Gynecomastia

Gynecomastia

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Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: David Perlstein, MD, FAAP

• What is gynecomastia?
• What causes gynecomastia?
• What are the risk factors for gynecomastia?
• What are the symptoms of gynecomastia?
• When should I call the doctor about gynecomastia?
• How is gynecomastia diagnosed?
• What is the treatment for gynecomastia?
• What are the complications of gynecomastia?
• Can gynecomastia be prevented?
• What is the outlook for gynecomastia?
• Gynecomastia At A Glance

What is gynecomastia?

Gynecomastia is enlargement of the gland tissue of the male breast. During infancy, puberty, and in middle-aged to older men, gynecomastia can be common. Gynecomastia must be distinguished from pseudogynecomastia, which refers to the presence of fat deposits in the breast area of obese men. True gynecomastia results from growth of the glandular, or breast tissue, which is present in very small amounts in men.

What causes gynecomastia?

Gynecomastia results from an imbalance in hormone levels in which levels of estrogen (female hormones) are increased relative to levels of androgens (male hormones). Gynecomastia that occurs in normally-growing infant and pubertal boys that resolves on its own with time is known as physiologic gynecomastia.

All individuals, whether male or female, possess both female hormones (estrogens) and male hormones (androgens). During puberty, levels of these hormones may fluctuate and rise at different levels, resulting in a temporary state in which estrogen concentration is relatively high. Studies regarding the prevalence of gynecomastia in normal adolescents have yielded widely varying results, with prevalence estimates as low as 4% and as high as 69% of adolescent boys. These differences probably result from variations in what is perceived to be normal and the different ages of boys examined in the studies.

Gynecomastia caused by transient changes in hormone levels with growth usually disappears on its own within six months to two years. Occasionally, gynecomastia that develops in puberty persists beyond two years and is referred to as persistent pubertal gynecomastia.

A number of medical conditions may also result in gynecomastia:

• Malnutrition and re-feeding (recovery from malnutrition) have both been shown to create a hormonal environment that may lead to gynecomastia. Similarly, cirrhosis of the liver alters normal hormone metabolism and may lead to gynecomastia.
  
  
• Disorders of the male sex organs (testes) can result in decreased testosterone production and relatively high estrogen levels, leading to gynecomastia. These disorders may be genetic, such as Klinefelter's syndrome, or acquired due to trauma, infection, reduced blood flow, or aging. Testicular cancers may also secrete hormones that cause gynecomastia.
  
  
• Other conditions that are associated with an altered hormonal environment in the body and may be associated with gynecomastia are chronic renal failure and hyperthyroidism. Rarely, cancers other than testicular tumors may produce hormones that can cause gynecomastia.

Gynecomastia can also be a side effect of a number of medications. Examples of drugs that can be associated with gynecomastia are listed below:

• spironolactone (Aldactone), a diuretic that has anti-androgenic activity;
  
  
• Calcium channel blockers used to treat hypertension [such as nifedipine (Procardia and others)];
  
  
• ACE inhibitor drugs for hypertension [captopril (Capoten), enalapril (Vasotec)];
  
  
• some antibiotics [for example, isoniazid, ketoconazole (Nizoral, Extina, Xolegel, Kuric), and metronidazole (Flagyl)];
  
  
• anti-ulcer drugs [such as ranitidine (Zantac), cimetidine (Tagamet), and omeprazole (Prilosec)];
  
  
• anti-androgen or estrogen therapies for prostate cancer;
  
  
• methyldopa (Aldomet);
  
  
• highly active anti-retroviral therapy (HAART) for HIV disease, which may cause fat redistribution leading to pseudogynecomastia or, in some cases, true gynecomastia;
  
  
• digitoxin;
  
  
• diazepam (Valium);
  
  
• drugs of abuse (for example, alcohol, marijuana, heroin); and
  
  
• lavender oil and tea tree oil, when used in skin-care products, have been associated with gynecomastia.