Male Gynecomastia; Causes, Effects And Treatment Options
What if a girl you just meet in your street asked you for a swim? Would you hide away because you are scared that she and the other people around would judge you for your Man Boobs?
Or would you take the plunge and get closer to her in a public place, showing your manly body that you are so ashamed of off? Don’t worry;this guide is dedicated to you, read very well.
Male Gynecomastia is the swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen (female) and testosterone(male).
Gynecomastia can affect one or both breasts, sometimes unevenly. Newborns, boys going through puberty and older men may develop gynecomastia as a result of normal changes in hormone levels, though other causes also exist.
Team leader, Dr. Brian I. Labow wrote “Merely having gynecomastia was sufficient to cause significant deficits in general health, social functioning, mental health, self-esteem, and eating behaviors and attitudes compared with controls.
Gynecomastia must be distinguished from pseudogynecomastia or lipomastia, which refers to the presence of fat deposits in the breast area of obese men.
This guide entails;
- Introduction to male gynecomastia/Meaning of male gynecomastia.
- Grades/types/classification/variations of male gynecomastia
- Causes of Gynecomastia
- Signs and Symptoms of Male Gynecomastia
- Conditions that cause similar symptoms or alike symptoms of male gynecomastia
- Epidemiology (how common is male gynecomastia)
- Diagnosis (how to diagnose male gynecomastia)
- Can male gynecomastia be prevented? (Prevention)
- Factors to control that may reduce the risk of gynecomastia
- Management of male gynecomastia
- Patient education (i.e. educating gynecomastia patient)
- When should I call/see the doctor about gynecomastia?
- Home care for gynecomastia
- What are the complications of gynecomastia?
- Physical and psychological effects of Male gynecomastia
- How to cope with gynecomastia (coping and support)
- Treatment options for gynecomastia
Gynecomastia is a benign enlargement of the male breast resulting from a proliferation of the glandular component of the breast.
Gynecomastia is defined clinically by the presence of a rubbery or firm mass extending concentrically from the nipples.
Although the condition is usually bilateral, it can be unilateral. The condition known as pseudogynecomastia, or lipomastia, is characterized by fat deposition without glandular proliferation.
Grades/types/classification/variations of male gynecomastia
Depending on its origin, gynecomastia is classified as:
- Pubertal Gynecomastia
It’s a physiological process that occurs at puberty (age 12-17) when the intense hormonal production causes an excessive development of mammary glands.
This phenomenon generally subsides within a couple of years. Read more about gynecomastia in puberty.
- Congenital Gynecomastia
The primary cause is the altered hormonal balance which can have familiar connotation (inheritance)
- Induced Gynecomastia
In these cases, taking certain medications that could affect the natural hormone function is more likely what caused the development of man boobs
Depending on the characteristics of gynecomastia, it can be classified into:
- Real Gynecomastia: the increase in breast volume is caused by the increase of the glandular component,
- False Gynecomastia: the increase in breast volume is caused by the fatty tissue in the breast area (pseudogynecomastia),
- Mixed Gynecomastia: the increase in breast volume is caused by the interaction of the two factors described above.
Causes of Gynecomastia
Gynecomastia is triggered by a decrease in the amount of the hormone testosterone in your body compared with the estrogen.
The cause of this decrease can be the conditions that block the effects of or reduce testosterone or a condition that increases your estrogen level.
Several things can upset the hormone balance, including the following:
- Natural hormone changes
The hormones testosterone and estrogen control the development and maintenance of sex characteristics in both men and women.
Testosterone controls your traits, such as muscle mass and body hair. Estrogen controls female traits, including the growth of breasts.
You might think that estrogen is as an exclusively female hormone, but you also produce in small quantities.
However, when your estrogen levels are too high or are out of balance with testosterone levels, it can cause gynecomastia.
Gynecomastia in male infants:More than half of male infants are born with enlarged breasts due to the effects of their mother’s estrogen. Generally, the swollen breast tissue goes away within two to three weeks after birth.
Gynecomastia during puberty: Gynecomastia caused by hormone changes during puberty is relatively common.
In most cases, the swollen breast tissue will go away without treatment within six months to two years.
Gynecomastia in men: The prevalence of gynecomastia peaks again between the ages of 50 and 80. At least 1 in 4 men in this age group are affected.
- Street drugs and alcohol
Substances that can cause gynecomastia include:
- Chronic Diseases
If you have one of the chronic diseases you are at risk of developing gynecomastia. Kidney failure as a result of malnourishment in you causes hormonal imbalances.
This occurs when there’s damage in your testicles and suppressed testosterone production due to high urea levels, known as hypogonadism associated with uremia.
If you are also afflicted with cirrhosis or liver failure, you are susceptible to develop gynecomastia. This occurs when your liver is unable to metabolize estrogen and it is impaired.
Additionally, if you are alcohol addicted, it is certain you have gynecomastia because the ethanol disrupts testosterone synthesis.
The presence of tumors – like Sertoli cell tumors or Leydig cell tumors — in your testicles could result in development of gynecomastia.
Other tumors which could alter the balance of the estrogen-testosterone ratio to cause or trigger your gynecomastia include pituitary gland tumors like prolactinoma, bronchogenic carcinoma, and adrenocortical tumors.
If you are a prostate cancer patient and you were treated with therapy using androgen deprivation, there’s an onset of you experiencing gynecomastia.
Age can be a factor and overweight males are at a higher risk to develop gynecomastia. As you are getting older, there is decline in testosterone production which can increase the accumulation of subcutaneous fatty tissue.
Developing man breasts is typical among males above fifty years of age, especially if you are genetically predisposed to retained fats in certain areas of the body such as buttocks, stomach, and chest.
Hyperthyroidism is a two words joined together, hyper means too much or higher while thyroidism is thyroxine which is hormone.
This occur when your thyroid gland produces too much of the hormone thyroxine.
- Malnutrition and starvation.
When your body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance. Gynecomastia can also occur once you don’t eat consistently.
If you are overweight, you are likely to develop enlarged breasts due to significant fat build-up in the chest as well as stomach area. Reducing foods that contain produce fats in your body really works a lot.
- Hormone Infused Poultry
Many poultry products such as eggs and chickens these days are loaded with hormones, which can cause breast enlargement in you as well as women.
These growth hormones inadvertently facilitate cell division, which can cause not only enlargement but the development of cancer as well.
- Herbal products
Plant oils, such as tea tree or lavender, used in shampoos, soaps or lotions have been associated with gynecomastia. This is probably due to their weak estrogenic activity.
This is where it got interesting. Some cases of gynecomastia are attributed to the use of medications, resulting in gynecomastia which is non-physiologic.
Don’t be intimidated by the names, you can always look up the names online to see if you’re on one or two of these. A number of medications can cause gynecomastia. These include:
Use of Anabolic Steroids – regular and/or prolonged use of steroids, whether you use it for the purpose of body building or otherwise, it inhibits the production of testosterone, which leads to the increase in breast tissue size.
Anti-androgens used to treat prostate enlargement, prostate cancer and some other conditions. Examples include flutamide, finasteride and spironolactone (Aldactone).
AIDS medications: You can develop gynecomastia as a HIV Patient when you are treated with regimen called highly active antiretroviral therapy (HAART).
Efavirenz (Sustiva) is more commonly associated with gynecomastia than are other HIV medications.
Other medications that cause gynecomastia are;
- Anti-anxiety medications, such as Valium.
- Tricyclic antidepressants.
- Ulcer medications, such as cimetidine (Tagamet).
- Cancer treatment (chemotherapy).
- Heartmedications, such as digoxin (Lanoxin) and calcium channel blockers.
The condition may occur in one or both breasts. It begins as a small lump beneath the nipple, which may be tender. One breast may be larger than the other.
Enlarged breasts in males are usually harmless, but may cause embarrassment for some men.
Some newborns may have breast development along with a milky discharge (galactorrhea). This condition usually lasts for a couple of weeks, but in rare cases may last until the child is 2 years old.
Signs and Symptoms of Male Gynecomastia
- Visible Enlargement of Breasts
The most obvious sign of male gynecomastia is the enlargement of your breast, with firm subcutaneous tissue in the chest which extends outward from the nipple’s areola.
Such enlargement typically occurs either only on one or both sides; this condition may be cause for anxiety, stress or panic for you to think that is breast cancer.
Naturally, your breast should be flat (especially the nipples) and devoid of flesh. In the case of male gynecomastia, the breasts become soft, supple, and full.
They are quite apparent even when wearing clothes, which is what makes the condition rather embarrassing.
- Distended Nipples and Puffy Areola
Normal male breasts are made of flat nipples and areolas. Gynecomastia causes your nipples to become raised and distended while the areolas tend to become larger and puffier (there is some discoloration as well).
In short, they start to resemble female (functional) breasts.
Conditions that cause similar symptoms or alike symptoms of male gynecomastia
When you discover that your breast swelled up, it does not mean you have gynecomastia there are other conditions that can cause similar symptoms. It includes:
- Fatty breast tissue. Some men and boys have chest fat that resembles gynecomastia. This is called false gynecomastia (pseudogynecomastia), and it isn’t the same as gynecomastia.
- Breast cancer. This is uncommon in men, but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.
- A breast abscess (mastitis). This is an infection of the breast tissue.
Epidemiology (how common is male gynecomastia)
Gynecomastia is the most common reason for male breast evaluation. The condition is common in infancy and adolescence, as well as in middle-aged to older adult males.
One estimate is that 60-90% of infants have transient gynecomastia due to the high estrogen state of pregnancy.
In older men, enlargement of the breast tissue happens in about one-third of men, who often have excess surrounding fatty tissue as well.
Gynecomastia is common and is thought to be present in at least a third of men in the course of their lifetime.
Diagnosis (how to diagnose male gynecomastia)
Patients with physiologic gynecomastia do not require further evaluation.
Similarly, asymptomatic and pubertal gynecomastia do not require further tests and should be reevaluated in 6 months. Further evaluation is necessary in the following situations:
- Breast size greater than 5 cm (macromastia)
- A lump that is tender, of recent onset, progressive, or of unknown duration
- Signs of malignancy (e.g., hard or fixed lymph nodes or positive lymph node findings)
Laboratory tests that may be considered include the following:
- Serum chemistry panel
- Free or total testosterone, luteinizing hormone (LH), estradiol, and dehydroepiandrosterone sulfate levels
- Thyroid-stimulating hormone (TSH) and free thyroxine levels
Imaging studies that may be helpful include the following:
- Mammography: Indicated if one or more features of breast cancer are apparent upon clinical examination, followed by fine-needle aspiration or breast biopsy as appropriate.
- Testicular ultrasonography: Indicated if the serum estradiol level is elevated and the clinical examination findings suggest the possibility of a testicular neoplasm.
- Breast ultra sonography (though the positive predictive value of imaging in males is low.
Gynecomastia is not physically harmful, but in some cases it may be an indicator of other more serious underlying conditions, such as testicular cancer.
The glandular tissue typically grows under the influence of hormonal stimulation and is often tender or painful.
Furthermore, gynecomastia frequently presents social and psychological difficulties such as low self-esteem or shame for the sufferer.
Weight loss can alter the condition in cases triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss.
Massive weight loss can result in sagging chest tissue known as chest ptosis.
Other than the associated risk of breast cancer, gynecomastia does not cause any long-term complications.
In approximately 90% of cases, pubertal gynecomastia resolves within a period of months to several years. However, macromastia seldom resolves completely and often requires surgery.
Gynecomastia that occurs secondary to an underlying, treatable cause (eg, drug-induced gynecomastia) usually responds to treatment or removal of the primary cause.
Men with Klinefelter syndrome have a 10- to 20-fold increased risk for breast cancer.
Research has indicated that the psychological effects of gynecomastia can include depression, anxiety, disordered eating, body dissatisfaction, and reduced self-esteem
Can male gynecomastia be prevented? (Prevention)
To prevent man boobs it’s a good idea to follow these rules:
- Do not exceed with the consumption of meat and always make sure where it came from (in some non-North American and non-EU countries, quality controls may be poor).
- Remove visible fat because the toxic substances accumulate mainly in the animal adipose tissue.
- Maintain a high-fiber intake (consume plenty of fruits and vegetables), since the non-edible plant residues are able to reduce the excess of estrogen in the body.
- Follow a regular program of physical activity, in many cases (see false gynecomastia), this disorder is caused by the simple increase of localized fat in the breast area and the concomitant relaxation of the pectoral muscle.
- Keep your body weight under control : in obese subjects testosterone levels are greatly reduced, and the estrogen levels increase instead
Factors to control that may reduce the risk of gynecomastia
There are factors that make you to have gynecomastia, controlling this factor will help you;
- Don’t use illegal drugs. Examples include steroids and androgens, amphetamines, heroin, and marijuana.
- Avoid alcohol. Don’t drink alcohol, or drink in moderation.
- Review your medications. If you’re taking medication known to cause gynecomastia, ask your doctor if there are other choices.
General management considerations are as follows:
- As a rule, no treatment is required for physiologic gynecomastia
- Pubertal gynecomastia resolves spontaneously within several weeks to 3 years in most patients; breasts larger than 4 cm in diameter may not regress completely.
- Identifying and managing an underlying primary disorder often alleviates breast enlargement.
- For patients with idiopathic gynecomastia or with residual gynecomastia after treatment of the primary cause, medical or surgical treatment may be considered.
- If medical therapies are used, they should be tried early in the condition’s course
Patient education (i.e. educating gynecomastia patient)
Reassure patients with physiologic gynecomastia regarding the benign nature of their condition, and inform them that most cases spontaneously resolve.
Counsel patients regarding the various treatment modalities available for gynecomastia, and highlight the risks, adverse effects, success rates, and benefits of each modality
When should I call/see the doctor about gynecomastia?
Apart from the above-mentioned physical symptoms, severe emotional stress is a cause for concern, which justifies a trip to your doctor.
The psychological effects of male gynecomastia can be far more damaging than the physical ones, and they should be addressed properly.
Once it has been determined that the enlargement is not of any significant threat to your health, it is time to explore a number of options on how to treat the condition.See your doctor if you have:
- Nipple discharge in one or both breasts
Home to care for gynecomastia
Apply cold compresses and use pain relievers as your health care provider recommends if swollen breasts are also tender.
Other tips include:
- Stop taking all recreational drugs, such as marijuana
- Stop taking all nutritional supplements or any drugs you are taking for bodybuilding.
What are the complications of gyno?
Gynecomastia has few physical complications, but it can cause psychological or emotional problems caused by appearance.
Physical and psychological effects of Male gynecomastia
The main problem you have with male gynecomastia is how you think about it, you felt depressed among people.
You can’t do what other people are doing because they will notice your breast disorder (gynecomastia). It has these effects on you;
- Limited Physical Activities
Men are generally used to carrying significant load in their chests, so having enlarged breasts would certainly limit your hamper movements to a certain degree.
Certain types of exercises will become difficult, if not impossible; to perform such as running/jogging, curl-ups, jumping jacks, and pretty much everything else that requires running and/or jumping up and down.
- Depression, Anxiety, and Overall Emotional Distress
While enlarged male breasts are not necessarily life threatening, it can be quite disconcerting especially since large breasts are a predominantly female attribute.
Suffering from this condition can make you feel emasculated and extremely conscious of your appearance.
In severe cases, affected males start covering up their chest area by wearing thick layers of clothing (regardless of the prevailing weather) in order to steer people’s attention away from their breasts.
The embarrassment over your physical appearance can extend to your overall social behavior, which usually starts with avoiding people, especially the opposite sex.
Since having enlarged breasts is attributed to feeling less of a man, it can cause one’s self-esteem and confidence to plummet.
Dating, or even being around women in general, becomes more of a chore for you.
How to cope with gynecomastia (coping and support)
Whatever your age, you may feel like your body has betrayed you and you may feel unhappy with yourself.
Enlarged breasts can be stressful and embarrassing. Gynecomastia can be difficult to hide and a challenge to romantic relationships.
During puberty, gynecomastia can make boys a target for teasing from peers. It can make activities such as swimming or changing in the locker room traumatic.
These feelings are normal, but to help you cope. Consider these;
- Get counseling:
Talk therapy can help you avoid anxiety and depression caused by gynecomastia.
It can also help you communicate with your partner or family members so that they understand what you’re going through.
- Reach out to your family and friends
You may feel embarrassed to talk about gynecomastia with the people you care about. But explaining your situation and asking for help will likely strengthen your relationships and reduce stress.
- Connect with others who have gynecomastia.
Talking with men who have had a similar experience can help you cope. There are few credible websites that provide a forum for connecting with others who have the condition.
Treatment options for gynecomastia
Gynecomastia can be treated in many ways; it depends on which one you choose. But is better to choose the easiest, cheapest and effective treatment. The treatments are;
If you don’t mind going through the pain of knife cut, consider surgery as a quick and long term solution for enlarged breasts.
The procedure is quite simple, as the surgeon simply removes the excess flesh and fat (Mammoplasty).
However,since this option is costly and not without risks, it is often the last resort for most men.
- Topical Solutions
There are creams sold online as well as some pharmacies that are formulated to target and remove excess fat on the breasts.
These solutions are quite affordable but are often unreliable so you cannot always count on excellent results.
- Natural Supplements/Pills
Since hormonal imbalance is the usual proximal cause of Gynecomastia, there are a number of natural supplements that are specifically formulated to correct it.
There are certain natural pills sold online that offer effective breast reduction for men without any serious side effects.
- Food/diet as a treatment.
There are specific food items that can either help or worsen your man boobs. See below the list of food you should eat and the ones you should not.
Foods That You Should Eat: These foods are known to be rich in zinc which can help in increasing testosterone levels. Testosterone is known to help in muscle building and reduction of fat levels.
This will just provide you with a list of foods that you need to eat more and it does not mean you can eat these foods abusively.
They are: dark chocolate, watermelon seeds, shrimp, crab, beef liver, egg yolks, lobster, turkey, peanuts, brown rice, squash seeds, salmon, lean beef, lima beans, and spinach..
Foods That You Should Not Eat:This list below just give you an idea which food to eat in moderation.
These food items are in the list because these have natural amount of estrogen which can defeat the body’s fat burning ability and Remember that these should not be completely eradicated in your diet.
They include:apples, carrots, barley, oats, red beans, rice, tomatoes, soybeans, cherries, chickpeas, olive oil, eggplant, dates, eggs, cucumbers, parsley, peppers, potatoes, wheat, yams, plums, and pumpkin.
- Exercise as a treatment to male gynecomastia
You can get rid of your breast (gynecomastia) by sculpting your chest muscles with strength training and getting cardiovascular exercise. These exercises include;
- Push-ups: One of the most effective ways to sculpt your chest muscles is by doing push-ups and variations of them.
Push-ups target your chest muscles and the smaller muscles around your chest area. In addition, they can help build back and abdominal muscles, which can help you slim down overall.
Procedure for push-ups: Get into a plank pose. Keep your arms straight and your hands slightly wider than your shoulders.
Bend at your elbows and lower your body until your chest nearly touches the floor. Remember to keep your abs and leg muscles engaged.
Try half-plank, or knee, push-ups if you are unable to do push-ups in a plank position.
To do this, start on your hands and knees instead of the plank position, then adjust so that your head, torso, and knees are all in a straight line.
Aim to get your groin, chest, and chin to touch the ground at approximately the same time. Your hips should not bend.
- Perform presses:Pressing any amount of weight up from your chest can also help to strengthen your chest muscles.
From chest presses to bench presses, doing a variety of these exercises can help you define chest muscles which can reduce your breast
Procedure for presses: Lie on your back on a bench with a weighted bar or dumbbells to do chest presses. Hold the weight at your lower ribs, bend your elbows, and press up until your arms are straight.
Stay at the top for one second and then slowly lower your arms back to your original position. Start with 5 lbs. (2.3 5kg) and work up to more weight once your form is good and you can safely finish three sets of 10 repetitions at the current weight.
This allows not just the muscles but also the connective tissues in your shoulders, elbows and wrists to strengthen and support more weight.
Try different presses every three to four weeks to challenge your muscles.
- Complete flyes. Pulling your arms together, which is called a flye (or fly), is another great way to sculpt your chest muscles to avoid or reduce gynecomastia.
Procedure for flyes: Lie on your back or stand at a slight incline. Use two 5 lb. (2.3 kg) weights and hold one in each hand, arms extended straight above your chest with your palms facing each other.
Slowly open your arms wide, as though spreading your wings. Then slowly bring your arms back up.
You can perform flyes using a resistance band, too. Stand and anchor the band at about hip-height (try wrapping it around a column or door handle), holding one end in each hand.
Start with your arms open, then bring your hands together in front of your chest, then slowly open again.
Vary your flye routine every three to four weeks to challenge your chest muscles which eliminate any kind of man boobs.
Lastly Choose activities that challenge your body and that you enjoy. It may take a little trial and error to find what works and what you like.
Consider activities such as walking, jogging or running, rowing, swimming, or biking. You can also use machines such as an elliptical, stair trainer, or rowing machine.
Keep in mind that team sports, running outside with your kids, or even activities like jumping rope or on a trampoline count towards your weekly exercise.
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