What is gynaecomastia?

When you think of breasts, it's likely you associate them primarily with women. But did you know men also have breast tissue? And sometimes, this tissue can grow more than it should. This brings us to gynaecomastia.

So, what is gynaecomastia? Gynaecomastia is the benign enlargement of male breast glandular tissue. It's different from lipomastia, which refers to fat deposits in the breasts of obese men.

Though the word might sound a bit intimidating, gynaecomastia is more common than you might think. It can occur at any age, and often it might be because of natural hormonal changes in the body.

What causes gynaecomastia?

There are a few different factors that can trigger the development of gynaecomastia, stemming from hormonal changes to medical conditions or medications.

Hormonal imbalance

If you've ever wondered why men have nipples, it's a testament to the fact that all of us, regardless of gender, start off in a similar way in the womb. As we grow and especially during puberty, hormones guide the development of our sexual characteristics.

Sometimes, there's an imbalance between testosterone and oestrogen levels. While we often consider oestrogen to be present in females, men produce it too. If oestrogen levels are too high or testosterone levels are too low, this can stimulate the growth of male breast tissue, leading to gynaecomastia.

Obesity

Carrying excess weight, especially around the midsection, can have more effects on the body than just heart health or diabetes risk. Fat cells produce oestrogen . So, more fat cells, especially around the chest and abdomen, can lead to increased oestrogen production. This can stimulate breast growth in men.

Medications and drugs

Ever read the side effects on your medication bottle? Some of them might surprise you. Drugs such as cimetidine (used to treat ulcers), spironolactone (a diuretic), and even some anabolic steroids can cause gynaecomastia.

These medications may alter hormone balance directly or have unintended oestrogenic side effects. It's crucial to consult with your doctor if you notice breast enlargement after starting a new medication.

Chronic diseases

Some diseases can throw off the body's hormonal balance. Conditions like thyroid disorders (hyperthyroidism), kidney failure or cirrhosis of the liver can alter the balance of hormones in the body, potentially leading to breast enlargement. For example, the kidneys and liver play a role in hormone balance, so when they are dysfunctional, they can disrupt normal testosterone and oestrogen levels.

Ageing

Just as women experience hormonal changes with age, so do men. As men get older, their testosterone levels decline (normally 1-2% per year after 30), and their body fat can increase, shifting the balance towards oestrogen excess – which can contribute to the development of gynaecomastia.

Puberty

Teenage years are a whirlwind of hormonal fluctuations. Most boys will experience some degree of breast enlargement during puberty due to testosterone and oestrogen imbalances. In many cases, the condition is temporary, resolving on its own as hormone levels stabilise.

Tumours

Though less common, some tumours can produce hormones or alter hormone balance in the body. Tumours in the testes, adrenal glands, or pituitary can be culprits in causing gynaecomastia, secreting hormones that dysregulate normal hormone production.

Genetic conditions

Some men have rare genetic conditions that cause gynaecomastia. For instance, Klinefelter syndrome—a condition where males are born with an extra X chromosome—can lead to larger breasts, reduced facial and body hair, and a host of other symptoms due to its impact on hormones.

So, while gynaecomastia might sound concerning, it's crucial to remember it's a common and treatable condition with many causes, that by itself is benign. If you or someone you know is experiencing gynaecomastia, it's essential to consult with a medical professional to determine the underlying cause and the best course of action.

Understanding the potential reasons can guide you toward the right steps for proper management or treatment, whether it’s hormonal imbalance or otherwise.

Signs and symptoms of gynaecomastia

If you're thinking, "Do I have gynaecomastia?", it's essential to know the signs and symptoms associated with this condition. Knowing these early can help you seek the necessary medical advice and potential treatments.

Swelling or enlargement

One of the most obvious symptoms of gynaecomastia is the enlargement of one or both breasts. This isn't merely about fatty tissue, but rather an actual growth of the glandular tissue.

This breast tissue growth can occur unilaterally in just one breast or bilaterally in both. It may range from subtle fullness to prominent female-appearing breasts.

Firm, rubbery feel

If you gently touch the breast area, you might notice a firm, rubbery circle of tissue, particularly around the nipple. This is different from the soft fat we sometimes accumulate with weight gain.

Tenderness or sensitivity

Some men with gynaecomastia experience tenderness, pain or achiness, or increased sensitivity in the nipples. This can be uncomfortable, especially when wearing certain types of clothing or during physical activities.

Appearance of feminine breasts

The enlargement may give the breasts a more feminine appearance. While this is entirely natural and nothing to be ashamed of, it can sometimes affect self-esteem.

The degree of gynaecomastia can range from mild puffy nipples to large, prominent breast mounds. Clothing may also fit differently – another telltale sign.

Gradual development

More often than not, gynaecomastia develops slowly over time, over months or years without noticable symptoms. So, if you're observing these changes, it's helpful to note when they started and how they've progressed.

Rapid swelling or redness

In rare cases, some men might experience sudden pain, redness, and swelling, which could indicate an acute infection, inflammation or injury, or even another medical issue. If you are affected by this it’s important you speak to a health professional quickly.

Breast reduction surgery: Martin’s story

Meet Martin Bryan, a patient who was treated for gynaecomastia at Ross Hall Hospital in Glasgow.

When Martin was diagnosed with gynaecomastia he struggled with his confidence. After undergoing surgery at Ross Hall Hospital he wanted to share his experience to make a difference to others with the condition.

Read more about Martin’s experience in our blog post here.

When to see a specialist

Not every symptom might be a cause for concern, but it's always wise to play it safe when it comes to your health. Here are situations when you might want to see a doctor:

• Breast lumps, swelling, tenderness, or a noticeable increase in size
• Changes to the nipple, such as inversion (nipple turning inward), increased sensitivity, or discharge
• Experiencing a sudden onset of painful swelling in the breast area
• If you've noticed persistent gynaecomastia symptoms lasting over one to two years

How is gynaecomastia diagnosed?

If you believe you have gynaecomastia, your doctor will use several methods to confirm the diagnosis and rule out other potential causes.

Medical history and physical exam

Your doctor will begin by asking about your symptoms, any medications you're taking, and your overall health history to check for health conditions that could impact hormones.

They will also perform a physical examination, focusing on the breasts by feeling for firm subareolar tissue, noting any nipple changes, asymmetry, or masses. Your doctor may also check your testicles to gain further information.

Blood tests

To determine any underlying causes, your doctor might order blood tests. These can measure hormone levels and check the health of your liver and kidneys, as well as screen for tumours.

Imaging

To get a closer look at the breast tissue, your doctor might request a mammogram or a breast ultrasound. These imaging techniques can help distinguish between gynaecomastia and other conditions.

Testicular exam

Sometimes, tumours or other abnormalities in the testicles can cause symptoms similar to gynaecomastia. A physical examination of this area to check for masses, swelling, tenderness, or dysfunction is essential to rule out such causes.

Specialist referral

If the root cause of your symptoms remains unclear, your doctor might refer you to a specialist, like an endocrinologist who focuses on hormones, or a urologist who specialises in the male reproductive system and urinary tract.

Treatment options for gynaecomastia

Living with gynaecomastia? The good news is that there are multiple treatment options available. Remember, it's essential to work closely with your doctor or healthcare provider to determine the best approach for you.

Medications

Some medications like selective oestrogen receptor modulators (SERMs ) and others have been shown to be effective in treating gynaecomastia, including:

• Tamoxifen: Commonly used to treat breast cancer, it can also reduce breast size in men
• Raloxifene: Typically used to combat osteoporosis in post-menopausal women, it's sometimes prescribed for gynaecomastia
• Aromatase inhibitors: While primarily for breast cancer treatment, they can sometimes be helpful for gynaecomastia caused by hormone imbalances

Surgery

Procedures like subcutaneous mastectomy to remove excess glandular breast tissue, and liposuction to eliminate adipose fat causing breast enlargement may be considered. For those looking for a more permanent solution, surgical options include:

• Mastectomy: This procedure removes the breast gland tissue and can often be done endoscopically (using small incisions)
• Liposuction: While it doesn't remove breast gland tissue, it can remove breast fat

Address underlying conditions

If gynaecomastia is due to an underlying health condition like liver disease, kidney failure or hypogonadism, treating the root cause (often causing the hormonal imbalance) might reduce the breast enlargement.

Medication review

Some drugs are known to cause gynaecomastia. If you suspect this might be the case, speak to your doctor about discontinuing or finding a safe alternative. They might suggest alternatives that won't trigger the condition, and even cause its reversal.

Weight management

Losing weight can reduce the amount of oestrogen produced by the body, and subsequently, the size of the breast tissue. For obesity-associated gynaecomastia, dropping excess body fat decreases aromatase and lowers oestrogen production.

Radiation therapy

While less common, low-dose radiation therapy might be suggested to prevent breast tissue growth, especially after a mastectomy. It is often used prophylactically before hormone treatment.
Treatment should be individualised based on the severity of gynaecomastia, impact on quality of life, underlying causes, age, and overall health.

Coping with gynaecomastia

Coming to terms with gynaecomastia can be challenging. But remember, you're not alone. If you are struggling with emotional distress from gynecomastia, keep these coping tips in mind:

• Understand the condition: Realise that gynaecomastia is common and not a serious threat to your health. Over half of boys and men experience it at some point in their lives
• Talk to your doctor: Feeling down or self-conscious? Don't hesitate to speak to your doctor or a therapist. They can provide both medical and emotional support
• Join a support group: Connecting with others online or in-person who have gynaecomastia and understand what you're going through, can provide invaluable insights and advice, shared experiences, and coping mechanisms
• Be cautious: Stay away from dubious or unproven or unlicensed supplements or ‘miracle cures’ claiming to cure gynaecomastia. They might be harmful and rarely deliver on their promises
• Stay vigilant: If you're on medication to treat gynaecomastia, monitor for side effects and report any breast enlargement to your doctor
• Patience is key: Treatments might take time to show results. It's crucial to be patient and allow your chosen treatment to work before considering more invasive options

When to seek a specialist’s opinion

While most cases of gynecomastia are benign, your GP or doctor may refer you to breast, endocrine, or oncology (cancer) specialists for further assessment if:

• You experience severe, rapidly progressive, or painful breast enlargement
• The problem remains in one area or is isolated to a confined region
• It continues to be a issue for over one to two years without improvement
• There is suspicion of male breast cancer based on risk factors or clinical exam
• There are signs of endocrine (hormonal) abnormalities like early puberty, pituitary tumour, low testosterone
• If there is a family history of cancers, unexplained weight loss, or additional organomegaly

Though rare, male breast cancer, hormone deficiencies, and chronic diseases can underlie gynaecomastia. Specialists help provide optimal treatment and surveillance when risk factors are present.

Take steps towards treating gynaecomastia today

Gynaecomastia can touch the lives of males at any age, from teens going through puberty to older adults causing a great deal of distress. While it's often a natural hormonal occurrence, understanding its causes, getting a proper diagnosis, and seeking appropriate treatments helps most cases improve, making a world of difference in how you feel about your body.

Remember, while medications and surgeries offer solutions, addressing any underlying health issues is just as crucial. If you or someone you know is grappling with gynaecomastia, support is readily available. With the right treatment, gynaecomastia can be managed to reduce anxiety and improve self-confidence.