Gynecomastia ( English American) or Gynaecomastia (English British ) is the growth of abnormally big breasts on men. It comes from the Greek word Gyne meaning "woman" and Mastos meaning "breast". The condition can occur physiologically in adolescents, in neonates, and in older men. In most adolescent boys the symptoms will disappear in a few months to a couple years at most. It is usually just a result of an imbalanced hormones, although there can be many different causes. Gynecomastia is not just a buildup of adipose tissue, it also includes development of glandular tissue.

Gynecomastia Causes
Physiologic gynecomastia occurs in neonates, with aging and in puberty.

Potential pathologic causes of gynecomastia are: increased serum estrogen, androgen receptor defects, medications including hormones, decreased testosterone production,  chronic kidney disease, HIV, chronic liver disease, and other chronic illness. Gynecomastia as a result of spinal cord injury and refeeding after starvation has been reported. In 25% of cases, the cause of the gynecomastia is unknown.

Medications cause over 15% of cases of gynecomastia. These include spironolactone, cimetidine,  finasteride, omeprazole and some antipsychotics. They can act directly on the breast tissues, while some lead to increased secretion of prolactin from the pituitary by blocking the actions of dopamine (PIF/Prolactin-Inhibiting Factor) on the lactotrope cell groups in that organ. Androstenedione, used as a performance enhancing food supplement, can lead to breast enlargement by excess estrogen activity. Marijuana usage is thought to be another possible cause.

Increased estrogen levels can also occur with certain testicular tumors, and in hyperthyroidism. Certain adrenal tumors cause elevated levels of androstenedione which is converted by the enzyme aromatase into estrone, a type of estrogen. Other tumors that secrete hCG can increase estrogen. A decrease in estrogen clearance can occur in liver disease, and this could be the mechanism of gynecomastia with liver cirrhosis. Obesity can also increase estrogen levels.

Decreased testosterone production can occur with congenital or acquired testicular failure, for example in genetic disorders like Klinefelter Syndrome. Diseases of the pituitary or hypothalamus can also lead to low testosterone. Abuse of anabolic steroids has a similar effect.

Although stopping these medications can lead to regression of gynecomastia, surgery is sometimes needed to eliminate the condition.

Gynecomastia Diagnosis
This condition  can usually be diagnosed by a physician. Occasionally, imaging by ultrasound or X-rays is needed to confirm diagnosis. Blood tests are required to see if there is any underlying disease causing the gynecomastia.

Gynecomastia Prognosis
Gynecomastia is not physically harmful, but in a few cases it is an indicator of more dangerous underlying conditions. Gynecomastia presents social and psychological difficulties for the sufferer. Weight loss can alter the condition in cases where it is triggered by obesity, but for many it will not eliminate it as the breast tissue remains.

Gynecomastia Treatment
Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Patients should stop taking medications which can cause gynecomastia. Anti-estrogen medications, such as clomiphene and tamoxifen or androgens can be used. Aromatase inhibitors are another treatment option, although they are not universally approved for the treatment of gynecomastia. Endocrinological attention may help during the first 2-3 years. After that window, however, the breast tissue tends to remain and harden, leaving surgery (either liposuction or reduction mammoplasty) the only treatment option. Radiation therapy is often used to prevent gynecomastia in patients with prostate cancer before estrogen therapy. Some men choose to live with the condition and wear a bra for support.

References

• Heruti RJ, et al. Gynecomastia following spinal cord disorder. Arch Phys Med Rehabil. 1997 May;78(5):534-7. PMID 9161376

• Glass AR. Gynecomastia. Endocrinol Metab Clin North Am. 1994 Dec; 23(4):825-37. PMID 7705322

• Braunstein GD. Gynecomastia. N Engl J Med. 1993 Feb 18;328(7):490-5. PMID 8421478

• Braunstein GD. Aromatase and Gynecomastia. Endocr Relat Cancer. 1999 Jun;6(2):315-24. PMID 10731125

• Peyriere H, et al. Report of gynecomastia in five male patients during antiretroviral therapy for HIV infection. AIDS. 1999 Oct 22;13(15):2167-9. PMID 10546872