Pseudogynecomastia is breast growth in men that occurs with obesity. Male breast enlargement can be physiological or pathological and often leads to loss of self-confidence.
What is pseudogynecomastia?
Pseudogynecomastia is characterized by an enlargement of the breast in men. While in true gynecomastia there is growth of mammary gland tissue, pseudogynecomastia occurs in cases of severe obesity, where there is only storage of fatty tissue in the breast. True gynecomastia can be divided into a physiological and a pathological form. The pathological form of breast enlargement in men is not an independent disease, but a symptom of another disorder. Physiological gynecomastia, in turn, can be divided into three forms: These are neonatal gynecomastia, pubertal gynecomastia and geriatric gynecomastia.
- Newborn boys sometimes develop a breast attachment caused by the influence of maternal estrogens during pregnancy.
- During puberty, hormonal changes occur. In this process, boys may also temporarily higher levels of estrogen. Both forms of gynecomastia usually disappear again after one to two years. The age gynecomastia is also physiological.
- Due to the higher proportion of adipose tissue in older men, formed testosterone is converted more quickly into estrogen, which leads to breast enlargement.
Causes
There are many causes of gynecomastia. As mentioned above, there are physiological forms of breast enlargement in men that can occur at certain stages of life. Newborn and pubertal gynecomastia usually regress when the hormonal influence of estrogen decreases. Although pseudogynecomastia often develops in cases of severe obesity, mixed forms with true gynecomastia can also develop. On the one hand, more fat is deposited in the fatty tissue of the breast, causing it to grow. On the other hand, the fatty tissue also ensures that testosterone can be converted into estrogens more quickly. This in turn leads to real growth of the mammary gland tissue. Thus, pathological gynecomastia can be caused by a decreased production of testosterone or by an increased production of estrogens. There are several hereditary conditions associated with hypogonadism due to low testosterone levels. These include Klinefelter syndrome with two X chromosomes and one Y chromosome or diseases with androgen receptor defects. Testosterone deficiency can also occur in diseases of the testes, castration, or endocrine system disorders. Estrogen excess often occurs in kidney and liver diseases such as cirrhosis. Among others, there are also estrogen-producing tumors such as certain forms of lung carcinoma. Furthermore, excess estrogen can also occur in hyperthyroidism or after malnutrition. Finally, there are also certain drugs that have an estrogenic effect. These include such drugs as cimetidine, omeprazole or spironolactone. In general, true gynecomastia is caused by estrogen influence on the mammary gland tissue. However, various causes can lead to an increase in estrogen levels. Often, although estrogen levels are not elevated, testosterone levels are lower. This changes the ratio of estrogen to testosterone in favor of estrogen. Pseudogynecomastia can occur unilaterally or bilaterally. It manifests itself in breast growth in men, which of course can cause subjective discomfort. The biggest problem with pseudogynecomastia is the disturbance of self-confidence. Often, due to fear of ridicule, psychological stress develops, which leads to avoidance of social contacts. In case of underlying other diseases, the “real” gynecomastia is associated with the other symptoms of the corresponding disease. In some cases, sensitivity to touch and feelings of tightness in the breast may also develop.
Diseases with this symptom
- Hypogonadism
- Malnutrition
- Obesity
- Klinefelter syndrome
- Hyperthyroidism
- Breast cancer
- Liver disease
- Lung cancer
- Hormonal imbalances
Diagnosis and course
Since pseudogynecomastia is a symptom, it can provide an important clue in the diagnosis of certain diseases. For possible treatment, it is important to know whether it is true gynecomastia or pseudogynecomastia.
Complications
Pseudogynecomastia, which is an insertion of fatty tissue into a man’s chest, can quickly end up in true gynecomastia, with a formation of true glandular tissue. The causes vary and can cause various complications. Due to the breast growth, most men are ridiculed, so it can cause psychological problems. The affected person usually isolates himself from society and may suffer from severe depression. On the one hand, a breast attachment can typically develop with obesity. The complications of obesity are many. Most sufferers also develop diabetes with its attendant consequences. These include diabetic retinopathy, diabetic foot syndrome, and diabetic nephro- and neuropathy. In addition, there are other metabolic disorders, so that the patients have a disturbed lipid metabolism. Blood lipids are much too high and secondary diseases such as atherosclerosis or fatty liver can develop, which can turn into liver cirrhosis. The risk of suffering a stroke or heart attack is increased many times over in obese people. Uric acid levels also rise, and gout can develop. On the other hand, a deficiency of testosterone, which can typically develop in various testicular diseases, can also cause pseudogynecomastia. Testicular diseases can lead to various complications, one of the most common being infertility and severe pain in the groin and testicular region.
When should you go to the doctor?
In any case, pseudogynecomastia should be clarified by a doctor. A medical diagnosis is already useful for reasons of finding the cause. For example, the breast enlargement may be based on a serious disease that can cause problems if left untreated. In addition, pseudogynecomastia must be diagnosed in order to initiate appropriate treatment. Those affected often suffer from a lack of self-confidence due to the physical changes, which can be strengthened again through therapy – provided that the cause of the enlarged breasts is known. A visit to the doctor is recommended at the first signs of breast enlargement. As soon as changes in the breast tissue are noticed, possibly associated with a pressing pain or a noticeable throbbing, a doctor must be consulted. Patients who have already been diagnosed with a hormone deficiency or metabolic disorder should talk to the doctor in charge if they suspect pseudogynecomastia. Exercise and a healthy diet can usually reverse breast growth. People with obesity or another eating disorder should speak with a nutritionist concomitantly.
Treatment and therapy
Pseudogynecomastia does not actually require treatment from a health perspective. If it is part of an underlying condition, that condition will need to be treated. However, breast enlargement leads to psychological stressful situations in many men, which can only be solved by breast reduction. In the case of hormonally induced gynecomastia, attempts are often made to bring it about by administering hormone preparations. However, this is not successful in all cases. During surgery, a small incision is made at the edge of the areola, from where mammary gland tissue and fatty tissue can be removed. However, the operation does not remove the cause of the gynecomastia or pseudogynecomastia. First of all, the possible underlying disease should be diagnosed and treated. Since fatty tissue has a great influence on the conversion of testosterone into estrogens, weight reduction should be aimed for in obesity patients by changing dietary habits and plenty of exercise. Furthermore, medications that may cause gynecomastia and are not absolutely necessary should possibly be discontinued. In the case of testosterone deficiency, the male sex hormone can be substituted. However, possible side effects should be taken into account.
Outlook and prognosis
Often, men are severely affected psychologically by pseudogynecomastia, as the enlarged breast can lead to inferiority complexes and decreased self-esteem. Most often, pseudogynecomastia does not occur alone, but is a concomitant of another disease. It not infrequently leads to depression and other psychological complaints. If pseudogynecomastia occurs due to obesity, diet can lead to a positive course of the disease. In severe cases, surgical intervention on the stomach is necessary, but pseudogynecomastia can often be treated with exercise and a healthy diet. If the skin has been overstretched due to obesity, it can still remain expanded if the affected person has lost weight. If pseudogynecomastia is caused by hormone deficiency or metabolic disorders, it can usually be treated well. If the treatment is not successful, breast reduction can also be performed. For this, a surgical procedure is necessary. In many cases, pseudogynecomastia occurs when taking certain medications. In this case, the patient should discontinue the respective medications or replace them with others after consulting the physician. In most cases, pseudogynecomastia results in a positive course of the disease without further complications.
Prevention
Pseudogynecomastia caused by obesity can be prevented by a healthy lifestyle with a balanced diet and exercise. A healthy lifestyle is also recommended with regard to underlying diseases such as cirrhosis of the liver or kidney disease. This includes abstaining from alcohol and smoking.
What you can do yourself
Pseudogynecomastia cannot be treated on the basis of “self-treatment” either with medications taken orally or with ointments, creams or tinctures applied externally. However, the psychological problems associated with pseudogynecomastia in the form of reduced self-confidence and inferiority complexes can be reduced on one’s own, as long as they do not occur in a massive form. It can already help to openly admit to this disease instead of trying to hide it under casual clothing. Recognition for other positive aspects of one’s own personality or for achievements can also help to reduce or even eliminate psychological deficits. Once you have managed to position yourself with your values and skills, you are already well on the right path. If the pseudogynecomastia is based on obesity, weight reduction is the first priority. If this is carried out constantly by the affected person, the size of the male breast is also often reduced as a welcome and desired side effect. The study of specialized literature concerning healthy weight reduction helps. Also, those who join a (professionally supervised) group in which everyone wants to reduce their weight will be able to achieve their goal. The same applies to sports activities to support the weight reduction measures.
