A common condition in men and boys, gynecomastia is a swelling of the breasts. Men and women both have breast glands, but they are generally not noticeable on a man’s chest because the glands are small and undeveloped.

What is Gynecomastia Anyway?

The enlargement of breast glands in males may affect new born boys, pubescent boys, and older men. Ninety percent of cases resolve themselves by adulthood. The incidence of enlarged breast tissues begins to increase again as men get older.

The Distinction Between Excess Fat and Gynecomastia

When a man is overweight and he appears to have breasts, this is not necessarily Gynecomastia. The extra fat does not create extra breast tissue. It is not possible to lose weight or exercise adequately to be able to reduce the size of breast tissue, but it is possible to exercise to reduce fat.

If you diet, the overall size of the appearance of the breasts may be minimized, but the breast tissue itself will not be reduced in gynecomastia. In fact, bodybuilders are often prone to gynecomastia, so it is obviously not about being out of shape, all the time.

Fat building up in the breasts on the chest is called Pseudo gynecomastia. This is a different condition, as fat builds up in the breast area, because of excess weight or obesity. This would simply be fat appearing to be breasts, with no abnormal breast tissue at all. Diet and exercise are usually the best treatment for this.


What Are the Causes of Gynecomastia

There are several factors could lead to gynecomastia. Many are within your control.

An imbalance between sex hormones estrogen and testosterone can cause gynecomastia.

Estrogen is the “female” hormone, which therefore is responsible for making breast tissue grow. Testosterone is the “male” hormone which is therefore responsible for stopping estrogen as it tries to make the male breast tissue grow.

Males and females all have estrogen and testosterone, but the testosterone is in higher concentrations in men. Women have higher concentrations levels of estrogen. When these two hormones are out of balance in a baby, teenager, or a man, there is a risk of the estrogen being sufficient to support the growth of breast tissue.

The American Family Physician says that up to 1 in 9 newborn baby boys have breast tissue that can be felt by hand. High levels of estrogen are passed from the mother on to her newborn son, so these high levels of the female hormone cause the breast tissue to swell in the baby. Within weeks, the estrogen levels should return to normal levels for the baby. When it does, the swelling naturally goes away.

Newborn boys, and pubescent boys are at highest risk for enlarged breast tissue. Adult men have little incidence, until they get older. It becomes more common again among middle aged men, and seniors. Older men are generally producing less testosterone than they did in their youth, and often they have more fat than they did when they were younger. Both the lower testosterone, and the higher fat levels can increase estrogen production and ultimately swell breast tissues in these older men.

Risk Factors for Gynecomastia

Some risk factors can be influenced by the man, and others may be more out of his direct control. Risk factors could include:

  • Liver Disease
  • Kidney Disease
  • Tumors of Testes
  • Tumor of the Pituitary Gland
  • Tumors on the Adrenal Glands
  • Alcohol abuse
  • Klinefelter’s Syndrome
  • Radiation Treatments of Testicles
  • Hyperthyroidism
  • Tumors anywhere in the body that are Hormonally Active
  • Ten to twenty percent of Gynecomastia cases stem from the patient’s medication or herbal supplement use.
  • Twenty five percent of all cases have completely unknown causes.
  • There could be a link between gynecomastia and some illegal drugs.

Can Medications Cause Gynecomastia? If So, Which?

The medications that have been known to cause breast enlargement in men include:

  • Tricyclic Anti Depressants
  • Anabolic Steroids
  • Valium (Diazepam) and several other drugs that are given to treat Anxiety
  • Some Antibiotics
  • Some types of Ulcer Medication
  • Chemotherapy
  • HIV Medication, specifically Efavirenz, (also called Sustiva)
  • Calcium Channel Blockers, Digoxin and other Heart Disease Medications
  • Drugs that are most commonly prescribed to patients with prostate enlargement or cancer, which are called Anti-Androgens.
  • Lavender and Tea Tree Oil as used in creams or shampoos have been suggested, but at least one meta-analysis says there is onlypoor quality evidence to support such a claim.

Can Muscle Building Supplements Cause Gynecomastia?

Men with a ‘good physique’ commonly find that their steroid use is an expected cause of breast enlargement, so reports Plastic and Reconstructive Surgery®, which is the official medical journal of the American Society of Plastic Surgeons (ASPS). Breast reduction surgery can achieve a good aesthetic outcome for these male bodybuilders with even severe enlargement of their breast tissues.

Registered Plastic Surgeon Mordcai Blau, MD, who works in White Plains, N.Y. in private practice has extensive experience with surgery for gynecomastia in bodybuilders. He explains that his patients have characteristics and technical issues in common. They are generally dealing with anabolic steroids plus hormone supplements as the causes for their enlarged breasts. He explains that they are often perfectionists who are keenly interested in exactly what the outcome will be aesthetically. He works closely with his patients to be certain their expectations are met, and their gynecomastia symptoms disappear.

Self-confidence and Embarrassment

Not normally a serious physical health problem, research shows that gynecomastia often affects a man’s self-confidence and causes embarrassment.

Breast enlargement in men and pubescent boys negatively affects their self-esteem and mental and emotional health. The April 2013 issue of Plastic and Reconstructive Surgery®, which is the official journal for the ASPS, (American Society of Plastic Surgeons) focused on the mental health effects on teens.

“Significant deficits in general health, social functioning, mental health, self-esteem, and eating behaviors and attitudes compared with controls,” are noted in teen boys with gynecomastia, says Brian Labow from Boston Children’s Hospital, MA.

Teens deal with different issues than adult men, as they work through other significant changes physically and emotionally. It is estimated that up to 65 % of all pubescent boys have some degree of breast tissue swelling, temporarily, during their teen years.

If the gynecomastia is unusually persistent, there are several treatments available.


What Are the Symptoms of Gynecomastia?

The symptoms of gynecomastia include:

  • Tenderness and swelling of the breast gland tissues in one or both of the breasts.
  • The area of darker pigmented skin surrounding the nipple, the areola, could increase in size, and chest tissues may begin to appear asymmetrical or lop- sided.
  • Unusual or persistent tenderness, swelling, pain, or discharge, or any combination thereof, means it is time to see a physician, immediately. These are not typical signs of simple breast enlargement, but could be symptoms with a much more serious underlying cause.

How to Know If You Have Gynecomastia?

A visit to the doctor is required to confirm the diagnosis.

Your doctor asks you about your symptoms, drug and medical history, and family history. You will have a physical exam of your breast tissue, abdomen and genitals.

If it appears there is a hormonal imbalance, the doctor normally advises the patient the condition will likely resolve itself within the year.

With lumps that are abnormally tender, large, one-sided, hard and fixed, or if they are associated with any nipple discharge, the doctor will likely order a biopsy, so that breast cancer can be ruled out.

Other Medical Tests

Other medical tests will work to eliminate other potential causes, like:

  • Cysts
  • Furuncles or Abscesses
  • Benign tumors likelipomas or hamartomas
  • Inflammation of the breast tissue, called Mastitis
  • Solid swelling of clotted blood or a Hematoma
  • Cancer that spread from somewhere else in the body, called Metastasis
  • Lumps that are a result of underlying damage to the fatty breast tissue, called Fat necrosis
  • Often blood tests are completed

Imaging Tests Often Include:

  • Breast Ultrasound
  • Mammogram
  • Chest X-ray
  • CT scan
  • MRI
  • Testicle Ultrasound
  • If appropriate, a biopsy of the tissues will take cells or tissue samples from the targeted area in the breast to be examined under the microscope at a lab.

How to Get Rid of Gynecomastia?

There are several different treatment options for Gynecomastia.

  • Gynecomastia usually resolves without treatment, but when there are underlying conditions, they will need to be treated.
  • When the gynecomastia is stemming from the use of a medication, switching to a different drugs usually clears up the problem. Sometimes the medication, like an antibiotic, would only be used for a short time anyway, in which case the condition will only be temporary.
  • When your gynecomastia has not resolved within 2 years, is causing embarrassment, tenderness, or pain, active treatment might be required. Ask your doctor.

What Are the Treatment Options?

Treatment for gynecomastia is actually quite rare as compared to how frequently the condition arises in men and boys. Your options will include surgery for breast reduction and hormone therapy that blocks the effects of estrogen. There are some natural treatment options, too.

Tamoxifen – Hormone Therapy That Blocks the Effects of Estrogen

Used for the treatment and prevention of breast cancer, Tamoxifen blocks the actions of the hormone estrogen. It also reduces the symptoms of breast enlargement and pain in men. It is specifically helpful with gynecomastia with breast pain that was caused by bicalutamide, which is used to treat prostate enlargement or cancer.

Tamoxifen dosages and treatment schedules have not been established definitively. So far, it has been unclear if prophylactic treatments are more effective than a therapy that is delivered at the early onset of the gynecomastia during the bicalutamide treatment. Italian researchers have compared prophylactic activities of tamoxifen take at the low dose of 10 mg to the therapeutic activity when it is administered at the typical dose of 20 mg when the initial signs of gynecomastia are noted in patients who take bicalutamide at a dose of 150mg/day for the treatment of prostate cancer.

The conclusion has been made that gynecomastia plus breast pain, even although it is reduced, still persists. 56% of patients still had gynecomastia and 34% still suffered from breast pain using the tamoxifen at a dosage level of 20mg/daily. Fortunately, gynecomastia induced bicalutamide sees a significant reduction, even though it is not completely eliminated, by using the tamoxifen as a prophylactic at a dose of 10 mg a day.

Aromatase Inhibitors

Aromatase inhibitors are used to treat ovarian and breast cancer in post-menopausal women and is used off-label as a prevention or treatment for gynecomastia in men.

Testosterone Replacement

Gynecomastia in older men who have low testosterone levels benefit from testosterone replacement therapy.


Are There Natural Remedies for Gynecomastia?

Men turn to natural remedies for gynecomastia, often before considering the more radical, traditional approaches. These are the recommended natural gynecomastia treatments.

  • Omega 3 fatty acids plus Zinc
  • Devil’s Claw
  • Mile Thistle
  • Turmeric
  • Guggul
  • Red Clover

By avoiding some foods, herbs, spices, and oils you may be able to treat or prevent your gynecomastia.

Avoiding things, such as:

Pollutants – Most specifically lead. Lead has a direct link with gynecomastia

Eating Soy based products – Soy products are known to drastically increase your estrogen levels. Stay away from Tofu!

Alcohol – Alcohol also encourages female hormone production and worsens the symptoms of gynecomastia

Cut your Salt intake – Salt will help retain fluids in your body

Lavender and Tea Tree oils Lavender and Tea Tree oils are absorbed into your skin, no matter where they touch you, not just on your chest. They will then go into your blood stream and that will take them all over your body, including into your breasts.  Be absolutely certain you do not come into contact with the oils, in their pure forms, or as ingredients in any cream, shampoo or other personal care or natural remedy.  and not just your chest region, but your hands, face or hair as well.

Homeopathy has been tried as a treatment but, unfortunately, the homeopathic remedies have not as yet showed to be very successful.

Ayurvedic treatments have worked for some people. Visit a specialist to see if you can be one of those people.

Gynecomastia Surgery

A Focus on Gynecomastia Surgery in Bodybuilders

Dr. Blau is considered to be an expert in breast reduction for men as he has performed the surgery in close to 1,600 bodybuilders and patients with what is referred to as a “good physique.” The latest report follows 1,073 patients, for 1 to 5 years after their surgery was performed.

The men were 18 to 51 years old. 15 % of them were competitive bodybuilders. They were all without hormonal imbalances or other underlying disease that causes gynecomastia. Sometimes, the gynecomastia developed in adolescence, which is usually temporary, but it became permanent once the patients had started to use steroids or supplements of hormones.

“Gynecomastia surgery calls for a different approach in bodybuilders”, Dr. Blau said. “In contrast to other groups of gynecomastia patients, who tend to be overweight or obese, bodybuilders usually don’t need removal of excess fat or skin.”

Bodybuilders do require special attention for the prevention of excessive bleeding and ugly scarring. The bleeding risk tends to be higher because of the blood flow being increased in highly developed chest muscles. Any use of steroids or unregulated supplements like protein shakes, vitamins, or fish oil might increase the bleeding risk, too.


How Much Does a Gynecomastia Surgery Cost?

On average the cost of the gynecomastia surgery itself is $3,641, this according to the 2017 statistics from the American Society of Plastic Surgeons. Gynecomastia surgery costs really do vary widely depending on the city, state, hospital or clinic and the surgeon. That average cost does not include any anesthesia, the operating room facilities or any other related expenses. More typically the total will be $6,000 to $8,500 once you are out of the hospital. There can be additional fees associated with visits to the surgeon, pre and post operatively.


What is the Recovery Time After Gynecomastia surgery?

Your chest will be swollen and bruised after surgery. You will likely need to wear an elastic pressure band garment for about 2 weeks. This will help to reduce the swelling.

Normally, it takes 6 weeks or so to be able to return to your normal routine. The complications from this surgery are quite rare. Insufficient removal of the breast tissue, contouring of the chest being uneven, or a reduced level of sensation in the nipples are possible complications.

There is a small risk of the formation of a blood clot. This could require draining.

Most Gynecomastia Cases Completely Resolve Without Intervention

Most often, gynecomastia cases will completely resolve without the requirement for any intervention or treatment. When treatment is required, it is generally very successful. Generally, gynecomastia is not considered to be connected with significant health problems in the future for the patients. The National Cancer Institute says there is a “slightly increased risk of breast cancer in men with gynecomastia.”

References:

https://www.cancer.gov/news-events/press-releases/2014/BreastCancerMalePoolingStudy

http://baaps.org.uk/procedures/gynecomastia

http://www.aafp.org/afp/2012/0401/p716.html%20%20%5Ct%20_blank

https://www.ncbi.nlm.nih.gov/pubmed/17825496

http://wolterskluwer.com/company/newsroom/news/health/2013/04/gynecomastia-has-psychological-impact-on-adolescent-boys-reports-plastic-and-reconstructive-surgery.html

https://journals.lww.com/plasreconsurg/pages/default.aspx

https://www.plasticsurgery.org/

https://www.ncbi.nlm.nih.gov/pubmed/14759718

https://www.cancer.gov/news-events/press-releases/2014/BreastCancerMalePoolingStudy