Gynecomastia: What is it, Causes, Symptoms and Treatment
Gynecomastia originates from the Greek words “gyne” (woman) and mastia (breast) and means having breasts like a woman.
What is Gynecomastia?
In men, benign excessive growth of the breasts and nipples, which is mostly seen in the glandular tissue, is called gynecomastia. Although the structural forms of male and female breasts are the same, the reason why male breasts are smaller than female breasts is that men do not have enough estrogen hormone. It is common in 3 stages of life; in newborns, adolescents and men over middle age. Gynecomastia is seen in one in every three men in our country. Although it may cause pain and suffering in some patients, it does not harm health. However, young and adult men may experience uncomfortable feelings such as embarrassment and shyness during physical activities such as swimming or doing sports. In many men, gynecomastia can cause insecurity, introversion and posture disorders. Gynecomastia can occur in one breast or in both breasts. In gynecomastia, hard and tight tissues are formed. Spontaneous regression or recovery is not possible. Today, gynecomastia is a treatable disorder.
Types of gynecomastia
Gynecomastia can be classified into 3 types:
- Glandular type gynecomastia: In glandular type gynecomastia, there are mammary glands that are hardened and do not produce milk, similar to the female breast.
- Fatty type gynecomastia: In fatty type gynecomastia, fatty tissue predominates. There is no increase in mammary gland tissue. Excessive weight gain or loss causes this type of gynecomastia.
- Mixed type gynecomastia: Mixed type gynecomastia is the type of gynecomastia in which excess glandular and fatty tissue occurs together.
Gynecomastia Symptoms
- Tenderness in breasts
- Pain and soreness in the breasts
- Discharge from one or both nipples
- Size difference between two breasts
- Feeling of a lump under the nipple
- Swelling in armpit lymph nodes
How is gynecomastia diagnosed?
First of all, a detailed physical examination is performed by the specialist physician, including breast tissue, genitals and abdomen. When deemed necessary by the physician, gynecomastia is diagnosed by using methods such as blood tests, mammography, Computerized tomography scans (CT), tissue biopsies, magnetic resonance imaging (MRI). The most important point in this regard is to distinguish gynecomastia from breast carcinoma. Thanks to examination and diagnostic methods, breast cancer and other diseases such as breast abscess can be easily distinguished and the correct treatment can be applied.
What are the causes of gynecomastia?
Gynecomastia generally occurs as a result of hormonal imbalance. If the testosterone hormone decreases in men and the estrogen hormone increases more than necessary, gynecomastia occurs. Medicines, herbal products or various diseases used other than hormonal imbalances may cause gynecomastia.
Hormonal changes:
Estrogen hormone is also known as the female hormone. It is responsible for providing many physical and structural changes in women, such as the development of breasts. Men also produce very small amounts of the estrogen hormone. The estrogen hormone produced at different periods of a man’s life can cause gynecomastia.
Gynecomastia in babies: The estrogen hormone secreted by the mother causes male babies to be born with enlarged breasts. Gynecomastia disappears in the baby 2-3 weeks after birth.
Gynecomastia during adolescence: Hormonal changes during adolescence cause gynecomastia. Most gynecomastia disappears within 6 months to 2 years without requiring treatment.
Gynecomastia in adults: The ages of 50-69 are the ages when gynecomastia is most common in men. It can be treated with medical or surgical methods.
Medicines:
Misuse or side effects of many medications and drug groups can cause gynecomastia.
- Anabolic steroids and androgens frequently used by athletes
- estrogens
- Anti-androgens (flutamide, finasteride) that inhibit prostate enlargement
- Some heart medications (Spironolactone, digoxin, amiodarone, ACE inhibitors captopril, enalapril, calcium channel blockers)
- Some medications used for heartburn and ulcers (Metoclopramide, Ranitidine, cimetidine and proton pump inhibitors)
- Anxiety medications (Diazepam)
- Medicines for fungal infections (ketoconazole)
- Medicines used for bacterial infections (Metronidazole)
- Medicines used to treat infertility (human chorionic gonadotropin hormone)
- Drugs used in the treatment of attention deficit and hyperactivity disorder (Amphetamines)
- Some antidepressant drugs (drugs belonging to the tricyclic group)
- Chemotherapeutic drugs (Alkalinizing agents, Methotrexate, Vinka alkaloids)
- Antiretroviral drugs used to treat AIDS
- Some antibiotics (Ethionamide, isoniazid)
- Substance use such as smoking
Herbal products:
The amount of estrogen contained in herbs found in cosmetic products such as shampoo, soap and lotion may cause gynecomastia. Particular attention should be paid to the use of herbs such as Dong quai, tea tree oil and lavender, which contain estrogen, and regular exposure should be avoided.
Health problems:
Some diseases can cause gynecomastia by disrupting the hormonal balance.
- Hyperthyroidism: Hyperthyroidism is the excessive secretion of thyroid hormone. Hormonal imbalance may cause gynecomastia.
- Renal failure: Gynecomastia is frequently seen in hemodialysis patients with renal failure.
- Tumors: Tumors can be seen in the testicles, adrenal and pituitary glands for various reasons. These tumors can cause gynecomastia by disrupting the production of testosterone and estrogen hormones. Just as tumors can cause gynecomastia, treatment methods such as chemotherapy and radiotherapy can also cause gynecomastia at a rate of 15%.
- Hypogonadism: Hypogonadism is a disorder caused by inadequate testicular functions in men. It occurs as a result of Klinefelter syndrome or hypothalamic abnormalities. This disease causes a decrease in testosterone hormone and triggers the formation of gynecomastia.
- Hermaphroditism: Hermaphroditism is the condition in which an individual has both female and male reproductive organs. In these people, estrogen secreted from the ovarian tissue causes gynecomastia.
- Cirrhosis: Gynecomastia is observed in 67% of cirrhosis patients. In patients, the conversion of increased androstenedione into estrogen in the adrenal glands or high doses of spironolactone used in the treatment of cirrhosis causes gynecomastia.
- Starvation: In a study conducted on soldiers captured after the Second World War, long-term hunger caused a decrease in gonadotropin and testosterone levels, while the development of gynecomastia was observed due to the continuation of normal estrogen production.
- Aging: With aging, testosterone production in the testicles decreases. These reasons may cause gynecomastia.
- Obesity: In men who are obese as a result of unbalanced and irregular nutrition, the body fat rate increases uncontrollably. Fat tissue is an active place where men can switch from testosterone to estrogen. This decrease in testosterone level causes gynecomastia.
How is gynecomastia treated?
Treatment is planned by investigating the source of gynecomastia formation. If the person is suspected of developing gynecomastia due to hormonal disorder, it is diagnosed and treated by an endocrinologist.
Nydick classification is used especially in gynecomastia that occurs during adolescence. In this classification, the size of the glandular tissue disc located under the brown ring (aerola) on the nipple is taken into account.
People whose diameter is less than 4 cm are checked with periodic examinations that will last 3-6 months, without any intervention.
Medical treatment is applied to patients with a diameter of 4-6 cm. Medical treatments applied vary depending on the patient’s age and hormone level.
For complaints that are larger than 6 cm in diameter and do not go away for a long time, it is necessary to perform surgical intervention on the patient. Gynecomastia surgery is the most effective and definitive treatment method.
The surgery is planned according to the type of gynecomastia. Liposuction may be sufficient for fatty type gynecomastia, where the mammary gland is soft and oily.
Mastectomy is performed in patients with hard and large gynecomastia. It is a technique in which mammary gland tissue is removed by applying small incisions.
Although surgical interventions are performed under general anesthesia, local anesthesia may also be preferred in some cases. The patient can be discharged on the same day after surgery. After surgery, patients must use a gynecomastia corset for 2-3 weeks. There may be slight pain after surgery. Avoiding heavy activities and not moving the arms and shoulders excessively for 3 days after the surgery will speed up the healing process. After the 3rd day, the patient can return to daily life and work.
Since gynecomastia is a hormonal disorder, it is not possible to prevent its formation. However, the risk of gynecomastia can be reduced by not smoking, eating healthily, and not using medications without the supervision of a doctor.
