Enlarged breasts, sometimes referred to a ‘man boobs’ is a problem for many men. Sometimes it is just a matter of obesity but in other cases it can be actual breast tissue enlargement due to hormonal activity. This is known as gynecomastia and can affect one or both breasts. Overall gynecomastia is not a common condition. It is more likely to be seen in newborn male babies,  adolescent boys (around the time of puberty) and elderly men. Gynaecomastia apart from being an embarrassing and emotional stressful condition does not pose any threat to the health of the person. Many of the cases of gynaecomastia disappear spontaneously without any treatment . In other cases drugs to treat underlying problem and even surgery are helpful.

What are the symptoms?

The symptoms of gynecomastia extends beyond just breast enlargement although this is the most prominent of all clinical features of the condition. In fact more men may seek medical advice for the breast enlargement, which they find embarrassing, rather than the breast discomfort that is sometimes seen in gynecomastia. Breast enlargement or swelling may be one-sided (unilateral) or affect both sides (bilateral). It is often an uneven enlargement when it affects both breasts. In addition, men may also complain about :

• Pain in the breast tissue
• Discharge from the nipples (commonly white)

The psychological impact of the condition among elderly men may not be as severe as is the case among adolescents. In younger males, it can lead to depression as a result of the psychosocial impact of the condition.

What causes gynecomastia?

It is often difficult to pinpoint the exact cause behind gynaecomastia but according to the most popular hypothesis, it is due to an imbalance between male hormone (testosterone) and female hormone (estrogen). Remember that both male and female hormones are present in both genders – the male hormones are at higher levels in men and the female hormones higher in women. Gynecomastia mostly occurs because there is an increased level of binding-protein of testosterone in the blood stream resulting in small amounts of free testosterone available for action since bound testosterone is physiologically inactive. Elderly men between 50 to 80 years of age are considered a high risk group due to low testosterone levels as a result of advancing age.

Sometimes certain drugs (by lowering the active level of testosterone or by reducing it’s the activity) may be responsible. These include :

• Antiestrogen drugs used in prostate cancer like flutamide.
• Spironolactone (low efficacy water pills) used in heart failure and cirrhosis.
• Anabolic steroids used by athletes.
• Antiretrovirals for HIV infection.
• Anti-anxiety drugs.
• Some antidepressants.
• Certain antibiotics, especially if used over prolonged periods.
• Anti-ulcer drugs (cimetidine).
• Anti-cancer drugs.
• Certain drugs used in heart failure (digitalis).
• Substance abuse (alcohol, amphetamine, heroin, marijuana) may also lead to gynaecomastia.

Certain medical conditions may lead to gynaecomastia due to hormonal imbalances. This includes :

• Hypogonadism (poor function of testes, low level of testosterone).
• Tumors (especially of testes, pituitary and adrenal glands).
• Overactivity of thyroid gland (hyperthyroidism).
• Organ failure (kidney and liver).
• Malnutrition and starvation may also lead to gynaecomastia (fall in testosterone level with unchanged estrogen level).

How is gynecomastia treated?

In many cases gynaecomastia disappears without any medical intervention. In other cases where the causative factor can be identified, treatment of the underlying disease or cessation of drugs known to cause gynaecomastia, often helps. Prescription medication that may be causing gynecomastia should not be stopped with medical supervision.

There are drugs (tamoxifen and raloxifen) approved by the FDA (Food and Drug administration) for treatment of gynaecomastia. In persistent cases surgery can be done (liposuction and mastectomy). Patients need to be made aware that the condition is not usually harmful and no complications will arise. Therefore treatment is not always necessary, especially in milder cases.