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Dr. Nitika Makhija
MDS, BDS
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Dr. Rajeev Sharma
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Last updated on:
30 Apr 2024 | 12:03 PM (IST)

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Gynaecomastia

Gynaecomastia

Overview

Gynaecomastia refers to the enlargement of breasts in males. It is the most common breast condition in males affecting at least 30% of men in their lifetime.

Most of the cases of gynaecomastia are physiological and resolve on their own by the age of 19 years. It shows three age peaks during a male's lifespan: infancy, puberty, and adulthood. It can be a sign of underlying medical condition also such as tumors, end stage kidney disease, liver disease, thyrotoxicosis, obesity and infertility. 

Early diagnostic evaluation is very necessary to overcome anxiety, psychological discomfort, and fear of breast cancer. As it is medically harmless, simple reassurance helps in managing the condition. The other treatment approaches include medications and surgery to remove breast (mastectomy).

Male breast cancer is rare and gynaecomastia should not be considered a precancerous condition.

Key Facts

Usually seen in
  • Individuals between 13 to 14 years of age
Gender affected
  • Male
Body part(s) involved
  • Breast
Mimicking Conditions

  • Pseudogynecomastia

  • Breast cancer

  • Lymphoma

  • Dermoid cyst

Necessary health tests/imaging
Treatment

Symptoms Of Gynaecomastia

The basic signs and symptoms are

  • Enlargement of the breast in men in either one breast or both breasts.

  • Feeling of a small and rubbery lump under the nipple. 

  • The palpable mass feels tender, firm, mobile, and a disc-like mound of tissues that is not as hard as breast cancer. 

  • Soreness, pain and tenderness in the nipples generally in the initial months. 

NOTE

If the palpable mass is felt over only one breast and is hard, fixed and peripheral to the nipple, it can be a sign of breast cancer. Breast cancer is also associated with nipple discharge, skin changes or lymphadenopathy (swelling of the lymph nodes)

Causes Of Gynaecomastia

Gynaecomastia refers to the enlargement of the breast in male. Before understanding the exact cause of it, it is important to know the structure of breast and the basic difference between male and female breasts. 

Structure of breast

Each breast has around 15 to 20 lobes that are arranged like petals. Each lobes has smaller structures called lobules that produce milk in females through tiny bulbs. All these structures are linked through ducts. These ducts lead to the nipple with the dark area at the center called the areola. 

What is the difference between male and female breast development?

  • The development of male and female breasts occurs in a similar way till puberty from gestation. 

  • At birth, there is a rapid decline in fetal prolactin and estrogen, which is previously supplied by the mother's body. This stops the development of breasts after birth. 

  • The complex hormonal interplay during puberty results in growth and maturation of female breasts in adulthood.

  • Breast development is initiated by several hormones such as estrogen, progesterone, prolactin, growth hormone, and IGF-1 (insulin like growth factor-1). 

  • Males have testosterone which has an antiproliferative effect (suppress cell growth) on breasts which inhibits the maturation of breasts throughout their life.

Cause of enlarged breasts in males

Testosterone is converted into estrogen by the enzyme aromatase. The excess of this conversion increases the level of estrogen which can lead to breast development in males. This can happen due to:

  • Changes  in the level of testosterone

  • Increase in the activity of the enzyme aromatase

Did you know?

Hormonal fluctuations are not always the cause of gynaecomastia. In some cases, mutations (changes in genetic structure) in the chromosomes that lead to overexpression of the enzyme, aromatase can also cause gynecomastia.

Types Of Gynaecomastia


Gynaecomastia can be divided into two types according to the cause:

Physiological gynaecomastia

This type of breast development is seen in almost all men as a part of physiological development. It is reversible. It can occur normally during three phases of life:

  • Neonatal gynaecomastia: This is seen in infants. It is due to the high fetal blood levels of estradiol and progesterone (produced by the mother).  Almost 65–90% of infants have this condition. 

  • Pubertal gynaecomastia: Almost 60% of boys have clinically detectable gynecomastia by age 14. It usually resolves within 3 years of onset 

  • Elderly gynaecomastia: It is frequently seen during older age (>60 years). The reported prevalence varies from 36 to 57%. 

Did you observe milky discharge from your newborn's breasts?

Well, this is harmless and common for the initial few days after birth. It is called witch’s milk and released due to high levels of maternal estrogen in the blood of the baby. The presence of estrogen in the breast milk during initial weeks can also contribute to this discharge. 

Pathological gynaecomastia

It refers to a medical condition that causes breast enlargement in men. It can be caused due to some medication, medical conditions such as tumors, and other reasons. It needs medical attention.

Risk Factors For Gynaecomastia


Obesity

Obese individuals are at high risk of developing gynaecomastia. 

This is due to the high estrogen levels in them due to increased aromatase activity in adipose tissue. Leptin – a hormone that regulates weight increases in obesity and promotes gynaecomastia.

Know the symptoms of obesity and its treatment.

Family history

Individuals having any family member with gynaecomastia are at high risk of developing it. This is the rare familial form of gynaecomastia in which affected family members have an elevation of aromatase activity. 


Certain medications

The use of certain medications also increases the risk of gynaecomastia. Examples include:


Interesting fact!

The topical estrogen spray, used for relief of menopausal hot flushes is also known to be associated with gynecomastia in children through skin contact. 


Occupation

Bodybuilders and athletes are at high risk of gynaecomastia in case of use of aromatizable androgens for muscle building.


Hypogonadism

Hypogonadism is characterized by reduced concentrations of testosterone. The diseases that can cause gynecomastia due to hypogonadism include:

  • Klinefelter syndrome (genetic condition in which a male is born with an extra copy of the X chromosome)

  • Kallmann syndrome (condition characterized by delayed or absent puberty and an impaired sense of smell)

  • Kennedy disease (a genetic neuromuscular disorder that causes progressive weakening and wasting of the muscles)


Medical conditions

Certain medical conditions are associated with an increased risk of breast development. Some of these are:

  • End stage kidney disease

  • Liver disease

  • Spinal cord disease

  • Thyrotoxicosis

  • Infertility

  • Diabetes

Here are 6 interesting facts about diabetes!

Stress

Stress increases the risk of developing gynaecomastia by stimulating the adrenal glands to secrete excess estrogen precursors.

Keep stress at bay. Explore mental wellness products from our extensive range.

Cancer

The following cancers/ tumors can increase the risk of gynaecomastia through increased estrogen levels:

  • Testicular cancer

  • Germ cell tumor

  • Sex-cord tumor

  • Fibrolamellar hepatocellular carcinoma

  • Adrenal tumors

Did you know about refeeding gynaecomastia?

It is a reversible form of gynaecomastia that is observed in men recovering from a malnourished state. Lack of nutrition can temporarily reduce testosterone levels. Most cases of refeeding gynaecomastia regress within several months after resuming a normal diet. 

This type is first observed in men returning home from prison camps during World War II.

Diagnosis Of Gynaecomastia

The following are the treatment approaches of gynaecomastia:

Medical history

The knowledge of detailed medical history plays a very important role in diagnosing gynaecomastia. The clinician enquire about:

  • Medications and alcohol abuse

  • Chemical exposures

  • Symptoms of underlying systemic illness such as hyperthyroidism, liver disease, mumps and renal failure

  • Weight loss or gain

  • Onset and duration of breast enlargement

  • Pain and discharge from the nipples 

  • Undescended testes (testicle that doesn't move down into its proper place in the scrotum before birth)

  • Infertility, erectile dysfunction, and libido to rule out hypogonadism

  • Body mass index

  • Family history of gynaecomastia

Physical examination 

The physical examination of the breast plays a very important role in differentiating gynaecomastia from pseudogynecomastia and breast cancer. 

These two conditions may be distinguished by having the patient lie on his back with his hands behind his head. The examination is done by placing a thumb on each side of the breast and slowly bringing them together. The following observations differentiate the three conditions:

  • True gynaecomastia: Feeling of a ridge of glandular tissue to the nipple-areolar complex

  • Pseudogynecomastia: Inability of the fingers to meet until they reach the nipple

  • Breast cancer: Feeling of an immobile, unilateral hard, irregular mass located outside the areola, which may be accompanied by skin dimpling and nipple discharge

Abdomen and testicles are also examined. Signs of liver, kidney disease, or hyperthyroidism can be determined by a physical examination.

Laboratory evaluation

Gynecomastia is a complex interplay of the fluctuations of several hormones. The following blood tests are performed to assess the exact cause of gynaecomastia. 

The further testing is done according to history, physical examination and blood levels of the above mentioned hormones. 

Imaging tests

Scrotal/Testicular USG: It involves ultrasound scanning of the scrotum (the bag-like structure that contains testis). It is used to assess any abnormality in the testis particularly if an abnormal testicular mass is detected during physical examination. The testicular ultrasound is also required if the serum HCG levels are found to be elevated.

Mammography (MMG): It is an X-ray imaging method used to examine the breasts when there is a suspicion of cancer. This method is highly sensitive and accurate to differentiate between true gynecomastia from breast cancer. It also reduces the need for biopsies. 

Breast ultrasonography (USG): The sonography of breasts is widely used in the diagnosis of gynecomastia cases and is more comfortable for male patients.

Abdominal CT: It involves use of X ray to detect the presence of non-testicular tumors. It is indicated when HCG levels come out to be high and ultrasound does not show a testicular mass. 

Karyotyping: In this, the chromosomes are examined under a microscope using a blood sample. A karyotype test shows the same results at any time in a person's life. This test is performed if the person has low testosterone level along with a family history of Klinefelter syndrome. 

Biopsy

Biopsy involves the examination of a tissue particularly for cancer. It is performed in high risk individuals having signs of cancer such as patients with Klinefelter syndrome

Prevention Of Gynaecomastia

Obesity, a lifestyle disorder involving excessive body fat accumulation increases the risk of many health problems including gynaecomastia.

Our Obesity screening package can aid in screening the cause of obesity, which can be a combination of inherited factors, combined with poor diet and sedentary lifestyle choices.

Book our Obesity screening package.

A well-balanced nutritious diet and an active lifestyle with at least 30 minutes of exercise a day can reduce the risk of obesity and hence, gynaecomastia(further discussed in-home care section).

Prevention of gynaecomastia in prostate cancer

Men having prostate cancer are at high risk of developing gynaecomastia due to anti-androgen therapy. Gynaecomastia in this condition can be prevented by:

  • Medications such as oral tamoxifen

  • Radiation therapy 

How do you know if you have prostate cancer?

Specialist To Visit

The following doctors can be consulted for gynaecomastia, more so in the case of sudden breast pain or tenderness, any new onset of enlargement, rapid growth, or a breast size >5 cm :

  • Endocrinologist

  • Andrologist

  • Reproductive endocrinologist

  • Oncologist

  • Surgeon

Endocrinologists are the experts in the diagnosis and treatment of the hormonal system of our body. Since there is an involvement of several hormones in gynaecomastia, an endocrinologist helps in diagnosing and managing the same. 

Andrologists specialize in male reproductive diseases and can also be consulted.

Since, gynaecomastia and infertility coexist in some situations, reproductive endocrinologists can be consulted. These are specially trained in fertility-related problems in both men and women. 

In case of suspicion of cancer, consult an oncologist. Surgeons can take care of surgery, if required. 

Consult India’s best doctors online to give you all the care and guidance you need in this journey.

Treatment Of Gynaecomastia

Most cases of pubertal gynaecomastia resolve on their own within one to two years. The treatment is initiated after a confirmatory diagnosis of the cause behind gynaecomastia. Individuals in which no abnormalities are detected are observed closely. Breast exam every 3 to 6 months is recommended for such individuals.  

Approach of treatment

The approach of treatment differs as per the cause. The different approaches include:

  • Any detected endocrinologic or systemic disease is treated first

  • Any detected tumor is surgically removed followed by chemotherapy

  • Medications causing gynaecomastia should be discontinued considering the need of the ongoing therapy

  • Breast is removed, if a breast biopsy indicates cancer

The acute gynecomastia (less than 6 months) with no other clinical findings is generally reversible with medications. However, regression is hardly possible, if the breast enlargement is chronic. 

In general, the treatment options include:

Medications

The medications that are used in gynaecomastia include:

Androgens: These drugs alter the level of testosterone which helps in balancing the testosterone/estrogen ratio. The common examples include:

  • Testosterone: It is most commonly used in hypogonadism that is characterized by low serum levels of testosterone. 

  • Dihydrotestosterone: It is a non-aromatizable androgen and does not convert into estrogen. It has shown a good response in individuals having prolonged pubertal gynecomastia.

  • Danazol: It is a weak androgen that inhibits gonadotropin secretion. This leads to decrease in the production of testosterone which ultimately reduces estrogen. It helps in the regression of breasts through these hormonal effects. 

Antiestrogens: These drugs decrease the activity of estrogen which is the main trigger for breast development.  The common examples include:

  • Clomiphene citrate: It is mostly used in  painful gynecomastia.

  • Tamoxifen: It has shown excellent results in cases where the exact cause of gynaecomastia is not known. 

Aromatase inhibitors: These drugs inhibit the enzyme aromatase that converts testosterone into estrogen. The common examples are: 

  • Letrozole: Its use is also associated with decreasing breast size. 

  • Anastrozole: It has shown excellent effect in pubertal gynaecomastia and in individuals having sertoli cell tumor. Individuals having breast enlargement due to familial aromatase excess are also benefited by this drug. 

Liposuction

This is performed in individuals having excess fat. The procedure involves removing excess fat and fluid through a vacuum tube thus reducing the size of breasts.

Surgery

It involves surgical removal of breasts. It is recommended in the following cases:

  • Longstanding gynaecomastia

  • If the gynaecomastia is interfering with the daily, social, and career choices of the individual 

  • Suspicion of breast cancer

 

Things to avoid while considering gynecomastia surgery

  • Sunbathing for at least 2-3 weeks before surgery as tanning of the chest skin may potentially increase the risk of permanent scarring.

  • Smoking and alcohol at least 2 weeks before the surgery

  • Blood thinners and aspirin-containing products, herbal supplements, and Vitamin E supplements.

Post-operative care

  • Pat dry the dressings after bathing

  • Keep your compression shirt or garment on at all times except to shower and wash the garment

  • Avoid swimming for at least two weeks

  • Avoid lifting weights over 10lbs for 2 weeks.

  • Refrain from heavy activity, straining, or sports that will put strain on the incision for two weeks

Home-care For Gynaecomastia


Use cold compresses

Gynaecomastia causes tenderness and soreness of the breasts. The cold compression helps in reducing the pain by contracting the swollen nerve. 

Suffering from breast pain. Order a cold pack from the comfort of your home.

Make dietary modifications

Foods to include

The foods that decrease the overall body fat should be included in the diet. Such food include:

  • Lean proteins (chicken, turkey, and fish)
  • Fruits and vegetables
  • Whole grains (oats, brown rice, and whole wheat)
  • Healthy fats (avocado, nuts, and olive oil)
  • Low-fat dairy products (milk and yogurt)
  • Legumes (beans and lentils)
  • Foods rich in antioxidants (berries and leafy greens)

Foods to avoid

If you have gynecomastia, the following food items you must avoid eating as they can aggravate the condition.

  • Soy products
  • Beetroot
  • Processed foods
  • Frozen food
  • Fried food

Exercise regularly

Individuals should engage themselves in regular physical activity and exercise including strength training exercises that target chest muscles. This helps in reducing overall body fat that makes gynaecomastia less noticeable. 

The exercises that help in gynecomastia include:

  • Swimming
  • Walking
  • Running
  • Bench press
  • Push ups
  • Bent forward cable crossover
  • Rowing machine


Try home remedies

The following home remedies can be an adjunct to conventional treatment of gynaecomastia. However, it is better to consult your health care provider before starting any of these:

Turmeric (haldi): Curcumin, a major ingredient of turmeric promotes the production of testosterone. It also reduces swelling that may be seen in some cases of gynaecomastia. 

It can be consumed by mixing one tablespoon of turmeric powder in one cup of hot milk. 

Vitamin E: It is rich in antioxidants and also helps in gynaecomastia by serving following functions:

  • Blocks the aromatase enzyme

  • Naturally reduces the estrogen levels

Individuals with gynaecomastia should consume Vitamin E rich foods such as 

Flax seeds (alsi): They are highly rich in omega 3 fatty acids, which increases testosterone level and decreases estrogen level. The lignanas present in flax are also known to have anti-estrogenic properties. These properties help to manage gynaecomastia.

It can be directly consumed by adding in smoothies, cereals, and yogurt. 

Fish oil: The oil from the cold water fishes such as tune, mackerel, and salmon are also a rich source of omega 3 fatty acids. These fatty acids help in combating gynaecomastia by boosting testosterone levels. 

These fishes can be directly consumed and their supplements are also readily available for the medicinal benefits. 

Explore our wide range of fish oil supplements.

Zinc: Zinc helps in management of gynaecomastia by regulating testosterone levels. Zinc rich food include:

Green tea: It is highly rich in antioxidants and also has fat burning properties. The intake of green tea helps in preventing fat deposition around breasts.

Shop for green tea from our extensive collection.

Plant-based therapies

Milk thistle: It is a plant popularly known as silymarin, used to treat liver disorders. Since breast enlargement can be a sign of liver dysfunction, it is used to regress the size of breast. 

Its crushed seeds are taken with water. It can also be consumed as a supplement as directed by your physician. 

Shop for Milk Thistle supplements.

Dandelion: It is a wildflower that has yellow flowers. It helps to flush extra estrogen which protects the breast from its effect. 

Its leaves can be added to salads, sandwiches, and teas. 

Passionflower: It is a plant that is known as a natural testosterone booster. It is widely available in several herbal supplements. 

It can also be consumed in the form of tea that is made by adding dried passion flowers to boiling water. 

Red clover: It is a herb that is known for its effect on the metabolism of estrogen. It helps in gynaecomastia by normalizing estrogen and testosterone levels.

It can be consumed in the form of tea which is made by boiling approximately 4 grams of dried flower tops to 1 cup of boiling water.

Complications Of Gynaecomastia


Gynaecomastia does not cause any physical complications itself. However, the feminine appearance can cause psychological or emotional problems in men and lead to:

Living With Gynaecomastia

Gynaecomastia is medically harmless but can reduce the overall quality of life. The following measures help to manage the symptoms at both physical, psychological and emotional level. 

Reduce stress

The chronic stress can aggravate the symptoms of gynaecomastia by causing hormonal imbalances. The following measures can be taken to reduce stress:
  • Practice mindfulness and mediation
  • Indulge in yoga 
  • Do deep breathing exercises

Make conscious clothing choices

The individuals having gynaecomastia should wear loose fitting clothing that doesn't cling tightly to the chest. Dark-colored clothing also helps in improving visible appearance. 

Wear compression garments

Men with gynaecomastia should wear compression shirts or undershirts. This helps in flattening the chest area and reduces the visibility of gynaecomastia. 

Maintain a good posture

Proper posture can improve body alignment and minimize the prominence of gynecomastia. Individuals should stand straight without bending their shoulders.

Dealing with the psychological aspect

Gynaecomastia can have a long-lasting effect on the emotional health of the individual. The unwanted change in physical appearance especially in puberty can lead to bullying and self-consciousness. 

The feeling of insecurities can lead to even depression and anxiety. It can also cause emotional isolation, feeling of loneliness, and sometimes development of wrong habits such as drug abuse and alcoholism. 

Individuals may also alter his activities such as not participating in gym class or any sports. The adolescent boys are seen to have difficulty in developing relationships. 

Educating and understanding the following fact helps in reducing the emotional burden:

  • It is a medically harmless condition
  • Most of the cases are of physiological gynaecomastia that resolves on its own after puberty or adolescence
  • Gynaecomastia is not a sign of breast cancer

How to cope with it?

  • Self acceptance
  • Communicate with your loved ones. It helps in managing the stress and anxiety
  • Indulge yourself in fun loving activities
  • Seek support from a therapist

Role of family 

The family and friends should understand the signs of instability in their loved one’s and support them. The peers should looks for following signs of instability:
  • Is he becoming withdrawn?
  • Has he stopped participating or showing interest in his usual activities? 
  • Has there been a noticeable decrease in performance and motivation at school or work? 
  • Does he avoid intimacy?

Noticing the symptoms early will help minimize the long-term damage of the gynecomastia. 

Note: Individuals with gynaecomastia can suffer from inferiority complexes. It is the feeling of inadequacy or inferiority where we feel less intelligent than our peers. Here is a detailed video by our expert to know about inferiority complex and ways to identify it.

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