Gynecomastia | |
---|---|
Adult male with significant gynecomastia | |
Pronunciation | |
Specialty | Endocrinology, plastic surgery |
Complications | Psychological distress |
Usual onset | Any age |
Duration | Usually up to 2 years, but can be lifelong |
Causes | Increased estrogen/androgen ratio (physiologic, medications, chronic kidney disease, obesity, cirrhosis, malnutrition, certain cancers, anabolic steroids) |
Diagnostic method | physical exam, mammography (if indicated) |
Differential diagnosis | Pseudogynecomastia, breast cancer |
Treatment | Lifestyle modifications, aromatase inhibitors, SERMs, or surgery |
Gynecomastia (also spelled gynaecomastia)[a] is the abnormal non-cancerous enlargement of one or both breasts in males due to the growth of breast tissue as a result of a hormone imbalance between estrogens and androgens.[4][5] Gynecomastia can cause significant psychological distress or unease.[6]
Gynecomastia can be normal in: newborn male babies, due to exposure to estrogen from the mother; adolescent boys going through puberty; older men, over age 50; and obese men.[4] Most occurrences of gynecomastia do not require diagnostic tests.[4][5] Gynecomastia may be caused by abnormal hormone changes, any condition that leads to an increase in the ratio of estrogens/androgens such as liver disease, kidney failure, thyroid disease and some non-breast tumors. Alcohol and some drugs can also cause breast enlargement.[4][7] Other causes may include Klinefelter syndrome, metabolic dysfunction, or a natural decline in testosterone production.[4][6][8] This may occur even if the levels of estrogens and androgens are both appropriate, but the ratio is altered.[7]
Gynecomastia is the most common benign disorder of the male breast tissue and affects 35% of men, being most prevalent between the ages of 50 and 69.[5][9] It is normal for up to 70% of adolescent boys to develop gynecomastia to some degree.[6] Of these, 75% resolve within two years of onset without treatment.[10] If the condition does not resolve within 2 years, or if it causes embarrassment, pain or tenderness, treatment is warranted.[11][12] Medical treatment of gynecomastia that has persisted beyond two years is often ineffective. Gynecomastia is different from "pseudogynecomastia",[5][6] which is commonly present in men with obesity.[13][14]
Medications such as aromatase inhibitors have been found to be effective[15] and even in rare cases of gynecomastia from disorders such as aromatase excess syndrome or Peutz–Jeghers syndrome,[16] but surgical removal of the excess tissue can be needed to correct the condition.[17] In 2019, 24,123 male patients underwent the procedure in the United States, accounting for a 19% increase since 2000.[18]
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