Family Med-eZine TeamThursday, 21 Aug 2014, 05:41 pm

Gynaecomastia is the medical term used for an enlargement of the male breast tissue, a condition most commonly nicknamed as “man-boobs”. Although not a serious medical condition, it is embarrassing for both men and young boys and can even lead to emotional disturbances due to social sensitivity in some cases.

Enlarged breasts in men can be due to a number of reasons - both normal physiological as well as abnormal pathologic enlargement. Physiological enlargement is common in new born babies, during adolescence and in elderly men. Pathological causes are usually intake of some specific medication; tumours that upset the normal sex hormone balance or certain chronic diseases like liver cirrhosis, alcoholic liver disease, chronic kidney disease and kidney failure.

The enlarged breast tissue is actually glandular tissue in the area of one or both the breasts, resulting in the appearance of swollen or enlarged breasts and may be accompanied with pain. When both breasts are affected, there may be chances of an uneven enlargement on one side. Also, in some men, breast enlargement may be accompanied with discharge from the nipples.

Why does it occur?

The main cause of gynaecomastia is an imbalance in the level of the sex hormones – testosterone and oestrogen. When the levels of the male sex hormone testosterone become low (usually levels are high in men) and levels of the female sex hormone oestrogen become high (usually levels are low in men), it triggers the development of female traits in men, resulting in breast enlargement. 

GynaecomastiaIt can occur physiologically in new born babies, in adolescent boys and in aged men. New born male infants may develop enlarged breasts when their mother’s oestrogen is passed on to them. During puberty, fluctuating hormone levels can cause breast enlargement but this enlarged breast tissue is temporary, self-regressing in a few weeks and usually requires no treatment. During middle age – around the 50s, hormonal changes can strike again, as testosterone levels drop down with age, resulting in gynaecomastia. Additionally, certain conditions like testicular tumours, liver diseases, hyperthyroidism and Klinefelter’s syndrome affect the normal balance of hormones in the body causing gynaecomastia.

More often, enlarged male breasts can occur as a side effects of some drugs (steroids, drugs to treat prostate enlargement, heart medications, anti-anxiety drugs and anti-depressants), excessive alcohol and substance abuse and sometimes, even as an aftermath of a chronic illness.

Managing Gynaecomastia 

  • Gynaecomastia is not due to extra fat and hence losing weight by involving in vigorous physical exercises will not help get rid of it. 
  • Physiological Gynaecomastia in new born babies and adolescent boys can resolve itself within few weeks and requires no treatment. In adolescents, if it is not self-resolving or causing significant pain and embarrassment, it is best to consult the doctor.  
  • Certain medicines help restore the balance of hormone levels.
  • If the condition does not self-resolve the doctor may advise surgery, which may involve removal of fat in the breast tissue (liposuction) or removal of the breast glandular tissue (mastectomy)

Gynaecomastia and male breast cancer

Gynaecomastia in men is generally benign. Breast cancer in males is very rare, comprising about 1% of all breast cancer cases. Certain signs which can create suspicion of breast cancer in men include:

  • Longstanding breast enlargements (unilateral or bilateral)
  • Rapidly occurring growth
  • Hard/fixed/irregular growth
  • Pain
  • Skin changes around nipples

If some or all of these symptoms are noticed, it is prudent to get medical opinion, as soon as possible.