Gynecomastia: A Comprehensive Guide
Gynecomastia, or male breast tissue, is a common condition in boys and men. Although the breast tissue itself is usually harmless, it can be a sign of another medical disorder, and it can be an embarrassing and frustrating issue. Fortunately, there are several ways to get rid of male breast tissue. If you struggle with this problem, you should understand what exactly the condition is, why it occurs, and what you can do to treat it.
What Is Gynecomastia?
Gynecomastia, also known as man boobs or man breasts, is the swelling or enlargement of breast tissue in men. It is typically caused by an imbalance of hormones, and it can last anywhere from months to years before going away.
Signs and Symptoms of Male Breasts
The main sign of the condition is enlarged breast tissue. This may start as a small lump of tissue under the nipple, but it can grow over time. Some people also experience rubbery or firm nipples, sensitivity, and tenderness. However, in most cases, the breast tissue is the only symptom, and the condition is completely painless. It's important to understand the difference between pseudogynecomastia and the true form of the condition. True gynecomastia is caused by enlarged glandular tissue, and pseudogynecomastia is caused by an excess of fat tissue in the breast area. The two conditions may look the same, but they have different underlying causes and treatments.
Causes Attributed to Gynecomastia
The condition is typically caused by a hormonal imbalance. The hormone testosterone is responsible for male traits, and the hormone estrogen is responsible for female traits. Men usually have higher levels of testosterone, and women have higher levels of estrogen. However, an imbalance in either of these hormones can cause men to develop female traits and women to develop male traits. All men have a small amount of breast tissue, but when men experience higher-than-normal levels of estrogen, it can cause their breast tissue to become larger and more noticeable. There are certain times across the lifespan where it's normal and natural for men to develop some breast tissue. This is known as physiologic gynecomastia, and it accounts for about 25 percent of all cases of the condition. The following are the three most common times for boys and men to develop breasts: After birth: Newborns receive estrogen from their mothers while they're in the womb, which can cause female traits shortly after birth. The majority of newborn boys have enlarged breast tissue, but it usually goes away within a few weeks. During puberty: Hormone levels can change drastically during puberty, which typically occurs in boys between 12 and 14 years old. For some boys, these hormonal imbalances can cause male breasts. At this age, breast tissue should go away within two years of starting puberty. Later in life: At least 25 percent of men between the ages of 50 and 80 have breast enlargement. It's common to experience a mild case of gynecomastia at this point in the lifespan.
Health Issues Attributed to Gynecomastia
Although there are times when it's normal and even expected for men to develop some breast tissue, the condition can also occur as a symptom of a different health problem. This is known as nonphysiologic gynecomastia. The following are some of the most common causes of nonphysiologic male breasts: Obesity: Studies have found a correlation between BMI and male breast tissue. Being overweight or obese could cause enlarged breast tissue even if you don't have a hormonal problem. If you have excess fat across your body, some of it may be dispersed around your chest, making it look like you have breasts. Obesity can also cause increased levels of estrogen, which can further enlarge your breast tissue. Tumors: Testicular tumors are rare, but about 10 percent of men with testicular tumors experience breast tissue as their only symptom. In one study, 3 percent of men who visited a surgeon to reduce breast tissue were diagnosed with a testicular tumor. Adrenal tumors can also cause male breasts because they can secrete estrogen, disrupting the balance of estrogen and testosterone. Hyperthyroidism: Between 10 and 40 percent of men with hyperthyroidism have breast tissue. Studies have found that restoring normal function to the thyroid can cause the breast tissue to recede within two months. Hypoandrogenism: Also known as androgen deficiency, hypoandrogenism is a lack of sufficient androgenic activity. Androgens are hormones that regulate and maintain male characteristics. If your body doesn't produce enough androgens, you may experience a wide variety of symptoms, including the development of breast tissue. The main cause of hypoandrogenism is dysfunction or failure of the gonads. Kidney failure: It's common for men with kidney failure to develop breast tissue because the condition can cause testicular damage and suppress testosterone production. Malnutrition is common during kidney failure, too, which may play a role in the development of breast tissue. Liver disease: Damage to the liver can lead to an increase in estrogen in men. Liver damage caused by alcohol abuse is particularly likely to cause breast tissue growth because alcohol also inhibits testosterone production.
Medication or drug side effects
Medicine and substance use accounts for 10 to 25 percent of all cases of male breasts. The following are some medications that have been linked to male breast tissue:
- Prostate cancer drugs
Alcohol and illicit drugs can also cause male breast tissue to develop. In most cases, discontinuing the use of the drug or medication causes the breast tissue to go away within three months. About 25 percent of cases are idiopathic, which means they occur for no known reason.
Effects of Gynecomastia
Gynecomastia is usually a physically harmless issue. If you have an underlying condition causing the breast tissue, you may experience discomfort or other side effects. However, male breast tissue itself is typically painless. This does not mean it isn't a problem, though. Male breasts can be a serious psychological struggle. One study found that even mild cases of male breast tissue had negative psychological effects on adolescent boys. The study's participants scored lower on a quality of life assessment and had lower scores for mental health, self-esteem, and social functioning than boys without breast tissue. It's common for adolescent boys with breast tissue to feel embarrassed or ashamed of the problem, which can cause them to withdraw socially. This is a problem for adult males with breast tissue as well. A literature review identified the following problems associated with male breast tissue:
- Perceived stigma
In one survey, 43 percent of men interviewed said developing male breast tissue would make them question their masculinity. Because breasts are typically a female trait, many men feel like they have lost their masculinity when they develop breast tissue. Also, although it's a fairly common problem, many people don't realize how many others have struggled with it. This causes people to feel isolated or alienated. Even if you have breast tissue that doesn't cause physical pain, it can be a psychologically difficult experience. To restore both your physical and mental health, you should speak to your doctor about the issue.
Although it's normal for male breast tissue to develop at some points in the lifespan or as a symptom of another medical condition, you should speak to your doctor if the problem lasts for more than a couple months. It may be a sign of another medical problem, and your doctor probably has suggestions for treating and managing it. Your doctor will probably start by checking your medical history and performing a general physical exam. This should rule out other possible conditions that may be causing the breast tissue, including pseudogynecomastia, breast cancer, lipoma, or a sebaceous cyst. It's usually easy for doctors to diagnose gynecomastia because it is a visible condition. However, your doctor may be concerned about the underlying cause of the breast tissue. It may be a symptom of a more serious problem, so your doctor may request some of the following tests:
- Breast ultrasound
- Blood test
- CT scan
- MRI scan
- Testicular ultrasound
- Tissue biopsy
Once your doctor diagnoses the condition and determines the underlying cause, you can start treatment to reduce the breast tissue.
How to Get Rid of Gynecomastia
The best treatment for male breast tissue depends on your age, the severity of the problem, and whether you have an underlying medical condition. If you've only recently developed breast tissue, your doctor may suggest that you wait a couple months to see if it recedes on its own. If it doesn't go away, there are a variety of treatments you can try that may help get rid of the breast tissue.
Treating the Underlying Cause
If your doctor discovers that your breast tissue has developed because of another medical problem, the first step should be to seek treatment for that issue. In most cases, treating the condition responsible for the breast tissue will cause the tissue to go away within a few months.
Doctors sometimes prescribe medications to reduce male breast tissue. No medicines have been approved by the FDA for gynecomastia treatment, but the following drugs have been used successfully:
- Clomiphene: an anti-estrogen medication that can be taken for six months
- Tamoxifen: a selective estrogen receptor modulator that can reduce breast volume
- Danazol: a synthetic testosterone that decreases estrogen production
Testosterone replacement therapy can also be effective for older men who have low levels of testosterone, but it is not a helpful treatment for men who have normal testosterone levels.
Gynecomastia surgery is usually used as a last resort to treat severe or long-lasting breast tissue. The tissue can scar after 12 months, which makes it difficult to treat with medication. In these cases, doctors may recommend surgery. Reduction mammoplasty is the surgical procedure to eliminate male breast tissue. During the surgery, your doctor will use excision techniques to remove the glandular tissue. If you also have excess fat in the area, your doctor will use liposuction techniques to remove the fat and flatten your chest. Recovery from gynecomastia surgery is relatively easy, but it's important to give your body plenty of time to heal. Most people return to work after one week, but if you work a physically demanding job, you should wait longer. You may have to wear a compression garment for a few days to help with swelling. Your doctor may prescribe pain medication while the incisions heal. It can take several months to a year for your body to fully heal and for the effects of the surgery to be noticeable. According to the American Society of Plastic Surgeons, the average gynecomastia surgery cost is $3,978. This is only the cost of the surgery itself, though. The total cost, including anesthesia and operating room fees, can add up to over $5,000. Unfortunately, most insurance companies consider gynecomastia surgery to be a cosmetic procedure, so they do not offer coverage.
Surgeries, medications, and other medical treatments can be highly effective in reducing male breast tissue, but they can be expensive and invasive. Compression garments are an easier solution for cases that don't require medical intervention. Although the garments don't actually remove the breast tissue, they reduce the appearance of man boobs, which can help you feel much more comfortable and confident. One of the most popular garments is a gynecomastia compression shirt, which looks like a regular T-shirt or tank top but slims down the chest and hides extra fat and glandular tissue. You can also wear a gynecomastia compression vest underneath your normal clothes to help your shirts look better and fit more comfortably.
If you have enlarged or puffy nipples, another option is to use nipple covers to prevent them from showing through your shirt. You can either use these separately or put them on underneath a gynecomastia shirt. Compression garments are a popular solution because you don't have to wait for them to work. Medications and surgery can take months to be effective, and you may have to try a few treatments before you find the one that's truly effective. Once you own a compression garment, the appearance of man boobs will go away immediately.
Counseling and Psychological Support
Many men struggle with feelings of embarrassment and isolation as a result of male breast tissue. Even if you're treating the problem physically by taking medication, undergoing surgery, or using compression garments, you should still make sure to take care of your mental health. If you experience low self-esteem or feelings of shame because of your breast tissue, you should speak to a counselor. These issues can lead to severe problems with anxiety and depression, so it's important to keep your mental health in check. It can also be helpful to reach out to other people who have been through the same problem. There are several online forums and communities for men with gynecomastia where you can share advice and empathize with others with similar experiences. Male breast tissue may go away on its own, but you don't have to wait it out. There are several treatment options available for mild to severe breast tissue. However, not every treatment is right for everyone, so you should consult your doctor before choosing a solution. With the help of your doctor, you should be able to get the breast tissue under control within a couple of months at most, so you can go back to feeling comfortable and confident.