Gynecomastia: What It Is, Causes, Symptoms, and Treatment

Gynecomastia is derived from the Greek words "gyne" (woman) and "mastia" (breast), meaning having breasts like a woman.

What is Gynecomastia?

Gynecomastia refers to the benign (non-cancerous) and excessive enlargement of the breast tissue and nipples in men, mostly in the glandular tissue. Although the structural forms of male and female breasts are similar, the reason why male breasts are smaller than female breasts is the lack of sufficient estrogen hormone in men. It is commonly seen in three stages of life: newborns, during adolescence, and in men over middle age. In our country, one in three men experiences gynecomastia. While it may cause pain and discomfort in some patients, it is not harmful to health. However, it can lead to embarrassing feelings such as shyness or discomfort during physical activities like swimming or exercising. Many men with gynecomastia may experience low self-confidence, introversion, and poor posture. Gynecomastia can affect one or both breasts. It results in firm and dense tissue formation. Spontaneous regression or healing is not possible. Nowadays, gynecomastia is a treatable condition.

Types of Gynecomastia

Gynecomastia can be classified into three types:

• Glandular Type Gynecomastia: In glandular type gynecomastia, hardened breast tissue resembling that of a female breast is found, but it does not produce milk.
• Fatty Type Gynecomastia: In fatty type gynecomastia, the tissue is primarily composed of fat. There is no increase in glandular tissue. This type is caused by significant weight gain or loss.
• Mixed Type Gynecomastia: Mixed type gynecomastia is characterized by the presence of both glandular and excess fat tissue.

Symptoms of Gynecomastia

• Tenderness in the breasts
• Pain and discomfort in the breasts
• Discharge from one or both nipples
• Difference in size between the two breasts
• Lump under the nipple
• Swelling in the lymph nodes under the armpit

How is Gynecomastia Diagnosed?

First, a detailed physical examination involving the breast tissue, genital area, and abdominal region is performed by a specialist. If necessary, the doctor may use methods such as blood tests, mammography, computed tomography (CT) scans, tissue biopsies, and magnetic resonance imaging (MRI) to diagnose gynecomastia. The most important aspect of this process is distinguishing gynecomastia from breast carcinoma. Through examination and diagnostic methods, it is possible to easily differentiate gynecomastia from other conditions like breast cancer and breast abscess, ensuring the correct treatment is applied.

What Are the Causes of Gynecomastia?

Gynecomastia generally occurs due to hormonal imbalances. In men, gynecomastia occurs when testosterone levels decrease and estrogen levels rise excessively. In addition to hormonal imbalances, medications, herbal products, and various diseases can contribute to the development of gynecomastia.

Hormonal Changes:

Estrogen is known as the female hormone and is responsible for various physical and structural changes in women, such as breast development. A small amount of estrogen is also produced in men, and during different stages of a man's life, the production of estrogen can lead to gynecomastia.

• Gynecomastia in Newborns: The estrogen secreted by the mother can cause male newborns to be born with enlarged breasts. Gynecomastia in newborns typically resolves within 2-3 weeks after birth.
• Gynecomastia During Puberty: Hormonal changes during puberty can cause gynecomastia. In many cases, gynecomastia resolves on its own within 6 months to 2 years without the need for treatment.
• Gynecomastia in Adults: The highest incidence of gynecomastia occurs in men aged 50-69 years. It can be treated with medical or surgical methods.

Medications:

Many medications and drugs can cause gynecomastia due to misuse or side effects.

• Anabolic steroids and androgens commonly used by athletes
• Estrogens
• Anti-androgens used for prostate enlargement (flutamide, finasteride)
• Some heart medications (Spironolactone, digoxin, amiodarone, ACE inhibitors like captopril, enalapril, calcium channel blockers)
• Medications for acid reflux and ulcers (Metoclopramide, Ranitidine, cimetidine, proton pump inhibitors)
• Anxiety medications (Diazepam)
• Antifungal drugs (ketoconazole)
• Antibiotics for bacterial infections (Metronidazole)
• Fertility drugs (human chorionic gonadotropin)
• Medications for ADHD (amphetamines)
• Some antidepressants (tricyclic drugs)
• Chemotherapeutic drugs (alkylating agents, Methotrexate, Vinca alkaloids)
• Antiretroviral drugs used in AIDS treatment
• Some antibiotics (Ethionamide, isoniazid)
• Substance use, such as smoking

Herbal Products:

Herbs found in cosmetic products like shampoos, soaps, and lotions may contain estrogen and contribute to gynecomastia. Special attention should be paid to herbs like Dong Quai, tea tree oil, and lavender, which contain estrogen, and prolonged exposure to them should be avoided.

Health Problems:

Certain medical conditions can disrupt hormonal balance and lead to gynecomastia.

• Hyperthyroidism: Excessive secretion of thyroid hormones can lead to hormonal imbalances and the development of gynecomastia.
• Kidney Failure: Gynecomastia is commonly seen in hemodialysis patients with kidney failure.
• Tumors: Tumors in the testes, adrenal glands, or pituitary gland can alter the production of testosterone and estrogen, leading to gynecomastia. Treatments like chemotherapy or radiotherapy can also cause gynecomastia in 15% of cases.
• Hypogonadism: A condition where there is insufficient function of the testes in men, leading to decreased testosterone levels and triggering gynecomastia.
• Hermaphroditism: Individuals with both male and female reproductive organs may experience gynecomastia due to estrogen secretion from ovarian tissue.
• Cirrhosis: 67% of cirrhosis patients experience gynecomastia. The increased production of androstenedione in the adrenal glands, which is converted into estrogen, or the high-dose spironolactone used in cirrhosis treatment can cause gynecomastia.
• Fasting: Studies conducted on prisoners of war after World War II showed that prolonged fasting leads to decreased gonadotropin and testosterone levels, while normal estrogen production continues, contributing to the development of gynecomastia.
• Aging: Testosterone production decreases with aging, which can contribute to the development of gynecomastia.
• Obesity: In obese men, uncontrolled fat accumulation in the body increases, and fat tissue is an active site where testosterone is converted to estrogen. This reduction in testosterone levels can cause gynecomastia.

How is Gynecomastia Treated?

Treatment for gynecomastia is planned based on its underlying cause. If hormonal imbalance is suspected, an endocrinologist will diagnose and treat the condition.

In particular, during puberty, gynecomastia is classified using the Nydick classification, which focuses on the size of the glandular tissue disc located beneath the brown ring (areola) around the nipple.

• For individuals with a disc size smaller than 4 cm, periodic examinations are conducted without any intervention, typically every 3-6 months.
• For those with a disc size of 4-6 cm, medical treatment is administered, which varies depending on the patient's age and hormone levels.
• For those with a disc size larger than 6 cm or prolonged symptoms, surgical intervention is required. Surgery is the most effective and definitive treatment for gynecomastia.

Surgical treatment depends on the type of gynecomastia. For fatty gynecomastia, where the breast tissue is soft and fatty, liposuction may be sufficient. In cases of large and firm gynecomastia, a mastectomy is performed, where the breast tissue is removed through small incisions.

Surgical interventions are generally performed under general anesthesia, although local anesthesia may be used in some cases. Patients can be discharged the same day after surgery. After surgery, patients need to wear a compression garment for 2-3 weeks. Mild pain may occur post-surgery. Avoiding heavy activities and excessive movement of the arms and shoulders in the first 3 days accelerates recovery. After the third day, patients can return to their daily routine and work.

Since gynecomastia is a hormonal disorder, preventing its formation is not always possible. However, the risk of gynecomastia can be reduced by avoiding smoking, eating a healthy diet, and not using medications without a doctor's prescription.