A friend, who is usually active in his social circle, was absent from it, for a month. When asked, he said that he was embarrassed to come out and meet people. After much coaxing, he told the reason…he had developed breast like a female. He was even ashamed to get a consultation for physician. This condition is called gynecomastia; and should be given a medical treatment rather than wrapping it up in shame and embarrassment.
When Breasts form in males
Gynecomastia is derived from two Greek words, “gyne” meaning woman and “mastos” meaning breast which together mean uncharacteristic enlargement of the breast tissue in men.
Gynecomastia is a medical condition in which men develop abnormally large breasts. This unusual phenomenon can occur either in one or both sides of the chest. Breast tissue is located just underneath the nipple and this condition can make breasts to become soft and tender. This condition is common among boys of adolescent age up to 90% which can disappear in a matter of months or as soon as the puberty period is over in a few years. For the remaining 10% of the men, the condition may become an issue of social handicap or shame causing deep embarrassment and anxiety.
There are many causes for men developing breasts. In men and women, the sex characteristics are controlled by testosterone and estrogen. Estrogen is responsible for female characteristics such as development of breasts. Men also produce estrogen but in small quantities. Estrogen in men is also responsible for the density of the bones, production of sperm and the mood. When estrogen level is out of balance and higher than that of testosterone, then it can cause gynecomastia in men. This balance between testosterone and estrogen can be disturbed by natural hormonal changes, medications and certain conditions of health. In 25% of the cases, the actual cause of gynecomastia cannot be found.
More than 50% of the male infants exhibit gynecomastia due to the effects of estrogen from the mother. But within few weeks of birth, the swollen breasts disappear.
Puberty is accompanied by changes in the hormones. These hormonal changes cause gynecomastia which eventually disappears within six months to two or three years.
Certain medicines which may cause gynecomastia include cyproterone, flutamide, finasteride and spironolactone used for the treatment of the enlargement of prostate or cancer and some other conditions; HIV positive men receiving highly active antiretroviral therapy (HAART);anti-anxiety medications such as diazepam; anti-depressants; antibiotics; anti-ulcer medications such as cimetidine; heart disease medicines such as digitalis used to slow the heart rate and calcium channel blockers, used to reduce the pressure in the arteries.
Illegal drugs such as anabolic steroids and androgens (tissue building and growth hormones), alcohol, amphetamines (psycho stimulant that produces increased wakefulness and decreased appetite), marijuana (grass, pot or weed used as psychoactive) and heroin (derivative of opium used as pain killer and for recreation) may also cause gynecomastia.
Various other health conditions that cause gynecomastia include hypogonadism (Decreased functional activity of testes), tumors of hormone secreting glands, liver diseases, and nutrition deprivation and malnutrition.
Diagnosing gynecomastia
The doctor may ask you about your medical condition, the medications you may be taking and other information. Subsequently the doctor may conduct physical exam of your breasts, abdomen and genitals to carefully evaluate your breast tissue or other underlying causes for your gynecomastia. The doctor may order for blood tests to check the levels of your hormones and any conditions that lead to any irregularity in the production of sex hormones. In addition, a Mammogram would be needed to check for abnormalities such as tumors or cancers in the breasts.
Depending on the outcome of the initial tests, you may require further specialized tests which may include:
- Chest X-Ray: To check for gynecomastia, cancer or any other problems of the breast.
- Computerized tomography (CT) scan (using two dimensional X-ray images to produce three dimensional images): Required to confirm cancers or tumors
- Magnetic resonance imaging (MRI) scan (non-invasive medical imaging technique): technique used to detect gynecomastia.
- Ultrasound examination of the testes: Using sound to detect any abnormality in the testes.
- Biopsy of the tissue: A sample of the tissue is taken to carefully examine for any abnormalities.
Treating gynecomastia
In most of the cases, the condition retreats and disappears over a period of time. Your doctor may check the size and condition of the breast every few months and in 90% of the cases the condition regresses to normal condition within three years.
If the gynecomastia is caused by certain underlying conditions such as liver cirrhosis, or malnutrition or hypogonadism, your doctor may prescribe medications to treat the condition. Once the underlying condition is treated, then gynecomastia may disappear. If gynecomastia is caused by taking certain medications, your doctor may advise to avoid those medications or may advise different medications. Accordingly, gynecomastia problem can be managed.
If the condition does not improve and causes embarrassment, your doctor may recommend following various options depending on the cause.
- Medications: Your doctor may recommend medicines such as tamoxifen or raloxifene. These can reduce gynecomastia in some men.
- Surgery: If there is significant improvement with medications and if the situation worsens, your doctor may recommend surgery to remove the enlarged breasts. Tow kind are surgery are available.
- Liposuction: In this surgery the fat is removed but the breast gland which may be causing the condition.
- Surgical removal (mastectomy): Breast gland (mammary gland) is removed surgically using less invasive procedure by which only small incisions are made and the recovery time is drastically shortened. If gynecomastia is due a tumor or some other condition, then necessary treatment may be rendered.
Managing gynecomastia
Gynecomastia can be uncomfortable, stressful and traumatic. It may be difficult to conceal and could hurt your romantic relationships. If you are still in your puberty, you can become the target of teasing besides making activities like swimming a nerve racking exercise and changing cloths in the dormitory or gym class can be really distressing. Irrespective of your age, you may feel as if your own body’s has betrayed you and you may not be happy to be yourself. Though these things are normal, there are a few things you can do to cope with the situation.
You can talk about the way you feel and share your anxiety with someone who is professional. If possible talk to a counselor. You can communicate with your partner and other family members and let them know about what you are going through and how you feel. You can join the groups of people who are suffering from the same situation like you. You can make online friends and this might help you to cope with the situation.
Gynecomastia at a glance
Gynecomastia is an abnormal enlargement of breast gland. If you are an adolescent, it may regress and disappear though it can take up to three years. If you are an adult, consult your doctor. There may be other underlying conditions such as liver cirrhosis, hypogonadism or you may be taking some medications which cause gynecomastia. If these conditions are treated then there is every chance for gynecomastia to revert. The situation is very embarrassing and can certainly be traumatic. You can successfully manage by seeking help from your relatives, friends or counselor and support groups.
