What is it about ?
Excessive breast development in boys and men is called “gynecomastia”.
An imbalance between the female hormone (estrogen) and the male hormone (testosterone) causes swelling of the mammary gland tissue of one or both breasts.
The cause varies from one age group to another. In newborns, adolescents and men over 50, it is usually a natural phenomenon:
- At birth, all babies (both little boys and girls) have glandular tissue in the breast. In the womb, the baby receives estrogen from the mother through the placenta. This mammary glandular tissue usually disappears on its own after the first weeks of life and before the age of 1 year;
- During (pre) puberty, when hormones temporarily panic, the ratio of estrogen to androgen changes, which can lead to breast development. In this case, the gynecomastia is often asymmetric and transient. Very often (more than 9 times out of 10), this mammary glandular tissue disappears within 2 years;
- Older and overweight men produce less and less male hormone and more and more estrogen, which results in swelling of the breasts.
In some cases, gynecomastia can be caused by:
- Medication: hormones, certain diuretics, antidepressants, heart medications, stomach medications, cancer hormones;
- A disease (in rare situations): hormonal disorders and tumors (problems with the testes, adrenal glands, pituitary gland), genetic abnormalities (for example Klinefelter syndrome), liver, kidneys and thyroid;
- Drug use (cannabis and amphetamines);
- Doping (anabolic steroids);
- Excess weight (in fatty tissue androgens are converted into estrogen);
- Food supplement (if it contains some type of estrogen).
Gynecomastia does not increase the risk of breast cancer.
What is its frequency?
The natural, mild variant of gynecomastia is common among boys and men. Between the ages of 10 and 15, about 1 in 2 boys have gynecomastia. In the 50-69 age group, it affects 7 out of 10 men.
Men on hormone therapy for cancer treatment develop gynecomastia more than half of the time.
How to recognize it?
Gynecomastia is recognized by the swelling of 1 or 2 breasts. It usually takes on the appearance of an elastic swelling, circular and flat, located under the nipple. The swelling may be tender or painful. Sometimes it is accompanied by a discharge of fluid from the nipple.
How is the diagnosis made?
The doctor examines the breasts: he checks whether the swelling is behind the nipple, whether it is soft, hard or elastic and whether it is present on both sides. It can thus make the difference between gynecomastia, pseudogynecomastia (increase in adipose tissue) and breast cancer. He examines whether there is a nipple discharge.
He looks for signs of liver, kidney or thyroid disease, hormonal changes or disorders, such as a change in hair, testicles …
He asks you about the existence of other symptoms such asincapacity or decreased libido.
He then reviews your use of medications, supplements, and drugs.
If necessary, he can perform a blood test to assess hormones. In some cases, a genetic analysis is performed, most often in a specialized center.
If necessary, an ultrasound and / or mammogram (a special form of breast x-ray) may be ordered.
What can you do ?
If your breasts develop during puberty or after the age of 50, this is usually a mild problem and you don’t need to act on it.
However, contact your general practitioner in the following cases:
- Breast development between the ages of 16 and 50;
- Swelling appeared in a short time;
- Puberty-related gynecomastia, which does not go away after 2 years;
- Presence of other symptoms such as redness, warmth of the swelling and / or fever;
- Nipple discharge;
- Feeling of worry.
Try to reach and / or maintain a normal weight. Inform your doctor about all medicines, herbal products and food supplements that you use and do not take drugs or doping products.
What can your doctor do?
Most often, one can wait for the swelling to go away on its own. However, this swelling usually does not go away after the age of 50. Surgical removal of the breast tissue may be considered if you experience cosmetic discomfort.
If gynecomastia is the result of taking medication, your doctor will advise you to stop it. If the cause is other, it will usually be necessary to treat the cause in question.
Gynecomastia can be treated with hormone-based medicines, such as antiestrogens (eg tamoxifen).