Gynecomastia

Caused by an imbalance of the hormones estrogen and testosterone, gynecomastia can affect one or both breasts, sometimes unevenly. Generally, gynecomastia isn't a serious problem, but men and boys with gynecomastia may suffer embarrassment from female-looking breasts.

In men, gynecomastia peaks between the ages of 50 and 80. At least one in four men are affected during this time.

Gynecomastia may go away on its own. If it persists, surgery may help.

To correct gynecomastia, Dr. Poulos typically combines liposuction with direct removal of tissue through a small incision. Recovery time is typically 1-2 weeks.

Medications that may contribute to gynecomastia development include flutamide, finasteride (Proscar) and spironolactone (Aldactone).

• Anabolic steroids and androgens.
• AIDS medications. Gynecomastia can develop in HIV-positive men who are receiving a treatment regimen called highly active antiretroviral therapy (HAART). Efavirenz (Sustiva) is more commonly associated with gynecomastia than are other HIV medications.
• Anti-anxiety medications, such as diazepam (Valium).
• Tricyclic antidepressants.
• Antibiotics.
• Ulcer medications, such as cimetidine.
• Cancer treatment (chemotherapy).
• Heart medications, such as digoxin (Lanoxin) and calcium channel blockers.

Street drugs and alcohol

Substances that can cause gynecomastia include:

• Alcohol
• Amphetamines
• Marijuana
• Heroin
• Methadone

Health conditions

Several health conditions can cause gynecomastia by affecting the normal balance of hormones. These include:

• Hypogonadism: Any of the conditions that interfere with normal testosterone production, such as Klinefelter syndrome or pituitary insufficiency, can be associated with gynecomastia.
• Aging: Hormone changes that occur with normal aging can cause gynecomastia, especially in men who are overweight.
• Tumors: Some tumors, such as those involving the testes, adrenal glands or pituitary gland, can produce hormones that alter the male-female hormone balance.
• Hyperthyroidism: In this condition, the thyroid gland produces too much of the hormone thyroxine.
• Kidney failure: About half the people being treated with regular hemodialysis experience gynecomastia due to hormonal changes.
• Liver failure and cirrhosis: Hormonal fluctuations related to liver problems as well as medications taken for cirrhosis are associated with gynecomastia.
• Malnutrition and starvation: When your body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance. Gynecomastia can also occur once normal nutrition resumes.

Gynecomastia can be seen in individuals whose health profile includes:

• Adolescence
• Older age
• Use of anabolic steroids or androgens to enhance athletic performance
• Certain health conditions, including liver and kidney disease, thyroid disease, hormonally active tumors, and Klinefelter syndrome

Tests and diagnosis

Your doctor will ask you questions about your medical and drug history and what health conditions run in your family. The doctor will also do a physical examination that may include careful evaluation of your breast tissue, abdomen and genitals.

Initial tests to determine the cause of your gynecomastia may include:

• Blood tests
• Mammograms

You may need further testing depending on your initial test results, including:

• Chest X-rays
• Computerized tomography (CT) scans
• Magnetic resonance imaging (MRI) scans
• Testicular ultrasounds
• Tissue biopsies

Conditions that cause similar symptoms

Your doctor will want to be sure your breast swelling is actually gynecomastia and not another condition. Other conditions that can cause similar symptoms include:

• Fatty breast tissue: Some men and boys have chest fat that resembles gynecomastia. This is called false gynecomastia (pseudogynecomastia), and it isn't the same as gynecomastia.
• Breast cancer: This is uncommon in men, but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.
• A breast abscess (mastitis): This is an infection of the breast tissue.

Treatments and drugs

Most cases of gynecomastia regress over time without treatment. However, if gynecomastia is caused by an underlying condition, such as hypogonadism, malnutrition or cirrhosis, that condition may need treatment. If you're taking medications that can cause gynecomastia, your doctor may recommend stopping them or substituting another medication.

Prevention

There are a few factors you can control that may reduce the risk of gynecomastia:

• Don't use illegal drugs: Examples include steroids and androgens, amphetamines, heroin, and marijuana.
• Avoid alcohol: Don't drink alcohol, or drink very little.
• Review your medications: If you're taking medication known to cause gynecomastia, ask your doctor if there are other choices.

The procedure is typically paid out-of-pocket. In rare instances, insurance will cover the procedure.