SIGNS, SYMPTOMS AND CAUSES OF GYNECOMASTIA IN MALES

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Gynecomastia is the medical word for man boobs or gyno. It describes the abnormal enlargement of breast tissue in a male. Although all men have breast tissue, most do not notice it or perhaps do not even realise it is there, as it is so small that it can’t be seen or even felt. However if hormone levels in the man’s body change the breast tissue will grow, causing gynecomastia. Breast tissue grows in response to high levels of the ‘female’ hormone estrogen while high levels of the ‘male’ hormone testosterone stop it from growing. If anything in a man’s body causes a rise in estrogen or a fall in testosterone, this can mean the breast tissue grows. There are many things that can cause these changes, and most are not at all worrying. The condition often has few symptoms, is usually not painful, and most commonly happens on both sides – although it can more rarely be unilateral.

Gynecomastia is usually nothing to worry about, but it can be very embarrassing or distressing for the man. Understanding the causes and usual symptoms can help you cope with the problem and find the best way to try and get rid of your man boobs.
normal breast and gynecomastia

Symptoms of gynecomastia

Many men have no real gynecomastia symptoms. Some men describe itchiness of the nipple and perhaps the underarm area, which can be the first sign before there is any obvious breast swelling. For some the growing male breast can also ache or feel tender to the touch. Gynecomastia is usually not painful, and if there is significant pain something else could be causing the swelling. If a man finds he is experiencing significant pain in the breast it is best to be seen by a doctor who can fully assess the problem.

Signs of gynecomastia

The most obvious sign of gynecomastia – and the one which defines the condition – is the swelling of the breasts in a man. Early on, the man may notice that his nipples start to jut out or become prominent on the chest wall. As the condition develops he will notice there is a more obvious swelling behind the nipple and the pink area (areola) surrounding the nipple itself. The breast tissue can sometimes be felt as a smooth rubbery mass or lump.

As gynecomastia enlarges, the swelling will spread beyond the edges of the areola. It is usually pretty equal on both sides, although it’s not uncommon for one side to start earlier than the other and for one side to be slightly larger than the other. As the breast becomes larger it may develop noticeable ‘edges’ where the skin bends away from the chest wall. In the most extreme cases, the breast may start to ‘sag’ and take on the appearances of a woman’s breast. It’s important to realise that only a few men develop really significant gynecomastia, and most male breasts stop growing when they are much smaller.

Stages or grades of gynecomastia:

  • Grade 1 – Small swelling limited to the areola
  • Grade 2 – Moderate to significant swelling spreading beyond the areola with edges blending with the chest wall
  • Grade 3 – Significant swelling with clearly defined edges
  • Grade 4 – Significant to severe swelling which may ‘sag’ along with feminisation of the breast

These grades are used by doctors to describe a man’s gyno and keep track of how it’s growing or responding to treatment. They may also help in planning the best treatment.gynecomastia-grades

Causes of gynecomastia

The underlying cause of gynecomastia is usually a shift in hormone levels, but this in turn can have a range of different causes. Gynecomastia is very common at some times in life: for male babies, in teenage boys during puberty and in older age. At all these times, hormone levels can change and result in gynecomastia. Male babies may have higher levels of their mother’s estrogen in their system, teenagers have a storm of hormones released during puberty which can throw the balance off for a while, and older men naturally experience a drop in their testosterone. The best course of action for all these men is usually simply to watch and wait. As hormone levels settle down, the gynecomastia usually goes away on its own and no treatment is needed.

Other causes of gynecomastia include:

  • Some prescribed medications
  • Taking recreational drugs (most often steroids in bodybuilding or marijuana)
  • High intake of some foods (in rare cases)
  • Disease of the liver or kidneys
  • Rare genetic conditions
  • Hormone secreting tumours

When a man is thinking about what causes gynecomastia, he should think about whether any of these might be responsible. It is often a good idea to go and consult with a doctor to make sure there is nothing worrying behind the breast swelling.

It’s worth realising that there are other causes of breast swelling apart from true gynecomastia. Breast swelling is most common in men who are overweight or obese. There are two reasons behind this: firstly, fat can build up on the chest wall just as it does in other parts of the body. Secondly, fatty tissue encourages the body to produce estrogen. The slight rise in estrogen can be enough to send a signal to the man’s breast tissue to grow. So, in an overweight man there is often a combination of true breast tissue and fatty tissue causing the breast swelling. If only fat is causing the gyno, then this is called pseudogynecomastia.

Other causes of lumps or swelling in the breast area include infection or abscess formation and breast cancer. Both of these usually occur on one side only (are unilateral) and often have other changes associated with them (severe pain or changes in the skin, for example). If a man is worried one of these may be causing the problem then an urgent trip to the doctor’s is advised.

There are some symptoms or signs of gynecomastia that are more unusual and mean that an immediate visit to the doctor is advised. The following ‘symptom checker’ gives an idea of some of these:

  • Swelling that is unilateral (one-sided)
  • Swelling that is acutely painful
  • Separate firm or hard ‘lumps’ within the breast tissue
  • Discharge from the nipple – especially bloody discharge
  • Changes to the skin such as ‘dimpling’ or ulceration over the mass
  • Lumps or masses in other places, such as under the arms or testicles
  • Symptoms including fever or generally feeling unwell

Drugs that cause gynecomastia

There are several medications that can cause gynecomastia as a side-effect. Some of the more common medications with these side-effects are given in the list below:

  • Treatment for stomach ulcers such as cimetidine
  • Heart medication including digoxin
  • Some anti-depressants
  • Treatments for anxiety including diazepam
  • Steroids used to treat hormone conditions
  • HIV – HAART medication
  • Some chemotherapy drugs used to treat cancer

If prescribed medication might be the cause for gynecomastia, the man should discuss it with his doctor before stopping the treatment. In many cases there will be another drug available to treat the condition without causing gynecomastia. Stopping any prescribed medication without the advice of a doctor can be dangerous and isn’t advised.

Other drugs that can cause gynecomastia are recreational drugs, including those in the list below:

  • Excess alcohol
  • Marijuana
  • Anabolic steroids used in bodybuilding
  • Methadone
  • Heroin
  • Amphetamines

Drugs which cause gynecomastia

The most commonly used of these is probably marijuana. Marijuana is one of the most common recreational drugs stated to cause gynecomastia; however some doubt actually remains about whether this is really true, and whether smoking marijuana really can cause gynecomastia. We do know that animals given the active ingredient in marijuana show a decline in testosterone levels and shrinking of their testicles. If men who smoke marijuana develop the same fall in testosterone, this might be enough to cause gynecomastia. However, so far no good clinical trials have been done. We therefore don’t know whether smoking marijuana causes a man to be exposed to enough of the active ingredient to cause gynecomastia or not. However, it does seem that marijuana is regularly ‘blamed’ for causing gyno, so it may well be true. The simplest advice for a man who develops boobs and also smokes marijuana is to stop the drug use. That way if the gyno goes away he has a really simple cure for the problem.

Bodybuilding or anabolic steroids are also a common cause of gynecomastia. These steroids interfere with the body’s natural hormone regulation and cause an increase in estrogen levels. Pretty much all men taking steroids to build-up muscle bulk will develop gyno at some point. Again, the simplest advice is to stop taking the steroids and hope the gyno goes away. If it has been present for some time, gynecomastia can persist even though the steroids have been stopped. In this case other treatment might be needed. Taking steroids for bodybuilding is rarely a good idea as they can cause many negative side-effects, and the gyno can be hard to get rid of.

Foods which cause gynecomastia

In rare circumstances foods can cause gynecomastia. This is because some foods naturally contain high levels of phytoestrogens, chemicals which closely mimic estrogen and can ‘trick’ the breast tissue into growing in response. High levels of phytoestrogens are found in a range of foods, especially those with high levels of soy protein. Men who are most at risk for this cause of gynecomastia are those who obtain a lot of their protein from soy – particularly those following a vegan diet. If men think that food might be responsible for their gynecomastia, they should carefully look at how much soy they are eating in things such as tofu and vegetarian meat alternatives. It is worth checking the ingredients in commonly eaten prepared foods, as many producers use soy protein as filler in packaged food.

Some foods containing high levels of phytoestrogens include:

  • Nut oils and seeds – such as flax seed and sesame seed
  • Soy products such as soy milk and tofu
  • Cereals and bread, especially those containing flax seeds
  • Processed foods
  • Legumes including black beans and hummus
  • Fruits such as dried apricots

Foods which cause gynecomastia

Treatments for gynecomastia

Most men do not need treatment for gynecomastia. If the problem is caused by puberty, the simplest advice is to wait, as over 80% will get better on their own. This can take around two years, but is the safest and simplest thing to do.

For men who are overweight or obese, the first thing to do is to try and lose weight and exercise more. Losing excess weight will mean there is less fat in general and less fat in the breast area, thus reducing the breast swelling. In addition, less fat will mean the body produces less estrogen which can reduce true gynecomastia as well. In addition to losing weight, exercises designed to specifically target the chest area can help to develop muscles and improve the appearance of the chest. Losing weight and exercising more is often the most effective and natural way to get rid of gyno.

Before considering any other treatments, it is always a good idea to discuss the gynecomastia with a doctor. They will be able to assess the problem and help figure out what might be causing it. As well as going through a list of prescribed medications, they will ask about recreational drugs and other possible causes. They will usually perform an examination to check if the swelling really is caused by gynecomastia and may occasionally ask for some tests to rule out any worrying causes. Once all this is done they will be able to advise the best possible treatment.

Medication can alter the hormone levels. However, these medications are rarely recommended for straightforward gynecomastia as they often have unpleasant side-effects. For men who are intent on getting rid of their man boobs, surgery can end up being the best option. Surgery is usually only recommended if the gynecomastia is particularly significant, painful or distressing. Clearly having surgery is a big decision and one which needs careful consideration. It can be expensive, and is often not covered by health insurance plans. Although very safe, all surgery carries the risk of complications, and there is usually some post-procedure pain. It is crucial to find a surgeon who is certified and experienced in male gynecomastia surgery, and to discuss which type of operation is most appropriate and likely to give the best results.

Summary

What is gynecomastia? The answer is very straightforward: It is the abnormal enlargement of the male breast. However, there is a range of male breast swelling or gynecomastia causes and understanding these can help work out how to get rid of the problem. In most cases there are few symptoms associated with the breast swelling, and it is not usually painful. The most common time for male breast tissue to grow is during puberty when up to 70% of boys are affected. Things as varied as foods, prescribed drugs, recreational drugs (most commonly marijuana or steroids), or illness in other areas of the body can all lead to man boobs. Occasionally there is a serious cause for the breast swelling and it can be helpful to use a symptom checker to see if an urgent trip to the doctor is needed. Worrying symptoms can include unilateral swelling, severe pain or separate lumps – either in the breast or in another part of the body.

For most people, male breast swelling will either settle down on its own or get better with the help of diet and exercise. Stopping recreational drugs is always advised, and a doctor should be consulted about whether prescribed medication needs to be changed. If the problem persists, the most effective treatment is often surgery, although this needs to be thought about carefully.