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Gynecomastia - Symptoms, causes and treatment

Gynecomastia is a condition when the male breast glands enlarge. This enlargement can occur in one or both breasts and is accompanied by complaints in the form of breasts that feel supple, but do not feel pain.

Gynecomastia - Symptoms, causes and treatment


Gynecomastia can occur naturally due to hormonal changes in men of all ages, both in newborns to adults. However, in certain cases, gynecomastia can be a sign of a more serious disease.


Causes of Gynecomastia

Gynecomastia most often occurs due to an imbalance of the hormones estrogen and testosterone. Estrogen is a hormone that plays an important role in regulating female sexual characteristics, such as breast growth.


Meanwhile, testosterone is a hormone that regulates male sexual characteristics, such as muscle growth and body hair.


The hormones estrogen and testosterone can be found in men and women, but in different ratios. If estrogen levels increase or testosterone levels decrease in men, gynecomastia can occur.


Imbalance of these two hormones can occur naturally or as a result of certain conditions and diseases. Hormonal changes in men can occur due to the following factors:


Birth

Baby boys can have large breasts due to estrogen obtained from his mother while still in the womb. However, breast size will generally return to normal about 2-3 weeks after birth.

Puberty

The drop in testosterone and the surge in estrogen during puberty can cause male breast tissue to grow. Generally, breast size can return to normal within 6 months to 2 years.

Adulthood

Breast enlargement is more common in men aged 50-80 years due to decreased levels of the hormone testosterone. In addition, having a lot of body fat can also stimulate the production of the hormone estrogen which causes gynecomastia.


In addition to occurring due to the factors above, there are several conditions or diseases that can cause gynecomastia, namely:

  • Chromosomal abnormalities, such as Klinefelter syndrome

  • aging

  • Hyperthyroidism

  • Obesity

  • Cirrhosis

  • Hypogonadism

  • Tumors affecting the testes or adrenal glands

  • heart failure

  • Kidney disease or kidney failure


Gynecomastia can also be caused by the use of a number of drugs or substances, such as:


  • Antiandrogen drugs, such as finasteride and spironolactone

  • Calcium antagonists for hypertension, such as amlodipine, or ACE inhibitors, eg captopril

  • Tranquilizers, such as diazepam

  • Heart disease medications, such as digoxin

  • Antibiotics, such as metronidazole

  • Ulcer medications, such as cimetidine

  • Fungal infection medications, such as ketoconazole

  • Drugs for chemotherapy

  • Muscle-building supplements, such as anabolic steroids

  • Drugs, such as heroin and marijuana

  • Alcoholic beverages


Gynecomastia Symptoms

Just like women, men also have breast glands, but they are smaller and underdeveloped. The size of the breast glands in men is generally less than 0.5 cm.


The main symptom of gynecomastia is breasts that are larger than the size of male breasts in general. This enlargement can occur in one or both breasts. The size of the enlarged breast can also vary on each side.


In addition to bulging breasts, men with gynecomastia may experience complaints in the form of breasts feeling supple or tight, pain, and nipples that are more sensitive when rubbing against clothing.


When to go to the doctor

Check with a doctor if you experience breast enlargement so that the cause can be identified. You are also advised to seek medical attention immediately if the breasts appear protruding and are accompanied by other complaints, such as:


  • Swelling

  • Breast pain when pressed

  • Breast lump

  • Discharge or pus from the nipple

  • There are sores or ulcers on the skin of the breast or around it


Gynecomastia Diagnosis

To diagnose gynecomastia, the doctor will ask about the patient's symptoms, medical history, and medications being taken. Next, the doctor will perform a physical examination, including measurement of height and weight, examination of the breasts, abdomen, and genitals.


Additional tests may also be performed to confirm the diagnosis, including:


  • Blood tests, to check liver, kidney, and thyroid function, and measure hormone levels in the blood

  • Scan with mammary ultrasound, CT scan, or MRI to detect breast tissue growth

Symptoms of gynecomastia can be similar to those of other diseases. To confirm the diagnosis, the doctor will perform a biopsy by taking a sample to be examined under a microscope.


Some diseases that can cause symptoms similar to gynecomastia are:


Breast cancer

Although rare, breast cancer can be experienced by men. Enlarged breasts with hard lumps can be a sign of breast cancer in men.


Breast abscess

A breast abscess is characterized by the appearance of a pus-filled lump in the breast. On scans, breast abscesses often look like gynecomastia.


Pseudogynecomastia

Pseudogynecomastia is also similar to gynecomastia, but this condition occurs due to the presence of fat deposits in the breasts.



Gynecomastia Treatment

Naturally occurring gynecomastia can resolve over time without treatment. However, gynecomastia caused by certain diseases, such as cirrhosis, hypogonadism, or kidney failure, requires immediate medical attention.


If gynecomastia is caused by taking medication, the doctor will ask the patient to stop taking the drug or replace it with another drug.


In adolescents with gynecomastia, the doctor will conduct periodic evaluations every 3-6 months to see if the condition can improve. This is because gynecomastia in adolescents generally goes away in less than 2 years.


If within the specified period the patient's condition does not improve, the doctor can treat it with hormone therapy. The types of drugs that can be given are tamoxifen and raloxifene.


In certain cases, doctors may perform surgery to treat gynecomastia. The surgical procedure can be in the form of liposuction or mastectomy. Liposuction aims to remove breast fat, while mastectomy aims to remove the breast glands.


Gynecomastia Complications

Gynecomastia can make sufferers feel insecure, causing anxiety and depression. In addition, men with gynecomastia are more at risk of developing breast cancer.


Gynecomastia Prevention

Most cases of gynecomastia cannot be prevented, because it is caused by changes in the body's hormones that occur naturally. However, there are several efforts that can be done to reduce the risk of developing gynecomastia, namely:


  • Avoid consumption of alcoholic beverages

  • Avoiding the use of drugs to increase muscle mass, such as steroids, and drugs, such as heroin and marijuana

  • Regularly consult a doctor if you suffer from a disease or are undergoing treatment that has a risk of causing gynecomastia

  • Maintain ideal body weight

  • Undergo hepatitis vaccination and practice healthy sexual behavior to avoid hepatitis which can develop into cirrhosis


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