Gynecomastia: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Overview of Gynecomastia

Gynecomastia is a health condition in which men develop enlarged breasts at any age. The main cause of gynecomastia developing is change in hormonal levels- estrogen and testosterone- in the male body. Due to an increase in estrogen level or decrease in testosterone level, the body develops women-like breasts. There are several contributing factors that can result in this hormonal imbalance.

Gynecomastia is a cause of concern for several men globally as it can cause extreme embarrassment and impair the self-confidence of the individual. This makes it difficult for the patient to be intimate with their partner or take in part in certain physical conditions.

Facts on Gynecomastia

• According to Mayo Clinic, every 1 in 4 men is affected by gynecomastia

• People in the age bracket of 50 and 80 are at a higher risk of developing gynecomastia

• Around 32-65% of men are affected by gynecomastia globally

Causes of Gynecomastia

• Age- Age is the main cause of gynecomastia development. As boys reach puberty, there are some hormonal changes in the body that leads to enlargement of the breasts. However, within 6 months to 2 years, these subside eventually. Also, men who are in their 50s, 60s, and 70s are at increased risk of developing large breasts as they are unable to produce enough testosterone.

• Medicines- Taking some medicines on a regular basis can curb the production of testosterone and other male hormones. The medicines that increase the chances of gynecomastia developing are-

  • Metronidazole that treats bacterial infections

  • Spironolactone, digoxin, amiodarone, and calcium channel blockers

  • For treating enlarged prostate, prostate cancer and others, Finasteride

  • Cimetidine and proton pump inhibitors used for heartburn

  • Diazepam taken for anxiety

  • Ketoconazole for fungal infections

  • Human chorionic gonadotropin for fertility problems

  • Doctors prescribed anabolic steroids and androgens that athletes take illegally for enhancing performance

  • Medicines for AIDS such as Efavirenz is closely associated with gynecomastia

  • Tricyclic antidepressants

  • Medicines for treating cancer

  • Medication for emptying the stomach as metoclopramide

• Medical conditions- In case a person is suffering from any medical condition such as tumor in the testicles, cirrhosis or any other liver ailment, renal failure, hyperthyroidism or hypogonadism, they are more likely to suffer from gynecomastia.

• Unhealthy lifestyle- People who are into unhealthy habits of taking drugs such as heroin, methadone or amphetamines and consuming alcohol excessively have higher chances of developing swollen breasts.

• Herbal products- Using products, oils, shampoos, soaps or lotions that contain herbs such as tea tree, lavender or any other essential oils can increase the risk of gynecomastia developing. The properties of these herbs can lead to breast enlargement in men.

 

Stages of Gynecomastia

The stages of gynecomastia have been researched several times and categorized by several authors. The most widely accepted categorization was identified by the authors of “Classification and surgical correction of gynecomastia”. Later, the American Society of Plastic Surgeons standardized this as the gynecomastia scale. There are four stages of gynecomastia-

• Grade I- Small enlargement without skin excess

• Grade IIa- Moderate enlargement without skin excess

• Grade IIb (commonly known as the Grade III)- Moderate enlargement with minor skin excess

• Grade III (commonly known as the Grade IV)- Marked enlargement with excess skin, mimicking drooped of the female breast

Symptoms That Develop In Each Stage Of Gynecomastia

• Grade I:

  In this stage of gynecomastia, the breasts enlarge but these are noticeable over clothes. In addition to this, there can be some tissue growth around the areola and nipple area. There is mild puffiness of the nipples and there can be some discoloration of the breasts.

• Grade II:

  The chest becomes broader due to excessive tissue growth throughout the chest but the swelling of nipples remains still unnoticeable. This grade is also known as mild to moderate breast enlargement that makes the chest feel tight. Additionally, there can be some firmness under the nipple area and the outer area can be soft and fatty.

• Grade III:

  The breasts start to become droopy and the chest width increases visibly. This stage is considered to be moderate to severe and the droopiness is quite evident even after wearing loose-fitting clothing.

• Grade IV:

  By this stage, the men have developed breasts similar to women-like. Also, this is the final stage of breast enlargement which means it is highly visible.

Types of Gynecomastia

Evidently, there are 7 types of Gynecomastia-

• Normal gynecomastia

• Adult gynecomastia

• Pure glandular gynecomastia

• Adolescent gynecomastia

• Asymmetric gynecomastia

• Pseudo-gynecomastia

• Severe gynecomastia

Diagnosis of Gynecomastia

The diagnosis of gynecomastia starts with a detailed physical examination of the breast area and the nipples. The physical examination mainly includes feeling the breast area to confirm the presence of any firm tissue. The doctor asks several questions related to the medical history of the patient to confirm if he is suffering from any other disease.

Followed by this, the doctor asks questions related to the age, duration of the condition, rate of swelling and other symptoms the person is suffering from. The doctor can also ask questions related to the development of other sexual changes in the patient to confirm the presence of gynecomastia.

After this, the doctor prescribes some hormone level tests and an ultrasound examination of the breast. Other tests include X-Rays, CT scans and MRI scans to check the presence of any tumors or other abnormalities that are resulting in breast enlargement.

Ayurvedic Treatment of Gynecomastia

In Ayurveda, gynecomastia is a medical condition that develops due to obesity. According to Ayurveda, the breasts enlarge as a side effect and not independently. Some of the common ayurvedic medicines that help to decrease the swelling are- Tribulus power, Arogyavardhini Vati, Hakam Churna, and Guggul capsules. There are some herbs such as black pepper, long pepper, rock salt, amla, dried ginger, Haritaki or Aksha that can get rid of the symptoms. Applying mustard oil around the nipples once a day is also another ayurvedic remedy that ayurvedic doctors recommend.

Allopathic Treatment of Gynecomastia

Using drugs and medicines to normalize the hormonal balance is a treatment option that has been approved by the United States Food and Drugs Administration (USFDA). There are two types of pills that can bring back hormonal levels normal- Pharmaceutical drugs and Natural supplements.

• Pharmaceutical drugs- The drugs can further be defined into two categories- Testosterone Replacement Therapy (TRT) and Selective Estrogen Receptor Modulators (SERMs). The former increases the testosterone level in the body and the latter fastens the metabolism of estrogen in the male body. The most common TRT drugs include Danazol. Clomiphene and Tamoxifen are types of SERMs.

• Natural supplements- These are pills made from natural herbs that work by burning out the chest fat. The main ingredients for preparing these supplements include sclareolides, guggulsterone and theobromine cacao.

Homeopathic Treatment of Gynecomastia

Conium Mac 200 mg is the prescribed homeopathic medicine for encouraging testosterone production. However, there are several side effects such as digestive disorders, headache, nausea, vomiting, etc. that it can cause.

Treatment of Gynecomastia At Home

Although not very effective, there are some remedies that can be tried at home for treating symptoms of gynecomastia.

Exercises- Exercises place a major role in leveling the chest either by reducing fat accumulation or preventing estrogen production. Some of the chest-targeted exercises to practice everyday include-

• Push-up

• Stand Cable Fly

• Bench presses

• Plank to Push-up

• Sprints

Aim for cardio at least 15 minutes in a day. Common cardio exercises to aim for are-

• Walking

• Taking the stairs

• Jogging

• Cycling

• Swimming

• Cycling

• Running

• Jumping rope

Diet- Some people mistakenly eat food items that are rich in phytoestrogens that increase the estrogen levels in the body. These are soy products, flax seeds, protein bars and powders, eggs and alcoholic beverages. Replace these food items with the following-

• Anti-inflammatory foods such as leafy greens, sweet potatoes, berries, citrus fruits and beans

• Zinc-rich foods such as Raw milk, Yogurt, Toasted wheat germ, Cocoa or chocolate, Nuts, Pumpkin seeds, Cashew, Spinach, Oysters, Veal liver, Lean beef, Salmon, Cheese

• Health fat rich foods such as egg yolk, coconut, olives, avocados, meat, organic nuts, pecans, almonds, potatoes, raisins, coffee, ginger, garlic, onions, etc.

• Vitamin D rich foods such as mushroom, caviar, eggs, pork, cereals, dairy products and oily fish.

Surgical Treatment of Gynecomastia

The ideal candidates of Gynecomastia are-

• Men who are embarrassed with their breasts being large or the puffiness of their nipples

• Men whose breasts have enlarged as much as possible and has stabilized

• Men who maintain a healthy lifestyle and are within their normal weight

• Men who expect realistic results from the surgery

• Men who are ready to follow to a healthy lifestyle even after the surgery to achieve the desired goals they have in their mind

• Men who neither smoke nor take drugs

• Men who are not suffering from any health conditions that can interfere with the recovery or cause severe side effects

• Men who are not satisfied with the results of ayurvedic, allopathic, and non-surgical treatment of gynecomastia

Gynecomastia treatment is a two-step process. It involves liposuction and gland excision surgery. Let’s have a look at them in detail-

• Liposuction- It is the surgical procedure to remove fat pockets from the body to enhance the overall appearance of the body. This is a technique to suck out fat from specific areas of the body such as the abdomen, buttocks, arms, neck, hip or thighs to shape these areas. This procedure is also referred to as lipo or lipoplasty. The whole procedure is performed under the influence of anesthesia, local or general. There are various types of liposuction- tumescent, ultrasound-assisted, laser-assisted and Vibration Amplification of Sound Energy at Resonance (VASER).

• Gland excision surgery- In this procedure, the doctor removes excess glandular tissue from the breasts. After this surgery, the individual has a flat, firm and more masculine chest. This surgery is performed on the basis of an outpatient basis but the patient may have to stay at the hospital for the night. This procedure is performed under the influence of anesthesia which means the patient is unable to feel any pain or discomfort. This surgical option offers permanent results.

Complications of Gynecomastia

Gynecomastia is a disease that has both physical as well as a psychological impact. Recent studies indicate that patients who are suffering from gynecomastia for a very long time, tend to have lower self-confidence than others. In addition to this, they also become easy targets for bullying that eventually has an effect on their mental and physical health. They are prone to developing an eating disorder to cope up with dampened self-esteem. Furthermore, they have difficulty socializing with their peers.

Prevention of Gynecomastia

Gynecomastia is preventable in nature. If you maintain a healthy lifestyle- including paying attention to eating proper food items and following some lifestyle changes- the chances of gynecomastia developing decreases considerably. Here are a few measures to consider-

• Aim to drink at least 2 liters or 9 cups of water in one day

• Cut down on food items that contain added sugar such as corn syrup, sugary drinks, processed juices, etc.

• Avoid overconsumption of food items prepared with refined carbohydrates or loaded with starch for a couple of months.

• Eat foods that are rich in testosterone such as ginger, garlic, low-fat milk, blueberries, beef, egg yolks, beef, beans, shellfish, macadamia nuts in your regular meal.

• Take rest for a minimum of eight to nine hours in a day. Sound sleep is important here.

• Make a meal plan at the beginning of a week and try to follow it as much as possible.

• Break your daily diet into three large meals with one or two snacks.

• Exercise on a daily basis for at least 30 mins five days a week.

• Experts recommend taking only 1500 calories per day for a faster metabolism.

• Remember overworking out doesn’t necessarily mean better body contour. Taking proper rest is also crucial for muscle building.