Definition.
Gynecomastia is a swelling of breast tissue in male infants and boys. It is caused by an imbalance of estrogen and testosterone. Boys going through puberty can have temporary gynecomastia caused by changes in normal hormone levels. More rarely, gynecomastia is caused by one of many possible health problems.
Other than gynecomastia being a sign of an underlying disease, it is not a serious problem. Boys with gynecomastia sometimes have pain or pressure in their breasts. They may feel embarrassed or shy about their bodies.
In most cases, this condition will go away on its own. If it is caused by drugs or medication, it usually goes away when it stops. Occasionally, the condition may require treatment with medications that help balance hormone levels. In rare cases, surgical removal of breast tissue is an option.
Symptoms.
Signs and symptoms may include.
Swollen breast glandular tissue.
Breast tenderness with pressure.
Nipple discharge.
Enlarged nipples (especially in adolescent boys).
Rarely, there are physical complications associated with temporary gynecomastia. This condition can be psychologically and emotionally troubling by appearance. Although rare, gynecomastia slightly increases the risk of male breast cancer.
Cause.
In most cases, gynecomastia is triggered by an imbalance of testosterone and estrogen. There are several things that can upset this hormonal balance, including
Natural changes in hormones.
Medications.
Certain health conditions.
In about a quarter of cases, the cause of gynecomastia is not found at all.
Hormone balance.
In both men and women, testosterone and estrogen control the development and maintenance of sex characteristics. Testosterone controls male characteristics, such as muscle mass and body hair. Estrogen controls the growth of female characteristics, including breasts.
Most people would think of estrogen as a female hormone. Men also produce estrogen, although in very small amounts under normal circumstances. In men, it helps regulate.
Bone density.
Sperm production.
Mood.
It may also have a role in cardiovascular health. However, too high levels of estrogen in men, or loss of balance with testosterone levels, can cause gynecomastia.
In infancy.
More than half of all male infants are born with enlarged breasts, which are attributed to the effects of estrogen coming from their mother. The swollen breast tissue usually disappears within 2-3 weeks after birth.
During puberty.
Gynecomastia caused by hormonal changes during puberty is common. It affects more than half of teenage boys. It is especially common in very tall or overweight boys. In most cases, swollen breast tissue disappears even without treatment within a few months. In a few cases, these swollen tissues take up to two or three years to disappear.
Medications.
Many medications can cause gynecomastia. Of the following medications, only antibiotics are commonly used in children. These include.
Drugs that block the effects of natural hormones (androgens). These drugs may be used to treat certain cancers. Examples of these drugs include: cyproterone, flutamide, finasteride.
HIV medications. gynecomastia can occur in HIV-positive men who are on a therapy called highly active antiretroviral therapy (HAART). It is especially common in men taking efavirenz, or didanosine.
Anti-anxiety medications, such as diazepam (Valium).
Tricyclic antidepressants.
Antibiotics.
Ulcer medications.
Cancer treatment (chemotherapy).
Cardiac drugs, such as digitalis and calcium channel blockers.
Street drugs and alcohol.
Items that can cause gynecomastia include
Anabolic steroids and androgens, gynecomastia occurs in more than half of the athletes who use these substances.
Alcohol.
Amphetamines.
Marijuana.
Heroin.
Health conditions.
Several health conditions can cause gynecomastia. These include.
Hypogonadism. This is a term that refers to male genitalia that are much smaller than normal in size. Conditions that cause hypogonadism prevent normal testosterone production. These conditions (such as Crohn’s syndrome or pituitary insufficiency) can also be associated with gynecomastia.
Tumors. Some children have tumors that alter the andro-estrogen balance. These tumors usually include: testicular, adrenal, pituitary, lung, and liver.
Hyperthyroidism. In this condition, the thyroid gland produces too much of the hormone thyroxine. This may cause gynecomastia due to changes in testosterone and estrogen.
Kidney failure.
Liver failure and cirrhosis.
HIV, the human immunodeficiency virus that causes AIDS, can cause gynecomastia. As mentioned above, some drugs used to treat AIDS can also cause gynecomastia.
Chest wall injury.
Spinal cord injury.
Starvation.
Diagnosis.
Collect a medical history. Consider the list of medications your child takes. Take a family history of disease. Perform an examination that includes breast tissue, abdomen and genitalia.
Your child’s health care provider will confirm that the breast swelling is really gynecomastia and not some other problem. Other conditions that can cause similar symptoms include
Obese breast tissue. Some boys have fat in their breasts that resembles gynecomastia. This is called pseudogynecomastia. It is not the same as gynecomastia.
Breast cancer. Rare in boys. An enlargement of one breast or an isolated hard nodule can raise concerns about male breast cancer.
Breast infection or abscess (mastitis).
Initial tests to determine the cause of a child’s breast development may include
Blood tests. Mammograms.
Further tests will need to be determined based on the results of the initial exam, including
Chest x-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, testicular ultrasound, and tissue biopsy.
Treatment.
Over time, most cases of gynecomastia will resolve without treatment. In some cases, the condition is caused by an underlying condition that requires treatment. Most commonly, the underlying cause is hypogonadism.
If you are taking medications that may cause gynecomastia, your health care provider may recommend stopping them or changing medications.
For teens with no obvious cause of gynecomastia, your doctor may recommend re-evaluation every 6 months to see if the condition has improved on its own. For 90 percent of teenage boys, gynecomastia disappears within three years without treatment.
Medications.
In rare cases, medications used to treat breast cancer and other diseases may be helpful for some boys with gynecomastia.
Surgery to remove the excess breast tissue.
Surgery may be considered if gynecomastia does not improve on its own, or if it causes significant pain, pressure or embarrassment. Two types of surgery are available to treat this condition.
Liposuction — This procedure removes the breast fat, not the breast glandular tissue itself.
Mastectomy — This type of surgery removes the breast glandular tissue. Only small incisions are used. The technique used is less invasive and has less recovery time.
Medical attention is required if there is
There is swelling, pain, pressure or nipple discharge in one or both breasts.
Are taking medications that are known to cause gynecomastia. Consult your child’s health care provider for other options.
Have had no improvement for 5-6 months.
Immediate medical attention is needed if
The skin around the nipple develops a red streak, and/or the breast is already reddish, painful to pressure, or swollen.
A fever of 102°F (38.9°C) develops.
Skin lumps occur around the breast and/or in the axillary area.
Skin breaks down or ulcers occur.