HOW TO TELL IF YOU HAVE GYNECOMASTIA

Gynecomastia is the medical word used to describe the abnormal enlargement of male breast tissue. Many people also call it gyno, man boobs or even moobs. All men have breast tissue, just like women. Just as in women, the breast tissue responds to hormones which tell it whether to grow or not. In most men for most of their life, the level of testosterone is much higher than the level of estrogen, so the breast tissue stays small. If these levels change – so either the testosterone gets lower or the estrogen rises – breast tissue responds by growing.

The diagnosis is usually made when a man notices his breasts beginning to swell. The man may first identify that his nipple starts to point out, and then the area behind and around the nipple – called the areola – begins to become more prominent. Over time the breast swelling may spread, causing a more obvious ‘boob’.

However, as well as true enlargement of the breast tissue, there is another condition that can cause boob-like swelling of the male chest. This happens when fatty tissue builds up on the chest wall in the area behind the nipple, and is called pseudogynecomastia. Sometimes a man might need to have some tests to make the diagnosis of gynecomastia, but usually this isn’t needed.

normal breast and gynecomastia

How do I know if I have gynecomastia?

So, how can you tell the difference between true gynecomastia breast swelling and simply fatty tissue, and does it matter? Firstly, in many men their man boobs will be caused by a combination of both true breast tissue and fat – but usually one is more prominent than the other. It can be very difficult to tell the difference between the two, and occasionally a doctor will do some tests or a scan to tell the difference. However, there are some pointers that will help many men make the diagnosis.

Fat build-up or pseudogynecomastia is much more common in men who are overweight or obese. If there is excess fat in other parts of the body, then it makes sense that fat also accumulates in the chest area. Because this is an area in men which usually doesn’t hold much fat, and because it sticks out from the body here, fat on the chest wall can be particularly obvious. If a man is generally slim, then pseudogynecomastia is much less likely to be the cause – although it can still happen in some cases.

True gynecomastia is much more common at certain times in life – especially during puberty or in older men (when testosterone levels naturally become lower). Gynecomastia can also be caused by other conditions, medications or recreational drugs. If these are present, true gynecomastia becomes more likely.

Some causes of true gynecomastia:

  • Medication including some treatments for gastric ulcer, depression or heart problems
  • Recreational drugs such as anabolic steroids and marijuana
  • Liver or kidney disease
  • Rare genetic disorders
  • Hormone – secreting tumours

In many men, chest swelling contains both fat and breast tissue, and only a test will tell for certain how much of each is present. If a doctor needs to be sure, they will organise some tests, perhaps blood tests as well as scans in order to check this out.

How to diagnose gynecomastia

To be sure what is causing a man’s boobs, it is sometimes necessary to carry out a test, usually an ultrasound scan of the chest wall. However, there are things about the swelling itself which can help a man self-diagnose or help their doctor to tell the difference between the two. If there were changes in the nipple which happened first – perhaps itching of the nipple or the man detected it was jutting out a lot – this might suggest true gynecomastia. Feeling the swelling can give some clues: when small, true gynecomastia is found only behind the nipple and the pink tissue surrounding it (the areola). The gyno grows as a firm round disc which can be clearly felt. It should not be painful, but may be slightly tender to the touch. As the gynecomastia grows it will spread beyond the areola, and it should remain slightly firm to the touch. If gynecomastia becomes very large the breast begins to look more and more like a female breast, perhaps hanging lower and with so-called feminisation of the nipple. By this stage it should be very obvious that true breast tissue is the cause of the swelling.

In contrast, fat build-up feels much softer, like fat on any other part of the body. The swelling will be soft and diffuse – not particularly centred around the nipple and with no clear edge. It may hang lower on the body and generally ‘sag’ more. Early nipple changes are unlikely and the swelling should not be tender or painful.

In both cases the swelling is usually fairly equal on both sides, although with true gynecomastia one side may be slightly bigger than the other. If the enlargement is on one side only, this makes it more possible that something else is causing the problem (such as infection or in rare cases a tumour), and a trip to the doctor is advised. If there are any lumps or swelling on other parts of the body, then it is crucial these are examined by a doctor who will be able to detect any hidden problems and make a diagnosis.

Chest fat vs gynecomastia

Although chest swelling or enlargement of any kind can be embarrassing or distressing for the man, knowing the difference will help him understand what is causing the problem, and most importantly, how to get rid of it.

If the problem is chest fat, then making it go away is really simple – although the advice is not always welcome. The best way to make chest fat go away is to lose weight and exercise. Tests are not usually needed, and the man can fix the problem himself. General weight loss will also mean that fat is lost from the chest wall, reducing the swelling. Exercise targeted at the chest area will help build up and define muscles, improving the appearance of the area. Although there are pills and creams advertised to specifically target man boobs, these are usually just weight loss pills. They may help speed up the process, but are usually expensive and may have negative side-effects. Surgery can also be carried out (liposuction to remove the fatty build-up), but diet and exercise should achieve the same result without the expense or risks.

If the swelling is true gynecomastia, then treatment may be more difficult. For young men in puberty the best advice is usually just to wait, as most will get better on their own as hormone levels settle down. For many men, diet and exercise will help reduce the fatty component and improve the appearance. If gyno is caused by recreational drugs, the best advice is to stop taking them as this will often make the swelling go away. If prescribed drugs are the cause, then it may be possible to take an alternative medication. In all cases, if a man thinks he has true gynecomastia and is worried about the cause, or if it has persisted despite simple changes, then he should discuss it with a doctor. The doctor may need to do some tests to detect any worrying causes. Treatment may rarely be possible with medication which changes hormone levels, but for many men with persistent or severe gynecomastia, surgery ends up being the best possible treatment.

gynecomastia and pseudogynecomastia

Conclusions

Man boobs may be caused by true breast tissue enlargement or by fatty tissue, or often by a combination of both. Telling the difference can be tricky, but there are often some pointers. Understanding the cause of chest swelling will help determine the best way to get rid of the swelling. Anyone who is worried or unsure should discuss the problem with a doctor. Once diagnosed, the doctor will be able to advise how best to deal with the problem. This occasionally involves tests and scans, although for many men a simple examination and advice is all that is needed.

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