Gynecomastia: What It Is, Causes, Diagnosis, and Treatment
Gynecomastia is the benign hyperplasia of glandular tissue in the male breast, associated with an imbalance between estrogen and androgens, usually with a relative decrease in testosterone activity. It can affect one or both breasts, often in an asymmetrical manner.
The Gynecomastia occurs naturally in newborns, adolescents, and older men. Although not a serious medical condition, it can cause psychological discomfort, pain, or tenderness in the breast area.
What Are the Symptoms of Gynecomastia?
Main symptoms include:
- Swelling under the nipple, often with a soft or spongy mass feel.
- Pain or tenderness, especially when clothing contacts the area.
- In some cases, secretion fluid from the nipple.
These symptoms often raise concern, but gynecomastia is usually benign.
What Causes Gynecomastia?
The Gynecomastia may result from:
- Normal hormonal changes:
- Over 50% of newborns due to maternal estrogens (resolves in 2-3 weeks).
- During adolescence (lasting 6 months to 2 years).
- In men aged 50-69 years (up to 65% prevalence).
- Medications:
More than 300 medicines have been associated with gynecomastia, such as:
- Antiandrogens for prostate conditions.
- Antiretrovirals for AIDS.
- Antidepressants and anxiolytics (e.g., diazepam).
- Anabolic steroids.
- Cardiac drugs (e.g., digoxin).
Gynecomastia usually resolves 4-6 months after stopping causative drugs.
- Illicit substances:
- Alcohol
- Cannabis
- Heroin
- Methadone
- Amphetamines
- Medical conditions:
- Hyperthyroidism
- Liver cirrhosis.
- Kidney/liver failure.
- Tumors affecting hormone balance (testicular, adrenal, pituitary).
- Hypogonadism
- Idiopathic gynecomastia:
No clear cause in about 25% of cases
How Is Gynecomastia Diagnosed?
Diagnosis is based on:
- Medical history and clinical examination.
- Blood tests (hormonal profile).
- Imaging tests such as breast ultrasound, mammography, abdominal CT scan, or brain MRI
- Scrotal ultrasound, if deemed necessary
- Breast biopsy, in selected cases, to rule out malignancy.
Diagnosis helps determine if the swelling is due to: Gynecomastia, adipose tissue or rarer conditions such as male breast cancer. The distinction between gynecomastia and pseudogynecomastia (adipose tissue without glandular hyperplasia) is important for guiding treatment.
How Is Gynecomastia Treated?
In most cases, the Gynecomastia goes away automatically within 6-24 months without treatment.
Depending on cause and severity:
- Follow-up every 3-6 months during adolescence.
- Discontinuation or substitution of causative medications.
- Treatment of underlying conditions.
In cases where gynecomastia causes severe pain or psychological burden, may need:
- Hormone therapy with selective estrogen receptor modulators (SERMs), such as tamoxifen, has been shown to be effective in selected cases, although there is no official indication from most regulatory agencies.
- Surgery to remove the swollen tissue (usually through a small incision and/or liposuction).
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