Gynecomastia

Gynecomastia is a descriptive term for female breast development in the male. It can involve one or both breasts. The condition is quite common (physiologic gynecomastia) in the newborn and during puberty, with 70% of young men having some degree of transient gynecomastia.

The appearance of gynecomastia in elderly men is not unusual, about 40% of men over 65 exhibit some breast tissue. The reasons for this are not clear. In both sexes, there is a balance of the male hormones (androgens or testosterone) and female hormone (estrogen). Gynecomastia occurs when this balance is upset. In pathologic gynecomastia, the increased estrogen effects can be caused by estrogen-secreting tumors of the testicles and adrenal glands, an overactive thyroid gland (hyperthyroidism and thyrotoxicosis), and liver disease, notably cirrhosis of the liver. Tumors that secrete human chorionic gonadotropin, such as carcinoma of the lung, can stimulate estrogen production. Decreased androgen production or its effects is largely due to congenital disorders (genetic defects) or testicular atrophy.

Drugs that can cause gynecomastia drugs have an estrogen-like effect or somehow block the action of testosterone. Alcoholics may have gynecomastia because of liver damage and shrinkage (atrophy) of the testicles.

History: An understandable concern with appearance and anxiety about possible breast cancer may prompt a man to seek medical advice. There could be some tenderness in the gynecomastia associated with puberty. A careful drug history should note all current and past drug use. A history of alcoholism would be significant.

Physical exam: The appearance can range from apparently normal male breasts to fully developed female breasts. Palpation of the breasts around and under the nipple (the areola) will reveal a granular consistency that is characteristic of gland development. This is important, as obese men can have fat deposits that mimic the appearance of gynecomastia.

Findings such as discoloration, skin fixation, nipple discharge or other masses could suggest cancer of the breast. The liver is examined for changes of cirrhosis. The testicles are examined for size and uniformity.

Tests: Adolescents with minimal gynecomastia of less than three years duration are excluded from further testing. Without a clear history of drug-induced gynecomastia, liver function, thyroid tests and blood levels for certain hormones are checked.

If the individual is an adolescent with the normal changes of puberty, the condition is self limiting and no treatment is necessary. Otherwise, treatment depends on the cause of the gynecomastia, but a satisfactory diagnosis is made in less than half of the cases.

Gynecomastia caused by drugs may resolve with stopping the particular drug and using alternative drugs, if possible. If the hormone imbalance is caused by a tumor, then the treatment would be directed towards the particular cancer, also thyroid problems would be treated accordingly.

The gynecomastia associated with cirrhosis of the liver is not treated. Replacement hormone therapy is given to men with testicular insufficiency. If the gynecomastia has progressed to the stage where there is fat deposition and fibrosis, and if there are permanent changes in the breast tissue, the enlarged breasts will persist and cosmetic surgery is an option.