue.

CHEN I CHUN | Shutterstock

Drug-induced gynecomastia

Some drugs have been known to be linked to gynecomastia, by several mechanisms such as their estrogenic properties, stimulation of estrogen production in the body, or supplying molecules which are easily converted to estrogen. These include:-

Estrogen vaginal creams, topical estrogen spray and herbs containing phytoestrogen

Certain antifungals

Some diuretics

Certain cardiac glycosides

Certain antibiotics

Some antacids

Some anti-androgens used to treat prostate cancer or enlargement

Certain drugs used to treat AIDS

Some anxiolytics

What are the other causes of gynecomastia?

Gynecomastia may also be seen in the following situations:

Chronic liver disease may increase female hormone production and lead to gynecomastia

End-stage renal disease, due to associated testosterone deficiency

Inadequate levels of testosterone or male hormones

Exposure to female hormones

Anabolic steroids

Certain illicit drugs and alcohol

Radiation therapy and cancer chemotherapy, especially for testicular and prostate cancer

Male hypogonadism, which may have several causes; genetic disorders associated with low testosterone levels in males, such as Klinefelter’s syndrome (which causes malformation and underdevelopment of the testes accompanied by gynecomastia), acquired testicular diseases causing primary hypogonadism, or enzyme deficiencies

Thyroid disorders, especially associated with hyperthyroidism

Tumors which secrete estrogen, including those of the testes, adrenal glands or pituitary gland, can alter the balance of estrogens and androgens in males

Malnutrition or severe dieting is associated with lowering of the testosterone levels without a corresponding dip in estrogens, causing gynecomastia in some cases, but refeeding after malnutrition is more common

Some herbs like tea tree or lavender have been associated with gynecomastia, purportedly due to their weak estrogenic action

In many cases, the cause remains unknown.

Does gynecomastia mean breast cancer?

Sometimes breast enlargement may be due to an underlying tumor or cancer in males, but this accounts for only 0.2% of all male cancers. Breast cancer in men is rare but needs to be excluded when gynecomastia is detected.

Breast cancer most often shows up as a lump that is firm or hard with or without pain and discharge from the nipples. Tumors and cancers tend to cause enlargement of a single breast, while gynecomastia is typically bilateral.

Sources:

http://www.nlm.nih.gov/medlineplus/ency/article/003165.htm

www.mayoclinic.org/…/syc-20351793

www.merckmanuals.com/…/gynecomastia.html

https://www.ncbi.nlm.nih.gov/books/NBK279105/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987263/

Gynecomastia | healthdirect

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What is gynecomastia?

Gynecomastia (sometimes spelled gynaecomastia) is a swelling of the breast tissue in boys and men, and can often be called ‘man boobs’. It can affect just one or both breasts.

Gynecomastia is very common — more than half of all boys develop the condition during puberty, and it normally disappears as they grow older. About 1 in 3 older men will develop it. However, if gynecomastia is causing you a lot of embarrassment, it can be treated with medicines or plastic surgery.

What are the symptoms of gynecomastia?

Gynecomastia causes enlarged breasts that feel rubbery or firm. The swelling spreads from underneath the nipple outwards over the breast area. It can sometimes be quite tender. Gynecomastia can cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple).

It is different from enlarged male breasts caused by being overweight. These are due to excess fat in the breasts.

It is also different from male breast cancer, which is usually on just one side, not always around the nipple, and feels hard or firm.

Usually gynecomastia is not serious, although it could indicate another underlying medical condition – and many men find the condition embarrassing and difficult to cope with.

Illustration showing the difference between gynecomastia (left) and a normal male chest (right).

What causes gynaecomastia?

Gynecomastia is often caused by a natural imbalance between the hormones oestrogen and testosterone, especially after birth, during puberty and as a man gets older

Gynaecomastia can also be caused by medicines that affect hormones. These include anabolic steroids, heart medicines, antibiotics, chemotherapy medicines and some medicines used to treat depression, high blood pressure, stomach ulcers and prostate cancer. Marijuana and alcohol can also cause enlarged breast tissue.

Your doctor can advise you about whether stopping taking a medicine might help with gynecomastia, but never stop taking a medicine without medical advice.

Other causes of gynecomastia include rare genetic conditions such as Klinefelter syndrome, kidney or liver disease, or tumours in the testicles or adrenal gland. Sometimes it is caused when the body has too much of the hormone prolactin, made in the pituitary gland. This can happen due to a tumour, taking antipsychotic or anti-nausea medications, having an underactive thyroid, kidney or liver failure, or from using marijuana.

How is gynecomastia diagnosed?

If you are worried about enlarged male breasts, the first step is to talk to your doctor. They will ask if you are taking any medicines or drugs and may order a blood test or a mammogram.

Other tests may include a CT or MRI scan, an ultrasound or a biopsy to take a small sample of tissue from the breast.

How is gynecomastia treated?

Gynecomastia often goes away by itself. This can take about 6 months to 2 years. If it is being caused by medicines, stopping the medicine will improve the gynecomastia. If it is caused by an underlying medical condition, treating that condition may lead to an improvement.

If the gynecomastia is painful or causing you a lot of embarrassment, other treatments are available. There are several medicines that have been shown to reduce breast size in men, but they do not work for everyone.

Another option is breast reduction surgery to remove fatty tissue from the breast or to remove the breast gland tissue.

You will need to ask your doctor for a referral to a plastic surgeon, who will assess whether surgery can help you. It may not work well in people who are overweight. Surgery may leave small scars around the areolae.

In the case of boys, it is best to wait until they have stopped developing before considering surgery.

When should I seek help?

It is important to see your doctor if you have:

swelling
pain or tenderness
a nipple discharge from one or both breasts

If your gynecomastia is upsetting you, it may be worth considering counselling and support from other people who have the condition. Your doctor can suggest where to get support.

Healthy Male – Andrology Australia has more information on gynecomastia.
To find a plastic surgeon, visit the Australian Society of Plastic Surgeons website.

Sources:

Healthy Male
(Male breasts (gynecomastia)),
Australian Society of Plastic Surgeons
(Gynaecomastia (male breast reduction)),
Hormones Australia
(Hyperprolactinaemia),
Elsevier Patient Education
(Gynecomastia)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: March 2021

Gynaecomastia surgery

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What you need to know about gynecomastia or ‘man boobs’

Gynecomastia, or “man boobs” is when male breast tissue grows larger than usual. It generally feels like a rubbery, firm mass under and around the nipple.

Normally, in men, the mammary glands are in an underdeveloped state and are a rudimentary organ, which consists of a small amount of glandular and adipose tissue, short ducts and a nipple. The formation and development of the breast depends on the content in the body of female sex hormones – estrogens and prolactin, which is produced by the pituitary gland. In the body of men, estrogens are in negligible doses in relation to androgens, and at the same time they are rapidly destroyed in the liver. The percentage of male and female hormones can change in the direction of increasing the latter, and sometimes tissues lose their sensitivity to the effects of testosterone. Under the influence of estrogens, the growth of the mammary glands in men occurs according to the female type with the intensive development of glandular tissue. In the presence of a pituitary adenoma that produces prolactin, there is a deposition of adipose tissue in the mammary glands. With gynecomastia, over time, the glands increase in size and thicken.

During puberty, gynecomastia occurs in half of adolescents. The increase may be small, or it may be very noticeable. This is due to the increase in testosterone and estrogen levels and their effect on breast tissue. As a rule, everything goes away in a year or two, however, if this does not happen, it is necessary to consult an endocrinologist. Gynecomastia is more common in overweight teenagers.

– Addison’s disease, hormonally active tumors, prostate adenoma and inflammatory lesions of the testicles;
– increased production of prolactin in pituitary tumors and hypothyroidism;
– diseases associated with impaired metabolic processes, such as diffuse toxic goiter, diabetes mellitus, obesity, pulmonary tuberculosis;
– cardiovascular insufficiency, HIV infection, chest trauma, herpes lesions of the chest, normalization of nutrition after exhaustion;
– chronic diseases of the liver, kidneys, ulcerative colitis;
– taking drugs that act on the receptors of mammary gland tissues and increase the production of estrogens or prolactin, blocking gonadotropin receptors.

If gynecomastia is caused by endocrine disorders, the symptoms may be manifested by lesions of the central nervous system. A decrease in testosterone and an increase in the concentration of estrogens in the blood of a man lead to a violation of potency and a decrease in libido. The timbre of the voice also begins to change – it acquires a high, “feminine” tone, men become irritable and nervous, hair loss occurs on the face and body. In the absence of adequate treatment, irreversible changes in the testicles occur, which can lead to the development of infertility.

The disease associated with the growth of glandular tissue in the mammary gland is considered to be true gynecomastia, the deposition of adipose tissue is referred to as false. The disease occurs mainly in the 11-14 years period, and is characterized by an increase in the size of the mammary glands and the presence of painful seals in them. There are two forms of the disease: nodular and diffuse. With diffuse gynecomastia, the mammary glands can increase to 10 cm or more.

Treatment of diffuse gynecomastia is conservative at stage 1, using anstiestorogens. In the presence of aesthetic indications and a nodular form, surgical treatment is recommended. The operation to remove excess tissue is carried out in the volume of subcutaneous amputation of the mammary gland from an incision along the edge of the halo, as well as using endovideo-assistance from an incision in the axillary zone.

Bilateral gynecomastia causes. Bilateral Gynecomastia: Causes, Symptoms, and Treatment Options