Gynecomastia is an emerging condition in men in the recent times. It can be referred with different names including Male breasts, Man boobs or simply moobs. Although harmless, the condition can cause serious trouble including the risk of developing breast cancer. The condition can easily be avoided although there are genetic causes, which means that the person is born with man boobs. This genetic condition is called Klinefelter Syndrome and less or nothing can be done in such a case.
What actually happens in gynecomastia is that there is an increase in breast tissue, particularly the glandular tissue and not the fat tissue in men. Men usually have breast tissue but not in large amounts as women do. The hormone that brings out this difference, calls estrogen and is usually in high amounts in females than males. Therefore, when a man develops breasts, most likely it will be an increase in the hormone estrogen.
The causes in one or more ways somehow will always point to an imbalance in the hormones estrogen and androgens. Any condition or substance that will lead to an increase in estrogen and a drop in androgens in makes will make them have gynecomastia.
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What are indicators of Gynecomastia?
Gynecomastia is a condition, which can easily be self-diagnosed. However, it is always advisable to see a medical specialist for proper medical diagnosis. It can occur in one or both breasts and in most cases; it starts out as a small painful or painless lump beneath the nipple. Eventually, the whole breast enlarges and then that will be gynecomastia. Breasts will enlarge unevenly sometimes. Some of the signs and symptoms include:
- The breast tissue becomes swollen.
- There is breast tenderness.
In some cases, it may be breast cancers causing the swelling. It is important to be able to distinguish between the two. Major differences between breast cancer in men and gynecomastia include:
- Cancer in most cases will be confined on one side while gynecomastia can be on either side.
- Cancer is usually not centered around the nipple unlike most cases of gynecomastia.
- Cancerous breast tissue usually feels hard or firm.
- Cancer have associated dimpling of the skin on the breast, the nipple may retract or some discharges nay be seen coming out and the axillary lymph node may be swollen.
How Gynecomastia is diagnosed?
Proper medical diagnosis of gynecomastia is done by a medical specialized in such a field. It basically involves taking your past medical history including drug use and medication accompanied by a physical examination of your breast tissue. Apart from doing the physical exam, other specialist go ahead to do other tests just in case you have other conditions. The most common tests include:
- Blood tests for example liver functions and even hormone tests.
- Testing of your urine.
- An x-ray of your breast tissue that has in low doses.
- Biopsy of the breast tissue when a suspicion of cancer is raised.
Risk factors of Gynecomastia
Who is likely to get gynecomastia? There are several risk factors that may lead to one getting this condition. Some are related to lifestyle while other are as a result of normal physiological processes. The risk factors implicated in gynecomastia include:
- Male teenagers growing normally are at risk of developing gynecomastia.
- Male infants.
- People exposed to certain diseases.
- Certain medications.
The causes of Gynecomastia
Gynecomastia has so many causes. Here, we highlight the top 9 causes of gynecomastia in men.
Obesity refers to a situation where there is increased fat content in the body. It can be a cause of Gynecomastia and has been a common one in the recent past where we have had increased cases of obesity all over the world.
So how does obesity come in to cause obesity? It is believed that the increased fat in your body as well as in your breast tissue has a role in disrupting the hormones in your body including the estrogen and the androgen and therefore bringing about gynecomastia. The disruption is carried out because of a hormone called leptin, which increases, in levels when there is increased fat in the body.
In cases of obesity, leptin will rapidly increase in the body and this result in a condition called leptin resistance. Leptin resistance causes the brain to see that the body is starving and it directs its activities in ensuring that the body is getting enough nutrients and that reproduction is not important here. This implies that the hormones for reproduction in males, the androgens are suppressed and there will be a rise in estrogen, which will then cause gynecomastia.
Perhaps the commonest causes of gynecomastia are the anabolic steroid used by bodybuilders and other athletes. Most if not all anabolic steroids are usually synthetic versions of testosterone. Since the body has the mechanisms of converting testosterone into estrogen, some of these anabolic steroids get converted into estrogen leading to development of gynecomastia.
Steroids >> HERE
Estrogen usually requires in the male body in limited amounts. It has several roles such as helping in maintaining healthy bones, sexual activities and help ensure that the fat content in men is low enough not to cause any health related conditions. However, beyond a certain limit, it comes with associated health risks one of which is gynecomastia.
So apart from causing trouble with your testicles among other side effects of the anabolic steroids, they can really make your life embarrassing by making you develop man boobs, which not every male person would want to be associated with. It is estimated that about half the cases of gynecomastia are as a result of anabolic steroid abuse.
There are certain types of cancers implicated in causing gynecomastia. Most of the tumors sometimes are usually undetected hence the importance of seeking a proper medical diagnosis. Since gynecomastia is a result of hormone imbalance, these types of cancers must have a part to play in causing the hormonal imbalance.
The major tumors that have been known to have an impact on hormones are the testicular tumors and pituitary tumors (Prolactinoma). These tumors will result in either an increase in production of estrogen or a decrease in production of testosterone.
Testicular tumors for example can result in increased synthesis and production of a hormone called Human chorionic gonadotropin (HCG). HCG closely resembles Luteinizing hormone (LH) both in structures and in function. It therefore will also lead to increased production of testosterone and also the conversion of the produced testosterone to estrogen and that is where trouble comes in.
4. Genetic hereditary disorders
Another common cause of man boobs are some hereditary disorders that one is born with and which most likely run through their families. Klinefelters syndrome is the commonest of the causes. In this condition, an individual has 3 pairs of chromosomes instead of the usual 2 pairs. Normally, a man has the XY chromosome combination. However, in Klinefelters syndrome, there is an additional X chromosome forming the XXY combination.
In such cases, the patients will be sterile and gynecomastia is an outstanding feature. This is a bit hard to manage because it is not easy to change the chromosomal arrangement of a person.
5. Side effects of certain medications
There is a wide range of drugs that have gynecomastia as a side effect of taking them. In fact drugs ranks highly in causing man boobs causing even as high as a quarter of all the causes of gynecomastia. So how do drugs come in when it comes to causing hormonal imbalance, which causes man boobs?
Well, most drugs and especially the ones that are prescribed harbor about three effects that are likely to cause gynecomastia:
- They have an estrogen like activity when taken.
- Can raise the levels of estrogen directly.
- Have androgens as part of them and these androgens can be converted to estrogens.
So, talk about amphetamines, antibiotics or any other common drugs and you will see that they somehow can be the reason why you are developing man boobs. It is good that you get to know the side effects of the drugs you are taking. Talk to your doctor about it and if you develop any signs of increased breast tissue, then you can consider stopping.
Here is a list of the drugs that are commonly known to cause gynecomastia:
- Spironolactone - it is a diuretic substance and contains activities that are opposite to those of androgens.
- Drugs that are calcium channels blockers that are important treating hypertension for example nifedipine.
- Drugs that inhibitors of angiotensin converting enzyme (ACE) also used in treatment of hypertension for example captopril.
- Antibiotics such as metronidazole and isoniazid.
- Drugs used in management of ulcers such as cimetidine and ranitidine.
- Digoxin and diazepam.
6. Abusing alcohol
There are several ways in which alcohol can cause gynecomastia. This happens when one drinks excess alcohol every day. One can be prepared to have grown his belly and also be prepared to have man boons as well.
The first way in which alcohol can cause man boobs is through its damage to the liver. The liver is a very crucial organ in getting rid of hormones and when it is damaged due to alcohol abuse, this activity tends to reduce and eventually stop. One of the hormone that will not be eliminated from the body is estrogen. Over time, estrogen gets to accumulate and its immediate effects includes causing Gynecomastia. Apart from being inefficient in eliminating estrogen, a damaged liver is even more likely to convert the androgens into estrogens.
Apart from damage to the liver, alcohol itself in most cases contain certain compounds that will influence the balance of estrogens and testosterone in the body. The most common compounds found in alcohol are the phyestrogens. Phytoestrogens are basically compounds that mimics the estrogen in the body. How do they get into the alcohol we consume? Well, the hops that use to make beer and also some plants that have a part in making most alcoholic beverages have these compounds in abundant and that is how they end up in the alcohol we consume.
As men age, most of them tend to have an imbalance in their hormonal composition. The first time you may experience gynecomastia is at puberty. During puberty, one produces lots of hormones in high amounts including the estrogens. This is likely to cause man boobs. This is usually not something to worry about since as you leave teenage behind, your hormones come to level and everything goes back to normal. So as long as it does not progress for a long time, there is absolutely nothing to worry about teenage Gynecomastia.
In other cases, you may experience what the experts call idiopathic gynecomastia at some point in life and this may not go away. Idiopathic implies that the growth of the breast tissue cannot simply be traced to the cause. However, there has been some explanations as to why there may be such a case. One common one is that as we men grow, different part of the body also grow including the breast tissue. But the body does not stay in one state all the time and it is likely that the as the body reduced to grow at some point, the breast tissue did not cease for some reasons, hence gynecomastia.
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As one grows older also, testosterone levels tend to become lower and lower probably because there is less production due to aging of the tissue responsible for its production. This means that estrogens have an upper hand and can now easily cause man boobs. Sometimes older people may have been exposed to some estrogens or something that causes hormonal imbalance without actually having an idea what it was. This might also cause Gynecomastia in old age.
8. Kidney and liver diseases
Another major cause of gynecomastia is severe disease of either the kidney or the liver or even both. These two organs are particularly important in regulating some hormones and other proteins that have a role in preventing development of man boobs.
The liver as seen in alcohol abuse has a major role to play when it comes to giving you gynecomastia if you do not take great care of it. Many conditions that damage the liver are due to alcohol abuse but any other disease that damages the liver including some viral diseases can lead to disruption of normal hormonal elimination hence causing man boobs. Apart from reducing disruption, the liver has a role in regulating synthesis of certain proteins and one crucial protein regulated is the sex hormone binding globulin (SHBG). The SHBG binds testosterone. In severe liver disease, this protein tends to be over produced and will bind more of the testosterone produced. This lowers the amount of testosterone in circulation leading to trouble.
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Kidney diseases also cause almost a similar situation only that the most severe forms of kidney disease will lead to such a condition. Although man boobs are also a clear symptom, one tends to notice other common symptoms first including abnormal urinary discharges and even skin rashes first before noticing gynecomastia.
9. Smoking Cigarettes And Using Marijuana
Cigarette smoking causes man boobs indirectly. Excessive smoking will lead to development of lung cancers some of which just like the testicular and pituitary tumors will cause a disruption in the hormonal balance and this will lead to gynecomastia. Lung cancers in fact have an upper hand when it comes to causing gynecomastia. All the other cancers that are known to cause hormonal imbalance. The good news is that the lung cancers are a bit more preventable unlike the other forms of cancers.
Apart from cigarettes, Marijuana is another common cause of man boobs. So many people are still not aware of this and therefore sometimes they tend to think that marijuana has no role in this. Using marijuana in excess amounts has the effect of increasing breast tissue in men. Hoe this happens is still a mystery but some studies suggest that marijuana depresses the levels of testosterone.
Other common causes of Gynecomastia
There are still so many other causes of man boobs and here are some of the honorable mentions:
- Depriving yourself of certain nutrition in the name of deprivation diets.
- Drugs used to manage hair losses.
- Plant oils and natural grooming products.
- Testosterone replacement therapy.
- Time in the womb as a fetus.
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Will the Gynecomastia go away?
Having looked at the causes of gynecomastia, you may be wondering how long does one need to have this condition before it goes away. The truth is, it depends on the type and cause of gynecomastia. Pubertal gynecomastia for instance may regress once one is out of puberty. Of course, there are rare cases where such gynecomastia persists in which case there will be need of medical treatment.
Other forms of gynecomastia stay for a longer period of time. Cases have been reported where gynecomastia has lasted for more than 12 months without treatment. If gynecomastia lasts that long, most likely, it will undergo fibrosis and this will complicate treatment.
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Treatment of Gynecomastia
There are two major approaches in the treatment and management of gynecomastia. However, gynecomastia in most cases is a condition which will go away on its own within a period of about six months provided that the condition leading to it eliminate as much as possible. If it does not go away, treatment can either be:
- Using drugs.
- Surgical approach.
Using Drugs in Treatment of Gynecomastia
There are several drugs, that we can use in the management of gynecomastia. Their effectiveness has been in question but they are still used. In fact, most if not all of them have not been approved by the FDA. The commonest drugs that have been in use include:
- Testosterone replacement in older men but not younger males who have normal testosterone levels.
- Clomiphene taken for a period of 6 months has also some good results.
Clomiphene Citrate >> HERE
- There has also been the selective estrogen receptor modulator tamoxifen, which works by reducing breast volume. It has also been helpful in cases of severe and painful gynecomastia.
- Danazol, a synthetic derivative of testosterone helps reduce the levels of estrogen in the body by limiting its production by the testis.
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Surgical Approach in the Treatment of Gynecomastia
Drugs are more effective in the treatment of gynecomastia during the early stages of the condition. However, after a period of about 12 months when the glandular tissue has been transformed into a fibrous tissue, drugs become less effective and only surgery might prove helpful here.
Surgical reduction of the breast tissue refers to as reduction mammoplasty and use it in cases where we have:
- Severe gynecomastia.
- Long term gynecomastia.
- Drugs have failed to bring the condition back to normal.
Prevention of Gynecomastia
Like treatment, prevention of gynecomastia depends on the types of gynecomastia one is talking about or how it is. Gynecomastia caused by hormonal imbalance as a result of for example aging or pubertal changes cannot be prevented. Other forms for example those which are caused by some medical conditions can be prevented. This will be through preventing the underlying conditions such as avoiding abuse of alcohol. Having a clear and sound knowledge of everything to do with Gynecomastia can help you avoid it in the future if it is the kind that can be prevented.
Gynecomastia is a common condition that has been a major cause of concern for men. It so many causes some of which have been highlighted in this article. Gynecomastia can easily be managed and one is bound to have his normal breast composition. It is however, an embarrassing condition and many men have been suffering silently. In case where you have the condition, you can do some of the following things so that you can avoid being depressed:
- Get some counseling from a trusted expert.
- Reach out to the people you love including your friends and family members.
- Connect to people with similar conditions or who have gone through the same condition.