A Brief Explainer on Gynecomastia in Boys and Men

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Gynecomastia is a condition where breast tissue, usually associated with women, develops in boys and men. While all boys are born with a small amount of breast tissue, it doesn't develop during puberty in the same way that girls do.

The reason for this is due to changing hormones. While both boys and girls make estrogen, the ‘female’ hormone, and both make testosterone, the ‘male’ hormone, it’s the balance of these two that makes the difference. During puberty, girls’ estrogen production increases, and boys’ testosterone production increases. For some boys, their estrogen production increases, too, leading to the development of more breast tissue.

This is actually more common than you might think. As many as 50% of teenage boys will experience breast swelling. It can also be a problem later in life, as aging disrupts hormone levels again. But then, why do our hormones go out of whack in the first place?

Hormones: The Science Bit

There are lots of reasons why hormones are thrown out of balance, and the reasons for developing gynecomastia are varied. In many cases, it's difficult to pinpoint an exact cause, but let's take a look at some of them.

- Testicular conditions or injury – Testosterone is made in the testicles (the clue is in the name), so anything that inhibits their ability to do so can cause problems.

- Obesity can cause increased estrogen production, leading to gynecomastia. Obesity also means higher amounts of fatty tissue in the chest, which can exacerbate the problem.

- Abnormal thyroid activity can cause gynecomastia, as this super-small, but super-important gland houses hormones that control sexual development.

- Liver disease, cirrhosis of the liver, or kidney failure

- Illegal drug use of drugs including steroids, marijuana, methadone, amphetamines, and heroin

- Certain types of cancer

- Malnutrition or starvation – When we're malnourished, estrogen levels remain the same, but testosterone levels drop. This causes the imbalance that leads to gynecomastia.

- Klinefelter syndrome – This is a condition causing men to be born with two or more X hormones, typically XXY instead of XY, that leads to hypogonadism (small testes) and low testosterone production.

- General aging – Hormone levels change naturally as we age.

Medications

There are several types of medication that can also cause gynecomastia. Let’s take a look.

- Anabolic steroids. These are often used illegally to build muscle or improve athletic performance, but may also be prescribed by doctors to treat certain conditions.

- Medications used to treat an enlarged prostate gland

- Some HIV and AIDS medications

- Some antibiotics

- Heart disease medications

- Anti-anxiety medications, including Valium

- Certain types of antidepressants

Please note that taking these medications doesn't mean you'll definitely develop gynecomastia.

As well as prescription medications, some herbal remedies are also thought to be risk factors – primarily lavender and tea tree oil. This is because they have a small amount of estrogenic activity.

Signs and Symptoms of Gynecomastia

In many cases, gynecomastia starts as a small lump under the nipple. This can be alarming, especially if it's tender or painful, as it may feel like breast cancer (a small number of men are diagnosed with breast cancer each year). If you're concerned about this, you can ask your doctor to run some tests to make sure.
To diagnose you with gynecomastia, your doctor will ask you about your medical history and any medications you might be taking. Your answers to these questions will be used to try and pinpoint an underlying cause from the list above. If this isn't possible, they may run blood or urine tests, or even a mammogram or biopsy to see what’s going on.

Gynecomastia may not be serious, but it can have repercussions for the mental health of sufferers. Many boys and men report feeling embarrassment, anxiety, or depression and struggling with their self-esteem. Some may even develop an eating disorder, trying to lose weight to minimize their breasts. If you're struggling, please speak to your doctor. They will be able to refer you to a therapist who can help with these issues.

Getting a Diagnosis

As well as attempting to discover the underlying cause of your gynecomastia, your doctor may also run tests to be sure you’re not actually suffering from something else entirely. Other conditions that may cause swelling of breast tissue in men include:

- Simple fat deposits. In some cases, what looks like gynecomastia is actually straightforward fat and can be corrected with weight loss.

- An abscess or infection of the breast tissue

- Breast cancer – This is rare in men, but will need to be ruled out. If you have any additional symptoms such as discharge from the nipple, tell your doctor.

Treating Gynecomastia

In many cases, especially if developed during puberty, gynecomastia will go away on its own as the hormones rebalance naturally. This could take just a few months or several years. If your gynecomastia is persistent, your doctor may refer you to a specialist endocrinologist – doctors who are experts in hormone conditions.

Your endocrinologist will be able to recommend any tests, medications, or treatments that you need to bring your hormones back into balance. What treatments you're given will depend on your age, your overall health, and the underlying cause of your gynecomastia.

There are medications that can be used to treat gynecomastia. Most of them are used primarily for the treatment of other conditions and aren't specifically approved for gynecomastia treatment. Some men may require liposuction or a mastectomy to remove their breast tissue surgically, although this is rare.

For some men, waiting for their gynecomastia to resolve itself or respond to treatment is a difficult time as they struggle with low self-esteem. In these cases, compression garments may help. These super-tight undergarments are designed to improve the contours of the body, and a compression vest could help minimize the appearance of breasts. You could also check out https://www.confidencebodywear.com/product/gynecomastia-compression-shirt/ for more options and additional advice.