March 16, 2023 Author : Sílvia Alexandre Silva Gynecomastia is the term used to designate the benign increase of glandular breast tissue in men . It translates into excessive breast volume; However, excessive breast volume in men is not always gynecomastia. Gynecomastia can cause discomfort, even pain, in addition to being a major source of embarrassment and difficult to overcome for many men. Causes of gynecomastia Gynecomastia is due to an imbalance in levels of estrogens and testosterone (sex hormones), with an increased ratio between estrogens and androgens. It can occur at any age, but because it is related to an imbalance of sex hormones, it is more common: In newborns, due to the influence of the mother hormone levels; During male puberty, when is estimated to occur in nearly 70% of teenagers; In the middle-aged and older age men, which 65% have gynecomastia. In addition to puberty and male aging, also side effects of some medications or other illnesses may cause gynecomastia, for example: Some medicines used to treat prostate cancer, hypertension, stomach ulcers and fungal infections; Some medicines and personal hygiene natural products; Anabolic steroids; Alcohol and some illicit drugs; Hypogonadism; Adrenal, testicular or pituitary tumors; Diseases of the liver, kidneys, thyroid, testicles; Klinefelter syndrome (a genetic disease). However, the excessive volume of male breasts is not always gynecomastia . For example, in men who are overweight and obese, regardless of their age, there may be an increase in breast volume, but in this case due to the accumulation of fat (adipose tissue) in the breast and not to the increase in glandular breast tissue, which characterizes gynecomastia; Such breast enlargement is sometimes called pseudo-gynecomastia or adipomastia. Symptoms and diagnosis In adolescents, the most common symptom is sensitivity to touch and local pain . Even when there is no significant increase in breast volume, most boys and men are able to identify a lump or mass under the nipple, a finding that may be accidental, or occur due to pain or sensitivity leading to the search for a reason that justifies them. The lump associated with gynecomastia is centered with the nipple. It can be unilateral, bilateral or even appear in one breast, disappear and then appear in the other. More rarely, sensitivity and pain can be extremely uncomfortable, even leading to not tolerating clothing that touches the breast. Although gynecomastia is the most common benign breast disease in men, the identification of a breast lump or breast enlargement, or any associated doubt, should lead to seeking medical care . A detailed medical evaluation will make it possible to rule out that it is male breast cancer, which is a rare but serious disease, whose early diagnosis increases the likelihood of cure. When it is not typical pubertal gynecomastia and when there is no history of taking medications that have gynecomastia as a known side effect, it is usual to request additional diagnostic tests, such as an ultrasound, mammogram or other imaging tests and some blood tests to search for other possible causes of breast enlargement. Treatment of gynecomastia The gynecomastia that occurs associated with male puberty resolves in most cases without any intervention, within a period of between 6 months and 2 years. In about 20% of boys with gynecomastia, it persists into adulthood. In persistent cases, with very marked breast enlargements and psychological impact or when there is significant pain, specific medication can be prescribed . When gynecomastia is a side effect of medication, its suspension or replacement, depending on the circumstances and particularities of each person, may be an option. If gynecomastia is due to a disease, treating the disease, as a rule, solves the problem. In extreme cases, in adult men, gynecomastia and pseudogynecomastia can still be treated surgically with tissue excision and/or liposuction . Talk with your doctor, protect your health If this is an issue that worries you, depending on your age, make an appointment with pediatrics or general and family medicine, or a specific breast appointment . Sources Braunstein GD, Anawalt BD. Clinical features, diagnosis and evaluation of gynecomastia in adults. Atualizado 2022. www.uptodate.com Taylor SA. Gynecomastia in children and adolescents. Atualizado 2022. www.uptodate.com Meet the general surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
