Gynecomastia is a medical condition in men that causes swelling of the breast tissues. The immediate cause of gynecomastia is an imbalance of hormones in men, in which either too much or too little estrogen is produced; however, there is often an underlying issue in the body that can lead to this hormonal imbalance.
Gynecomastia can affect men of any age, including infants, teens and adults. The swelling of the breast tissues can cause the formation of breast buds and can cause the breasts to feel either firm or rubbery. The breast buds may last for as long as two years in some cases and can be embarrassing, although they are usually not a health threat.  Treatment is not required unless the hormonal imbalance is causing other health concerns and/or unless the breast buds that grow are a sign of serious health problems such as male breast cancer.  Still, men who develop breast buds should consult with a physician to determine the reason for the gynecomastia and to ensure their safety is not at risk.
Symptoms of Gynecomastia
The primary symptom of gynecomastia is the growth of male breasts. The breast buds form as a result of glandular, not fatty tissue, becoming enlarged. Typically, when breasts form as a result of gynecomastia, the breast buds develop on both sides of the body and are approximately the size of a nickel or a quarter. If it appears that a lump or growth has occurred on only one side of the body, this can be an indicator of male breast cancer and an examination and biopsy may become necessary.
Gynecomastia is easy for men to recognize as they notice the growth of the breast buds. However, there are other symptoms that may accompany this condition including:
- Rubbery or overly-firm breast tissue that is symmetrical in location with regards to the nipple.
- Tenderness
- Sensitivity
These symptoms are not necessarily present in all gynecomastia cases. However, they differ from breast cancer symptoms as cancer is often accompanied by a hardness or firmness in the nipple; by enlargement of the lymph nodes in the underarm, by discharge from the nipple or retraction of the nipple; and by skin dimpling.
Causes and Risk Factors Associated with Gynecomastia
While gynecomastia results from a hormone imbalance, there are many potential reasons why the testosterone levels may drop or estrogen levels raise. Some of the reasons that a man may develop gynecomastia include:
- Exposure to estrogen in the womb. More than half of all male infants have gynecomastia at birth because they are exposed to estrogen while in utero. Typically, gynecomastia in infants lasts just two to three weeks.
- Aging/ natural hormonal changes. When a young man enters puberty and is hormones begin to change, gynecomastia is common. In fact, some estimates indicate that more than half of all boys develop gynecomastia when they are going through puberty. Older men are also likely to develop gynecomastia as a result of a natural drop in testosterone that comes with age.
- Cancer treatment. Chemotherapy can result in gynecomastia as can anti-androgens such as flutamide, Proscar and Aldactone, which are used in the treatment of prostate cancer and other common cancers. Alkylating agents that inhibit the growth of cancer cells and interfere with cell DNA also cause hormonal changes that can result in the growth of breast bids.
- Exposure to Risperdal. Risperdal is an anti-psychotic medication used to treat bipolar disorder; schizophrenia and certain symptoms of autism including irritability. Gynecomastia is recognized as a side effect of taking Risperdal.
- Steroid use. The use of prednisone and dexamethasone have been linked to gynecomastia.
- Medical conditions. Conditions including cirrhosis of the liver, liver cancer, lung cancer, pituitary or adrenal gland cancer, and overactive thyroid problems are some of the medical issues that can cause or increase the risk of gynecomastia.
The body may thus develop gynecomastia naturally or the condition may occur because of the impact of drugs and medications on the body. As a result, risk factors can include the natural aging process (especially reaching adolescence and old age); as well as the use of various drug therapies.
Treatments for Gynecomastia
A doctor can make a preliminary determination that a patient has gynecomastia by conducting a physical examination and identifying swelling of the breasts. Depending upon the patient’s age and the condition of the breast buds that have developed, a physician may also conduct other testing including:
- Blood tests.
- Mammograms.
- X-rays of the chest area.
- CT-scans or MRIs
- Biopsies of breast tissue.
- A testicular ultrasound.
The goal of diagnosis is to rule out other serious underlying health issues and, in some cases, to determine the cause of the hormone imbalance that led to the gynecomastia.
Treatment is typically limited for men suffering from gynecomastia, although underlying health problems that caused the breast growth may need to be treated. The breast buds themselves will typically go away over time without any medical intervention.
Doctors, therefore, might advice discontinuing a medication that resulted in the gynecomastia or may recommend resolving malnutrition or cirrhosis that led to the growth of the glandular tissues in the breasts. However, the breast buds themselves will simply be allowed to go away without medical intervention.
If the gynecomastia does not resolve itself and/or if there is significant pain, discomfort or embarrassment, treatment options including medication and surgery are both possible. Medications such as tamoxifen and raloxifene are often used off-label for the treatment of Gynecomastia, although the FDA has approved these medications only as cancer therapies.
Either a liposuction or mastectomy can also be an option. Liposuction is limited in its effectiveness because this procedure removes only fat in the breasts and not the breast gland tissue that has resulted in the development of breast buds. A mastectomy was traditionally a more invasive procedure, although it has become easier for patients to withstand since it can now be done on an endoscopic basis. This means only small incisions are used, shortening the recovery time of the patient.
Prognosis
For patients with gynecomastia, the prognosis is good provided there are no serious underlying problems that led to the hormonal balance. If the gynecomastia occurs as a result of normal hormone changes over the course of development or if the underlying health issue can be resolved, the patient should suffer no ill health effects due to the gynecomastia. For most people, the breast buds will go away on their own within one to two years maximum. If the breast buds do not resolve on their own, full removal of the breast buds is typically possible using surgical treatment options.