Why do some men develop breasts and what can be done about it?

Gynaecomastia is quite a frequently encountered condition in medical practice and it refers to the presence of a palpable enlargement of the male breast. Overall the incidence of gynacomastia is increasing throughout the world across a variety of age groups for a various reasons. Some of the causes attributed are endocrine disrupting chemicals in an increasingly polluted world, obesity, anabolic steroid (androgen) abuse, widespread use of medications that cause gynaecomastia and increased prevalence of diseases that cause gynaecomastia such as testicular cancer.

Gynaecomastia is common amongst teenage boys and also in elderly people who gain weight rapidly. Gynaecomastia can occur in upto 60% of pubertal boys (usually tall or obese teenagers) under the influence of hormones and most would spontaneously subside within a year.

What are the common causes for Gynaecomastia?

Often gyanecomastia occurs when an adult puts on weight very quickly. Even in pubertal children the incidence peaks between the ages of 12-14 in response to increased and fluctuating levels of male and female hormones that are secreted by the body. Most often (70% of the times) breast size would regress within a year. So when should one seek medical help and intervention?

In a teenage boy, persistence of breast tissue above the age of 17 or a sudden increase in size with pain may necessitate a visit to the doctor’s clinic. In adults, asymmetric breast enlargement especially if located below the areola of unusal firmness/hardness with nipple changes (retraction, eczema or bleeding) should alarm the individual enough to see a doctor.

The doctor after doing a thorough examination might ask for a few tests. Screening tests may include blood tests like Liver function and kidney function tests,hormonal assays of LH, FSH, Prolactin, Free and total Testosterone, Estradiol, beta hCG and thyroid function. Other scans such as Ultrasound breast, testes, CT for chest and adrenal glands and a FNAC may also be suggested.

Treatment is usually indicated for painful large breast masses (>5cm) in size with worrying features such as nipple bleeding or discharge, eczema or enlarged lymph nodes on doctors examination.

Medical treatment with drugs such as Raloxifene, Tamoxifen and Anastrazole would help in reducing the estrogens (or theri effect) in the body. Surgery is also an option with a high success rate of complete cure (90%).