Gynecomastia is a condition when the glandular tissue of the male breast enlarges. This enlargement can occur in one or both breasts, and can be recognized by the breasts looking more prominent, feeling supple, but not causing pain.
Gynecomastia can occur naturally due to hormonal changes, both in newborns, adolescents, and adult men. However, in certain cases, gynecomastia can also be a sign of a serious disease.
Causes of Gynecomastia
Gynecomastia is caused by an imbalance of the hormones estrogen and testosterone. Estrogen is a hormone that regulates female sex characteristics, such as breast growth, while testosterone is a hormone that regulates male sex characteristics, such as muscle growth and body hair.
Both men and women produce the hormones estrogen and testosterone, only in different ratios. Gynecomastia occurs when the hormone estrogen increases or testosterone levels decrease in men.
These hormonal imbalances can occur naturally or as a result of certain conditions or diseases. In its natural state, gynecomastia can occur at the following times:
- After birth
Newborn boys are still influenced by the hormone estrogen that they get from their mothers. More than half of baby boys are born with enlarged breasts, but they usually return to normal within 2 to 3 weeks after birth.
- Puberty
Hormone levels change during puberty (12 to 14 years of age) and can cause breasts to enlarge. Generally, breast size will return to normal 6 months to 2 years after puberty.
- Adulthood
Breast enlargement sometimes occurs in men in the age range of 50-80 years, due to decreased levels of the hormone testosterone. About 1 in 4 men in this age range has gynecomastia.
Meanwhile, some conditions or diseases that can cause gynecomastia are:
- aging
- Hyperthyroidism
- Obesity
- Cirrhosis
- Hypogonadism
- Tumor
- liver disease
- Kidney failure
- Malnutrition
In addition to the conditions and diseases above, gynecomastia can also be caused by the use of the following substances or medications:
- Antiandrogen drugs, such as finasteride and spironolactone
- Calcium antagonists for high blood pressure, such as amlodipine, or ACE inhibitors, such as captopril
- Tranquilizers, such as diazepam
- Heart disease medications, such as digoxin
- Antibiotics, such as metronidazole
- Ulcer medications, such as cimetidine and omeprazole
- Fungal infection medications, such as ketoconazole
- Nausea medications, such as metoclopramide
- Chemotherapy
- Muscle mass-building supplements, such as anabolic steroids
- Body care products containing tea tree oil or lavender
- Drugs, such as heroin and marijuana
- Alcohol
Symptom Gynecomastia
Just like women, men also have glandular breast tissue, it's just that they are small and undeveloped. The glandular tissue of the breast in men is usually less than 0.5 cm in size.
The main symptom of gynecomastia is breasts that are larger than the size of male breasts in general. This enlargement generally occurs in both breasts, but it can also occur in only one breast. The size of the enlargement can also be different for each breast.
In addition to the breasts looking bigger or protruding, gynecomastia can also be characterized by breasts feeling supple or tight and may be more sensitive to touch, but are generally painless.
When to go to the doctor
It is recommended to check with a doctor if you experience breast enlargement to confirm the diagnosis and find out the cause.
Immediately consult a doctor if you experience breast enlargement accompanied by the following symptoms:
- Black or bloody discharge from the nipple
- There are sores or ulcers on the skin of the breast or around it
Diagnosis Gynecomastia
In the process of diagnosis, the patient will be asked about the symptoms experienced, past medical history, and medications being taken. After that, the patient will undergo a physical examination which includes an examination of height and weight, as well as an examination of the breasts, genitals, liver, lymph nodes, and thyroid.
Generally, the doctor will perform blood tests to check liver, kidney, and thyroid function, as well as measure hormone levels in the blood. The doctor may also perform a breast scan with a mammary ultrasound to detect any growths in breast tissue.
If needed, the doctor will perform a further scan with a CT scan or MRI. The doctor will also perform a biopsy, which is taking a tissue sample to be examined under a microscope, if it is suspected that the patient may have:
- Breast cancer
This disease is very rare in men, but it can happen. Enlargement of one breast or the presence of a hard lump can be a sign of breast cancer in men.
- Breast abscess
A breast abscess is the appearance of a pus-filled lump in the breast caused by an infection.
- Pseudogynecomastia
This condition is similar to gynecomastia, but is caused more by fat deposits in the breasts.
Treatment Gynecomastia
Naturally occurring gynecomastia may resolve over time without treatment. However, if gynecomastia is caused by a disease, such as hypogonadism, malnutrition, or cirrhosis, then the condition must receive medical attention first.
If gynecomastia is caused by taking medication, the doctor will ask the patient to stop taking the drug and replace it with another drug.
In adolescents with gynecomastia, the doctor will evaluate every 3–6 months to see if the patient's condition is improving. Generally, gynecomastia in adolescents will disappear in less than 2 years.
Patients can also be referred to an endocrinologist, a doctor who specializes in hormone problems. An endocrinologist may prescribe medications that can correct hormonal imbalances, such as tamoxifen and raloxifene.
If needed, a surgical procedure can be performed. Surgery for gynecomastia includes liposuction or mastectomy. Liposuction is surgery to remove breast fat, whereas mastectomy removes glandular breast tissue.
Gynecomastia Complications
Gynecomastia can cause complications in the form of disturbances in the sufferer's mental health because of feeling ashamed, so that it can cause anxiety and depression.
Gynecomastia Prevention
In most cases, gynecomastia cannot be prevented because it is caused by changes in the body's hormones that occur naturally. However, there are several ways that can be done to reduce the risk of gynecomastia, namely:
- Avoid alcohol consumption
- Avoid taking supplements to increase muscle mass, such as steroids, and drugs, such as heroin and marijuana
- Consult a doctor and ask for other drug options if you are on medication that has a risk of causing gynecomastia