Brief overview
- Symptoms: Enlarged male breasts due to growth of mammary gland tissue, unilateral or bilateral, often no symptoms, sometimes feeling of tension in the breasts, restricted movement or sensitive nipples
- Causes: Physiological causes due to imbalance of male and female hormones (such as neonatal, pubertal or geriatric gynecomastia), pathological causes such as defects in the genetic material, chronic diseases, cancer, external supply of hormones through medication, drugs or care products
- Diagnosis: Documentation of medical history, palpation of the breast, abdomen and testicles, imaging procedures such as ultrasound, possibly blood tests, mammography if cancer is suspected, tissue sampling, sometimes chromosome analysis
- Therapy: In the case of temporary forms, no treatment or psychological support, in the case of a known cause, correction of the hormone balance such as renunciation of hidden estrogen sources, possibly taking medications that interfere with the hormone balance, surgery.
- Prevention: No preventive measures, if hormone balance is out of balance, for example due to overeating, heavy alcohol or drug use, it is advisable to avoid these triggers
What is gynecomastia?
Gynecomastia refers to breast growth in men. This involves the growth of glandular tissue, which goes through various stages similar to puberty in girls. Doctors distinguish different forms of gynecomastia based on their causes. Depending on whether it is a natural (physiological) or a pathological (pathological) process, the doctor decides on appropriate treatment.
How to recognize gynecomastia?
In gynecomastia, the mammary gland grows. This happens either on one side or on both sides.
There are those affected who have no complaints. Others complain of a feeling of tension in the breasts, are restricted in their movement or are particularly sensitive to touching the nipples.
What are the causes of gynecomastia?
The mammary gland tissue reacts very sensitively to fluctuations in the male hormone balance, so that disturbances of the balance promote breast growth. All things that interfere with this balance are therefore considered risk factors for the development of gynecomastia.
Physiological gynecomastia
Physiological gynecomastia results from an altered balance between female sex hormones (estrogens) and the male sex hormone (testosterone). The proportion of the female messenger substance, which is always present in the body in small quantities in men, increases. However, these changes do not always result from pathological processes, but sometimes occur naturally at certain stages of life:
Newborn Gynecomastia
Puberty gynecomastia
During puberty, some boys grow breasts because the balance of sex hormones changes. Due to the serious changes in the hormone balance, it happens that female sex hormones are also increasingly produced. Since fatty tissue plays a role in the conversion of the male sex hormone testosterone to female estrogen, pubertal gynecomastia is more common in overweight adolescents.
Age gynecomastia
As we age, the body’s percentage of adipose tissue increases and the production of testosterone decreases. The enzyme aromatase, which is particularly abundant in fatty tissue, converts testosterone to estrogen. Both effects promote the growth of mammary gland tissue. This form of breast growth is also more common in overweight people.
Pathological gynecomastia
Breast growth in men may also be an indication of a pathological process in the body that disturbs hormone balance, or that occurs directly in the breast itself.
Hereditary gynecomastia
Sometimes sections of the genetic material DNA are also missing, or the (female) X chromosome is present twice (Klinefelter syndrome). In such cases, the breasts, pelvis and buttocks may be female and male sexual characteristics may be present at the same time. Such deviations in the genetic material usually occur during the production of the sperm and the egg or during their fusion (fertilization).
Chronic diseases
Among other things, the liver breaks down hormones, especially estrogen. Liver disease, such as cirrhosis, may lead to excess female hormones and subsequently to gynecomastia.
A diseased kidney also possibly causes gynecomastia. Dysfunction (renal insufficiency) alters the filtering function and thus affects hormone balance. In cases of severe malnutrition, such as anorexia, testosterone levels drop dramatically and the liver no longer works at full capacity. If such a starvation phase is followed by a return to a normal diet, hormone levels are nevertheless disturbed for a certain time, which promotes gynecomastia.
Cancer
Tumors are clusters of cells that have lost their normal function. Some tumors produce effective amounts of hormones themselves, so that an excess of these messenger substances circulates in the body. Sometimes these are sex hormones that may stimulate breast growth. In this case, one speaks of “paraneoplastic symptoms” (neoplasia = tissue growth).
Breast cancer (mammary carcinoma) also occurs in men. This is much rarer than in women and is therefore often detected late. The acute, unilateral occurrence is typical. In contrast to gynecomastia, in which the breast tissue tends to be soft, elastic and evenly distributed around the areola, the breast tissue in mammary carcinoma is usually firm and unevenly distributed.
Medications, drugs or skin care products
A fairly common cause is external intake of hormones or substances that affect hormone balance. Some heart medications, antibiotics or antidepressants also alter hormone metabolism. In addition, long-term heavy alcohol or drug use (marijuana, heroin) is a possible cause of hormone imbalance with gynecomastia.
Pseudogynecomastia (lipomastia)
It is important to distinguish gynecomastia from pseudogynecomastia (lipomastia). In pseudogynecomastia, glandular tissue does not increase, but fat is deposited in the breast. Pseudogynecomastia occurs mainly in cases of severe overweight and obesity (adiposity). On the basis of the BMI (body mass index), the overweight itself can be estimated.
What are the examinations and diagnoses of gynecomastia?
In the case of an enlarged male breast, affected persons turn to the following doctors, depending on their age and the cause: general practitioner, pediatrician, specialist in urology, andrology (men’s health) or endocrinology (hormonology).
The most important tool of the doctor in gynecomastia is the patient interview (anamnesis). The doctor gets clues about a hereditary form if there are already “men with breasts” in the family. He asks whether and which medications or drugs are taken regularly. If it is a natural growth process during puberty, no further diagnosis is usually necessary in boys under 15 years of age.
- Stage B1: No mammary gland palpable
- Stage B2: areola enlarged, mammary glands bulging
- Stage B3: Breast gland body larger than areola
- Stage B4: Solid breast gland body, areola stands out
- Stage B5: Corresponds to the mature female breast
To distinguish whether true gynecomastia or pseudogynecomastia is present, palpation of the breast is helpful. In this way, the physician quickly distinguishes glandular tissue from simple fatty tissue and assesses whether abnormal growth of breast glandular tissue is present. Some physicians prefer to use ultrasound to determine this difference.
In addition, the doctor determines in the blood especially the liver and kidney values as well as the hormone levels of estrogen and testosterone and their degradation products.
In the case of unilateral gynecomastia with hard tissue (lumps), the affected person undergoes mammography to rule out breast cancer. If a malignant tumor is suspected, the physician will order a tissue biopsy.
If no cause for the gynecomastia can be found, or if it has existed since birth or puberty, a chromosome analysis may be helpful to rule out disorders in the genetic material. For reasons of cost, this examination is only performed if there are further indications of a genetic disorder.
How is gynecomastia treated?
In the case of gynecomastia, treatment depends on the cause of the condition. If it is a temporary problem, such as pubertal gynecomastia, it will regress on its own. Treatment is only necessary if pain occurs or psychological problems build up due to cosmetic reasons. If the level of suffering is very high, it is recommended to consult a clinical psychologist.
However, such drug therapy is controversial. Moreover, there is an assumption that this therapy has an effect at most in the first months after the onset of breast growth.
Surgery for gynecomastia
If medication does not help, the doctor may suggest surgical removal of the breast. Read all about it in the article Gynecomastia surgery.
Course of the disease and prognosis
In physiological gynecomastia, treatment is only necessary if the changes bother the patient. In addition, it is often a temporary appearance that recedes on its own after some time. Pubertal gynecomastia, for example, usually disappears by the age of 20. If the gynecomastia was triggered by a period of starvation followed by a period of normal eating, it usually disappears again within one to two years.
If it is pathological gynecomastia, various examinations help to identify possible underlying diseases and hormone disorders and to treat them accordingly.
Can gynecomastia be prevented?
Gynecomastia has many triggers, which have a natural or pathological origin. There are no proven measures to specifically prevent gynecomastia.
If the hormone balance is out of balance due to excessive eating, alcohol or drug abuse, for example, and those affected notice breast growth, it is advisable to reduce weight or stop heavy alcohol or drug consumption.
