Gynecomastia is the name given to abnormal but benign growth increasing the amount of breast tissue in men due to an imbalance between the estrogen and the testosterone hormones. Gynecomastia can affect one breast in some cases and both breasts in some cases. Both breasts can be affected irregularly and reach different sizes appearing asymmetrical.

Newborns, teenage boys, and older men can develop gynecomastia as a result of normal changes in hormone levels. However, there are other causes of gynecomastia.

Gynecomastia is not a serious problem in many cases, but coping with this condition can be difficult for individuals. It has been observed that men with gynecomastia feel pain in their breasts. In some cases, it can be seen that the individual feels ashamed of the situation leading to self-esteem issues.

Depending on the cause of gynecomastia, it may heal spontaneously in some patients, and in some patients, drug treatment or surgery may be required to solve this problem.

What Causes Gynecomastia?

Gynecomastia is often caused by fluctuations in the level of the hormone testosterone. The decrease in the amount of testosterone hormone can be caused by conditions that block the effects of testosterone in the individual, reduce testosterone or increase estrogen levels.

Hormone balance in the body can be disturbed for many different reasons. Causes of gynecomastia include natural hormone changes, medications, drug and alcohol abuse, complications from various health conditions, and the use of certain herbal products and supplements.

The hormones testosterone and estrogen control sex characteristics in both men and women. Testosterone controls masculine traits such as muscle mass and body hair, while estrogen controls feminine traits, including the growth of breasts.

Even though estrogen is defined as a female hormone, it is produced in very small amounts in men under normal conditions. Too much estrogen production above normal limits, or estrogen production in an unbalanced ratio with the testosterone level can cause gynecomastia.

Male babies can be born with enlarged breasts due to the effect of estrogen coming from their mother's body before birth during developmental period in mother’s womb. This swollen breast tissue disappears within two to three weeks after birth in most cases.

The occurrence of gynecomastia is relatively common during adolescence due to constantly changing hormone levels. Most cases of gynecomastia seen in adolescence, disappears without treatment.

The prevalence of gynecomastia in adults starts to rise again between the ages of 50-69. Studies indicate that at least one out of every four men in this age group shows signs of gynecomastia.

Some types of drugs can cause gynecomastia. These drugs primarily include anti-androgens, which are used to treat enlarged prostate, prostate cancer, and other similar conditions.

Anabolic steroids and androgens that are prescribed by doctors for certain conditions or sometimes used illegally by athletes to increase muscle mass or improve performance in competition can also cause gynecomastia.

There are publications reporting that some antidepressants and heart medications also cause gynecomastia.

In addition to amphetamines, which are normally used to treat attention deficit or hyperactivity disorder, drugs such as heroin, cannabis, and excessive alcohol production can also cause gynecomastia.

Some health problems can cause gynecomastia by affecting the body's normal hormone balance. For example, conditions that affect normal testosterone production and lead to hypogonadism, such as Klinefelter syndrome or pituitary insufficiency, may be associated with gynecomastia.

Hormonal changes that occur with normal aging can also cause gynecomastia, especially in overweight men.

Some tumors that affect the testicles, adrenal glands, or pituitary gland can affect hormone production, altering the male-female hormone balance and leading to gynecomastia.

About half of individuals undergoing dialysis treatment for kidney failure may develop gynecomastia due to hormonal changes.

Various liver problems and cirrhosis medications can cause gynecomastia by causing changes in hormone levels.

Malnutrition and starvation can cause gynecomastia because when the human body is deprived of adequate nutrition, testosterone levels drop while estrogen levels stay the same. This causes hormonal imbalance. Even if gynecomastia does not start during this period, it may also occur when normal nutrition starts again.

Complications That May Occur With Gynecomastia

The physical complications of gynecomastia are limited, but it can cause psychological or emotional problems in the individual arising from the external appearance.

How to Prevent Gynecomastia?

There are several factors that individuals can control to reduce their risk of gynecomastia. Alcohol consumption should be avoided as much as possible, it should be consumed in moderation. Unintended use of drugs should be avoided without physician control.

What are the Symptoms of Gynecomastia?

Signs and symptoms of gynecomastia primarily include swollen breast tissue and sometimes breast tenderness. In case of swelling, pain, or tenderness in the breast, or nipple discharge in one or both breasts, the individual should consult a doctor as soon as possible.

How Is Gynecomastia Diagnosed?

In order to diagnose gynecomastia, the doctor first performs a physical examination and aims to learn about the health history of both the patient and his family with various questions. The patient should discuss all the symptoms they observe with the doctor during this examination and share information about other conditions or diseases they may have.

During the physical examination, the doctor will evaluate the breast tissue and perform other examinations as required. In cases where gynecomastia is diagnosed, the doctor may consider it appropriate to perform blood tests to determine the cause of the condition. Depending on these initial test results, further tests such as computed tomography scans, magnetic resonance imaging scans, testicular ultrasound and tissue biopsy may be needed.

There are several other conditions with signs and symptoms similar to breast swelling due to gynecomastia. The first of these is excessively fatty breast tissue. Some men have a layer of breast fat that looks like gynecomastia. This is not the same condition as gynecomastia and does not need additional evaluation.

Breast cancer is rare in men. In cases where only one breast is enlarged or there is a hard nodule in the breast, the possibility of male breast cancer should be considered.

A breast abscess, which is an infection of the breast tissue, can also lead to enlargement of the breast.

How Is Gynecomastia Treated?

If gynecomastia does not resolve on its own or if it causes serious pain, sensitivity or psychological problems that affect the individual's quality of life, treatment may be required. Treatments may be in the form of medication or surgical intervention.

There are two different surgical intervention approaches commonly used for gynecomastia.

In liposuction, the surgeon removes only the breast fat, but leaves the mammary gland tissue behind.

In mastectomy type surgical interventions, the mammary gland tissue is completely removed by the surgeon. This surgery is usually done using only small incisions.

How does Gynecomastia Improve?

Most cases of gynecomastia get better on their own over time without the need for treatment. However, if gynecomastia is caused by an underlying condition such as hypogonadism, malnutrition, or cirrhosis, this condition may need to be treated.

The doctor may recommend that individuals stop taking their prescribed medications especially for drugs that are known to cause gynecomastia.

In cases that occur during puberty and have no obvious cause of gynecomastia other than normal hormone changes, the doctor may recommend periodic reassessments every three to six months to see if the condition improves on its own. In this scenario which is seen in many cases, gynecomastia usually heals spontaneously in less than two years without treatment or intervention.

Lifestyle Changes and Home Care for Gynecomastia

The anatomical appearance caused by an enlarged breast can be a stressful and embarrassing situation for some men. Gynecomastia that develops during adolescence can make boys the target of unfair taunts from their peers. Activities such as dressing room, swimming and dressing after sports can become traumatic for the individual.

Regardless of age, the individual may feel that his body has betrayed him and may lose his self-love. The individual can take various steps to cope with this situation and poor coping mechanisms may arise.

In case of gynecomastia, seeking professional counseling will help the individual. Cognitive talk therapy can both help avoid anxiety and depression caused by gynecomastia, and help the individual communicate with their spouse or other family members in a way that expresses what they are going through or feeling.

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