A clinical practice article on gynecomastia, using a case study as its focal point, is published today, Thursday 20th September in the New England Journal of Medicine by Glenn D Braunstein, chair of the Department of Medicine at Cedars-Sinai Medical Center, a large nonprofit academic medical center in Southern California, USA.
An expert in gynecomastia and other hormone-linked conditions, Braunstein said raising awareness about the causes and treatments of the condition "may help men and boys with gynecomastia be correctly diagnosed". He wanted to reassure them "they are not alone in experiencing this".
"Nearly half of all men will experience breast tissue growth during their lifetimes, but many are unaware of it or are too embarrassed to even discuss the problem with their doctor," said Braunstein.
Gynecomastia is when a rubbery or firm mass of tissue extends concentrically around the nipples. In about half of cases it appears in both breasts.
Other conditions can have similar symptoms, wrote Baustein. For example, fat deposition without increase in glandular tissue, called pseudogynecomastia, is also on the increase as obesity rates go up in American men.
Another condition with similar symptoms to gynecomastia, only far less common, is breast cancer. Breast cancer in men is usually only found on one side and the growth does not occur symmetrically to the nipple. It may also present with skin dimpling and nipple discharge.
Other rare conditions that cause breast enlargement in men include neurofibromas, hematomas, and dermatoid cysts.
Gynecomastia can occur normally in infant, adolescent and older males, or it can be a side effect of drugs or a disorder such as chronic kidney disease, androgen deficiency, hyperthyroidism, and testicular tumor.
50 per cent of gynecomastia in adult males is due either to persistent pubertal gynecomastia or medication side effects. Another 25 per cent have no known cause.
Nearly 65 per cent of 13 and 14 year old boys experience some degree of breast enlargement due to the normal ups and downs of hormone levels in puberty, but it usually goes away by itself later on in adolescence.
In adult and older men, gynecomastia is usually the result of low testosterone or hormone imbalance, or it can happen as a side effect of drugs or illnesses.
Increase in body fat, which converts male hormones into estrogens, can also result in gynecomastia, as can hormone therapies for prostate cancer.
Gynecomastia can be painful and feel tender. This can be treated with medications like the antiestrogen drug tamoxifen.
Braunstein, who holds the James R Klinenberg Chair in Medicine at Cedars-Sinai, said he had seen hundreds of cases of gynecomastia, and in many cases the men were not even aware they had it:
"It's fairly common, and in general, nothing to worry about from a medical standpoint," he said.
"If, however, the growth of breast tissue is very recent in onset, or if it is accompanied by pain or tenderness, it should be brought to the attention of your doctor who should take a careful medical history followed by exam and blood tests to rule out hormonal disorders or malignancies," he added.
If it is not serious, and the condition lasts for more than a year or the patient finds it troubles them, the breast tissue can be removed with surgery, often with good cosmetic result. However, no treatment is necessary for patients with no symptoms who are not particularly troubled by the condition.
Braunstein hopes the information reassures all men, but especially teenage boys and their parents who may be worrying about this unnecessarily.
The case study in Braunstein's article is of a 67-year-old man who was referred for lower back pain, who on examination was found to have gynecomastia on the right side.
Glenn D. Braunstein.
N Engl J Med 2007 357: 1229-1237.
Published online 20th September 2007.
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