Gynecomastia is swelling of the mammary gland in men. Indeed, the man has two mammary glands located under the nipples… just like the woman. This swelling of the mammary glands can occur on both sides or only one side and it occurs because of the effects of certain hormones.

Swelling from tumors is not gynecomastia.

When a man’s mammary gland has been stimulated by hormones and is swollen, if one does not act quickly enough in treating it, the breast volume can remain troublesome afterwards. In this case, alongside a treatment that is a little too late, surgery to remove the gland can make it possible to find an aesthetically more masculine thorax.

When the mammary gland remains swollen and gynecomastia is left untreated, cysts, fibroadenomas, such as in women’s breasts can occur. On the other hand, it is rare for breast cancer to occur in a man with gynecomastia.

A man has gynecomastia because there is an imbalance between estrogen-like hormones (which stimulate the proliferation of the mammary gland, for example at puberty in women) and the androgens which slow down this proliferation.

Thus, gynecomastia can be linked to an increase in the level of estrogen hormones or to a lowering of androgen-type hormones (testosterone in particular). Gynecomastia can be confused with what’s called lipomastia, which is an increase in the volume of fat around the nipples, without an increase in the volume of the mammary gland itself.

Gynecomastia is linked to a change in the hormonal balance between estrogen and androgen.

• Estrogens stimulate the proliferation of the mammary gland, so if they increase, the gland swells.
• Androgens (including testosterone) on the contrary block the proliferation of the mammary gland, so if they lower the gland can swell.

Normal gynecomastia

Many gynecomastias are unrelated to a health problem. These are physiological (or normal) gynecomastias.

In newborns, swelling of the mammary glands is normal and almost 90% of them have gynecomastia. It is linked to the passage of placental hormones (estrogen) through the circulation. It is a transient phenomenon which ceases on its own sometime after birth.

In adolescents, more than half of boys have gynecomastia around the time of puberty. This is a normal phenomenon generally occurring around 13-14 years old and linked to the hormonal phenomena of puberty. It lasts between 6 months and 2 years and it can be scary for a teenager, even if it is commonplace.

In older men, gynecomastia can appear with age after 50 years. The older we get, the more frequent this swelling of the mammary gland is. It is linked to the decrease in androgens over the years.

Gynecomastia related to an abnormality or disease

 

Some gynecomastias persist after adolescence and are therefore present in adult men. This represents ¼ of cases of gynecomastia in adult men. Medically, it does not have a serious nature, but it can be aesthetically embarrassing.

Gynecomastia due to the side effect of drugs

They also represent ¼ of gynecomastia in adult men.

The treatments in question are drugs that block androgens (cyproterone acetate, ketoconazole, spironolactone, finasteride, certain anti-HIV treatments, etc.), certain antibiotics (ethionamide, Isoniazid, etc.), anti-ulcer drugs cimetidine, ranitidine, omeprazole, etc. ), certain chemotherapies, amphetamines, hormonal treatments, central nervous system drugs (psychotropic drugs such as diazepam, haloperidol, tricyclic antidepressants, etc.), antihypertensives (ACE inhibitors or ACE inhibitors, anti-calciums), theophylline, amiodarone, etc. Alcohol, which is not a drug, is also often involved because it is a toxic substance with this side effect of causing gynecomastia, just like heroin or cannabis.

Gynecomastia with no known cause found

They also represent ¼ of gynecomastia. They are often present in overweight older men, possibly with other unknown factors as well.

• Diseases causing poor functioning of the testes (they produce androgens), trauma, surgery, radiotherapy to the testicles can be the cause of gynecomastia.
• Cirrhosis and malnutrition are also causes of gynecomastia,
• Tumors of the testes or adrenal glands (glands that are sources of androgens),
• Chronic renal failure,
• And other diseases that are much rarer.

Gynecomastia is an increase in the size of the mammary gland. It is perceived by palpating, under the nipple, a swollen gland. This can be discovered on examination by a doctor or by the man himself who then consults because he is embarrassed.

Since gynecomastia is linked to hormones circulating in the blood, both mammary glands are often affected. However, sometimes only one of the two glands can swell, because the tissues of the two mammary glands may have different sensitivity to hormones.

It is also important to observe whether there is any discharge from the nipples by pinching around the areola.

Swelling in the nipples in men can also be lipomastia, an increase in the volume of fat without an increase in the volume of the mammary gland. The consistency is then softer, is not centered on the nipple and is often associated with excess weight. 

• Newborns (normal gynecomastia)
• Adolescents (normal gynecomastia)
• Men over the age of 50 (usually normal gynecomastia unrelated to disease) are affected in approximately 50% of cases.
• Overweight men have a higher risk of gynecomastia. This is because fatty tissue has a hormonal effect. It works by converting androgens (anti-gynecomastia) into estrogens (pro-gynecomastia).
• Men taking certain drugs that can affect hormones.
• Men with diseases in which hormones are involved.

When a newborn or teenager has gynecomastia, it is not necessary to see a doctor.

In the case of a teenager, if the gynecomastia lasts more than a year or two, if it seems very important, it can be reassuring to seek the advice of a doctor, however.

The doctor to consult is the general practitioner or a specialist in hormones, the endocrinologist.

In a young (non-adolescent) man with swelling of the mammary glands on one or both sides, a doctor should be consulted.

If you are taking medication, you should read the package leaflets and side effects to see if this treatment is likely to lead to gynecomastia. In this case, it is as often as possible for the doctor to change the treatment.

Exams 

• Examination by the doctor: In front of a swelling under the nipples, the doctor begins by examining the man. He feels this swelling, pinches the nipples to see if there is a discharge.
• He also examines the testes, the thyroid gland, palpates the liver as these organs are involved in hormonal functioning and an abnormality may be involved in gynecomastia.
• Complementary examinations: these examinations are not always useful because a large number of gynecomastias do not show any disease …

When these examinations are necessary, they may consist of a breast ultrasound (completely painless ultrasound examination). Sometimes a mammogram (x-ray) may be ordered as well as an ultrasound of the testes and thyroid gland.

• Blood test: it is useful for determining what is happening with the hormones of a man with gynecomastia. This is therefore a thorough hormonal assessment (with in particular a dosage of FSH, LH, prolactin, estradiol, total and bioavailable testosterone, beta-hCG and SHBG).

Dr Catherine Solano general practitioner and andrologist:

“Swelling of the breasts in adolescent boys is very common since more than half of them have it. It is important to reassure them and tell them that it should pass in a few months (maximum 2 years). In older men, it is a frequent phenomenon which, if it is embarrassing, may justify cosmetic surgery. And then it is essential to read the undesirable effects of a drug in the leaflet in the event of the appearance of gynecomastia, because this is the most frequent cause … ”

Medical treatment for abnormal gynecomastia should be prompt, within the first 6 to 12 months, when the gland is swollen and tender. Indeed, thereafter, even if the treatment restores a satisfactory hormonal balance, the gland risks retaining a certain volume, the treatment no longer being able to make it deflate. 

• The first treatment is of course that of the cause. Stop the drug that is the source of gynecomastia to prefer a drug that does not have this adverse effect, treat the disease in question, lose weight …
• The treatment of gynecomastia, aimed at reducing the size and swelling of the mammary gland can consist of a drug like tamoxifen or raloxifene because they allow a reduction in the volume of the gland in more than 80% of cases. Danazol or anastrozol can also be used but are rather less effective.
• In the event of DALA, androgen deficiency linked to age (lowering of testosterone levels with age), a man with gynecomastia can receive testosterone-based treatment when there is no contraindication.
• Surgery allows a man with gynecomastia to have his mammary gland removed and restore proper aesthetics. However, this should not prevent treatment of the defect in question if it exists. The scar is then around the areola and it is extremely discreet or even invisible after a certain healing time.

There are also suction techniques with a scar under the armpit or a very small incision around the areola.