Gynecomastia is a swelling of the mammary gland in humans. 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 on one side and it occurs because of the effects of certain hormones.
Tumor swellings are not gynecomastia.
When a man’s mammary gland has been stimulated by the hormones and is swollen, if one does not act quickly enough by caring for it, the breast volume may remain troublesome thereafter. In this case, next to a treatment a little too late, a surgery to remove the gland can help to find an aesthetically more masculine chest.
When the mammary gland remains swollen and gynecomastia is not treated, cysts and fibroadenomas may occur, as in women’s breasts. On the other hand, breast cancer rarely occurs in men with gynecomastia.
Why is there a 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 that slow down this proliferation.
Thus, gynecomastia may be related to an increase in the level of estrogen hormones or to a lowering of androgen-like hormones (testosterone in particular). Gynecomastia can be confused with so-called lipomastia, increasing the volume of fat around the nipples, without increasing the volume of the mammary gland itself.
Gynecomastia is related to a change in the hormonal balance between estrogens and androgens.
- Estrogens stimulate the proliferation of the mammary gland, so if they increase, the gland swells.
- Androgens (including testosterone) instead block the proliferation of the mammary gland, so if they lower the gland can swell.
Many gynecomastias are in no way related to a health problem. These are physiological (or normal) gynecomastia.
In the newborn, swelling of the mammary glands is normal and nearly 90% of them have gynecomastia. It is related to the passage of the hormones of the placenta (estrogen) in the circulation. It is a transient phenomenon that stops itself some time after birth.
In adolescents, more than half of boys have gynecomastia at puberty. This is a normal phenomenon usually occurring around 13-14 years old and related to the hormonal phenomena of puberty. This 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 age 50. The older we get, the more this swelling of the mammary gland is common. It is related to the decrease of androgens with the years.
Gynecomastia linked to an anomaly or an illness
Some gynecomastia persists after adolescence and is therefore present in adult men. This represents ¼ of adult men’s cases of gynecomastia. On the medical side, this is not serious, but it can be inconvenient aesthetically.
Gynecomastia due to the adverse effect of drugs
They also represent ¼ gynecomastia of the adult man.
The treatments in question are drugs blocking androgens (cyproterone acetate, ketoconazole, spironolactone, finasteride, certain anti-HIV treatments, etc.), certain antibiotics (ethionamide, Isoniazid …), anti-ulcerous cimetidine, ranitidine, omeprazole.3. … ), certain chemotherapies, amphetamines, hormonal treatments, medications of the central nervous system (psychotropic drugs such as diazepam, haloperidol, tricyclic antidepressants …), antihypertensives (angiotensin converting enzyme inhibitors or ACE inhibitors), theophylline, amiodarone, etc. Alcohol, which is not a drug, is also often involved because it is a toxic substance with the undesirable effect of causing gynecomastia, just like heroin or cannabis.
Gynecomastia without known cause found
They also represent ¼ gynecomastia. They are often present in overweight older men, probably also with other unknown factors.
- Diseases causing testicular malfunction (they make androgens), trauma, surgery, testicular radiotherapy can cause gynecomastia.
- Cirrhosis and malnutrition are also causes of gynecomastia,
- Tumors of the testes or adrenal glands (androgenic glands),
- Chronic kidney failure,
- And other diseases much rarer.
The symptom of gynecomastia
Gynecomastia is an increase in volume of the mammary gland. It is perceived by palpating, under the nipple, an inflated 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, the two mammary glands are often affected. However, sometimes only one of the two glands may swell, because the tissues of both mammary glands may exhibit differences in hormone sensitivity.
It is important to also observe if there is a flow in the nipples pinching around the areola.
Nipple swelling in humans may also be lipomastia, increased fat volume without increased volume of the mammary gland. The consistency is then softer, not centered on the nipple and is often associated with being overweight.
People at risk for gynecomastia
- Newborns (normal gynecomastia)
- Teenagers (normal gynecomastia)
- Men over the age of 50 (gynecomastia most often normal not related to a disease) are involved in about 50% of cases.
- Overweight men have a higher risk of gynecomastia. Indeed, the fatty tissue has a hormonal effect. It works by transforming androgens (anti-gynecomastia) into estrogen (pro-gynecomastia).
- Men taking certain medications that may influence hormones.
- Men suffering from diseases in which hormones are involved.
When to consult
When a newborn or a teenager has gynecomastia, it is not necessary to consult a doctor.
In the case of a teenager, if gynecomastia lasts more than a year or two, if it seems very important, it can be reassuring to seek the advice of a doctor.
The doctor to consult is the general practitioner or a hormone specialist, the endocrinologist.
In a young man (non-adolescent) with swelling of the mammary glands on one or both sides, a doctor should be consulted.
If you take medication, you should read the instructions and side effects to see if this treatment is likely to result in gynecomastia. In this case, it is most often possible for the doctor to change treatment.
- 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 flow.
- It also examines the testicles, the thyroid gland, palpates the liver because these organs are involved in hormonal functioning and an abnormality may be involved in gynecomastia.
- Complementary exams: these exams are not always useful because a large number of gynecomastia do not show any disease …
When these tests are necessary, they may consist of a breast ultrasound (completely painless ultrasound examination). Sometimes a mammogram (x-ray) can be requested as well as an ultrasound of the testicles and the thyroid gland.
- Blood test: it is useful to determine what happens to the hormones of the man suffering from gynecomastia. It is therefore a thorough hormonal assessment (with in particular an assay of FSH, LH, prolactin, estradiol, total and bioavailable testosterone, beta-hCG and SHBG).
Treatments of gynecomastia
Medical treatment of abnormal gynecomastia should be rapid, in the first 6 to 12 months, when the gland is swollen and tender. Indeed, even if the treatment restores a satisfactory hormonal balance, the gland may retain some volume, the treatment is no longer able to deflate.
- The first treatment is of course that of the cause. Stop the drug source of gynecomastia to prefer a drug that does not have this adverse effect, cure the disease, lose weight …
- The treatment of gynecomastia, aimed at reducing the size and swelling of the mammary gland may consist of a drug such as 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 case of DALA, age-related androgen deficiency (lowering testosterone levels with age), men with gynecomastia may receive testosterone-based therapy when there is no contraindication.
- Surgery allows a man with gynecomastia to remove the mammary gland and find a correct aesthetic. However, this should not prevent the treatment of the anomaly in question if it exists. The scar is then around the areola and is extremely discreet or invisible after a certain time of healing.
There are also suction techniques with a scar under the armpit or a small incision around the areola.