Gynecomastia is a condition when the male mammary glands become enlarged. This enlargement can occur in one or both breasts and is accompanied by complaints of breasts that feel supple but do not feel painful.

Gynecomastia can occur naturally due to hormonal changes in men of all ages, both in newborns and adults. However, in certain cases, gynecomastia can be a sign of a more serious disease.

Causes of Gynecomastia

Gynecomastia most often occurs due to an imbalance of the hormones estrogen and testosterone . Estrogen is a hormone that plays an important role in regulating female sexual characteristics, such as breast growth.

Meanwhile, testosterone is a hormone that regulates male sexual characteristics, such as the growth of muscles and body hair.

The hormones estrogen and testosterone can be found in men and women, but with different ratios. If estrogen levels increase or testosterone levels decrease in men, gynecomastia can occur.

An imbalance between the two hormones can occur naturally or as a result of certain conditions and diseases. Hormonal changes in males can occur due to the following factors:

  • Birth
    Baby boys can have large breasts due to estrogen obtained from their mothers while still in the womb. However, breast size will generally return to normal around 2-3 weeks after birth.
  • Puberty
    A decrease in the hormone testosterone and a surge in the hormone estrogen during puberty can cause breast tissue in teenage boys to grow. Generally, breast size can return to normal within 6 months to 2 years.
  • Adulthood
    Breast enlargement is more common in men aged 50–80 years due to decreased levels of the hormone testosterone. In addition, having a lot of body fat can also stimulate the production of the hormone estrogen which causes gynecomastia.

Apart from occurring due to the factors above, there are several conditions or diseases that can cause gynecomastia, namely:

  • Chromosomal abnormalities, such  as Klinefelter's syndrome  or androgen insensitivity syndrome
  • Aging
  • Hyperthyroidism
  • Obesity
  • Cirrhosis
  • Hypogonadism
  • Tumors that affect the testicles or  adrenal glands
  • Liver failure
  • Kidney disease or kidney failure

Gynecomastia can also be caused by the use of a number of drugs or substances, such as:

  • Antiandrogenic drugs, such as finasteride and spironolactone
  • Calcium antagonist hypertension drugs, such as  ACE inhibitors ,  for example captopril; or alpha antagonists, such as methyldopa
  • Tranquilizers, such as diazepam
  • Heart disease drugs, such as digoxin
  • Antibiotics, such as metronidazole
  • Ulcer drugs, such as cimetidine
  • Fungal infection medications, such as ketoconazole
  • Drugs for  chemotherapy
  • Muscle mass enhancing supplements, such as anabolic steroids
  • NAPZA, such as heroin and marijuana
  • Alcoholic beverages

Symptoms of Gynecomastia

Just like women, men also have mammary glands, but they are smaller and underdeveloped. The size of the mammary gland in men is generally less than 0.5 cm.

The main symptom of gynecomastia is breasts that are larger than the average male breast size. This enlargement can occur in one or both breasts. Enlarged breast sizes can also vary on each side.

In addition to protruding breasts, men with gynecomastia can experience complaints in the form of breasts feeling lumpy or tight, sore, and nipples that are more sensitive when rubbed against clothing.

When to see a doctor

Check with your doctor if you have breast enlargement so that the cause can be found out. You are also advised to seek medical help immediately if your breasts look protruding and are accompanied by other complaints, such as:

  • Swelling
  • Painful breasts when pressed
  • Lump in the breast
  • Discharge or pus from the nipples
  • There is a wound or ulcer on the skin of the breast or around it

Diagnosis of Gynecomastia

To diagnose gynecomastia, the doctor will ask about the symptoms, the patient's medical history, and the medications currently being taken. Next, the doctor will carry out a physical examination, including measuring height and weight, examining the breasts, abdomen and genitals.

Investigations can also be carried out to confirm the diagnosis, including:

  • Blood tests, to check liver, kidney and thyroid function, as well as measure hormone levels in the blood
  • Scanning with mammary ultrasound , CT scan, or MRI to detect breast tissue growth

The symptoms of gynecomastia can be similar to those of other diseases. To confirm the diagnosis, the doctor will perform a biopsy by taking a sample to be examined under a microscope.

Some diseases that can cause symptoms similar to gynecomastia are:

  • Breast cancer
    Although rare, breast cancer can be experienced by men . Enlarged breasts accompanied by hard lumps can be a sign of breast cancer in men.
  • Breast
    abscess Breast abscess is characterized by the appearance of a lump filled with pus in the breast. On scans, a breast abscess often looks like gynecomastia.
  • Pseudogynecomastia
    Pseudogynecomastia is also similar to gynecomastia, but this condition occurs due to fat deposits in the breasts.

Gynecomastia Treatment

Gynecomastia that occurs naturally may resolve over time without treatment. However, gynecomastia caused by certain diseases, such as cirrhosis, hypogonadism, or kidney failure, needs immediate medical treatment.

If gynecomastia is caused by taking drugs, the doctor will ask the patient to stop using the drug or replace it with another drug.

In adolescents with gynecomastia, the doctor will periodically evaluate every 3-6 months to see if the condition can improve. This is because gynecomastia in adolescents generally disappears in less than 2 years.

If within the specified time the patient's condition does not improve, the doctor can treat it with hormone therapy. The types of drugs that can be given are tamoxifen and raloxifene.

In certain cases, doctors can perform surgery to treat gynecomastia. The surgical procedure may be a liposuction or a mastectomy . Liposuction aims to remove breast fat, while mastectomy aims to remove the breast glands.

Gynecomastia complications

Gynecomastia can make sufferers feel insecure, causing anxiety and depression . In addition, men with gynecomastia are more at risk of developing breast cancer.

Gynecomastia Prevention

Most cases of gynecomastia cannot be prevented, as they are caused by naturally occurring hormonal changes in the body. However, there are several efforts that can be made to reduce the risk of developing gynecomastia, namely:

  • Avoid consuming alcoholic beverages
  • Avoid using drugs to increase muscle mass, such as steroids, and drugs, such as heroin and marijuana
  • Consult your doctor regularly if you have a disease or are undergoing medication that has a risk of causing gynecomastia
  • Maintain an ideal weight
  • Undergoing hepatitis vaccination and practicing healthy sex to avoid hepatitis which can develop into cirrhosis
Back to blog