Gynecomastia is swelling of the breast tissue in men and can be caused by numerous hormonal imbalances (decreased testosterone and increased estrogen) in the body as well as being a side effect of certain medications. The condition may involve one or both breasts and in the latter, the involvement can be uneven. Gynecomastia is usually not a serious problem but it can be a cosmetic issue making it tough for some involved individuals to cope with.
Gynecomastia can cause breast tenderness and affected individuals are urged to consult with their doctor if they experience any swelling and pain that is causing great discomfort or if there is any discharge from the nipples.
There are several groups of causes of gynecomastia and these may include any of the following:
- Hypogonadism – any medical issues that affect the production of testosterone by the testicles can be associated with gynecomastia.
- Hyperthyroidism – increased production of thyroid hormones can affect testosterone and estrogen levels in the body.
- Liver and/or kidney failure – a failure of these organs can lead to hormonal fluctuations and thus gynecomastia.
- Malnutrition – when the body doesn’t receive adequate and essential nutrition then testosterone levels drop. Estrogen levels remain constant though resulting in a hormonal imbalance leading to gynecomastia.
- Cancers – some cancers, especially those that involve hormone-producing organs such as the pituitary gland, adrenal glands and testes can cause hormonal imbalances.
- Medications such as finasteride and flutamide, which are anti-androgens used to manage conditions such as prostate enlargement or cancer as well as spironolactone used to treat heart failure can cause gynecomastia.
- Androgens and anabolic steroids can cause testosterone levels to drop due to the body ceasing production of the hormone since it is received from another source.
- Efavirenz, a medication used to help control the viral load in HIV positive patients can also cause this condition.
- Anti-arrhythmic drugs such as digoxin and calcium channel blockers used to control one’s blood pressure.
- Stomach acid-controlling medications such as cimetidine.
- Anti-anxiety drugs such as diazepam and antidepressants such as those belonging to the tricyclic group.
Most of the mentioned causes of gynecomastia can resolve over a period of time without having to treat the condition. If, however, the cause of the gynecomastia is due to an underlying medical condition then any such cause needs to be managed appropriately in order for the gynecomastia to resolve. Medications that cause the condition will need to be stopped and changed to an alternative drug.
If gynecomastia doesn’t resolve on its own or it causes great discomfort for the patient then certain medications such as the aromatase inhibitors, raloxifene, or tamoxifen can be used.
If all these measures are ineffective then surgical intervention may be considered. This may include therapies such as:
- Liposuction – slender surgical instruments are used to remove excess fat tissue from the breast without causing any damage to the glandular tissue.
- Mastectomy – here, breast gland tissue is removed via an endoscopic procedure. This means that small incisions are made in the skin and small surgical instruments and a camera are used to perform the procedure. This is a less invasive surgery which means that the patients have a shorter recovery time and are less prone to developing post-surgical complications such as wound sepsis.
These surgeries can be performed by board-certified plastic and reconstructive surgeons and patients with gynecomastia that doesn’t resolve through conservative and medical measures are urged to consult with these specialists.