Gynecomastia

What is gynecomastia?

Gynecomastia is overdevelopment of the male breast. The glandular tissue of the breast swells, usually in response to an excess of the female hormone estrogen or a lack of testosterone, a male hormone. It occurs in babies, teen boys, and older men.

What causes gynecomastia?

In newborns, gynecomastia is caused by estrogen from the mother. It usually goes away in 2 to 3 weeks after birth.

In teen boys, gynecomastia is caused by the hormonal changes of puberty. About one-third of 13- and 14-year-old boys are affected.

In pre-teen boys, gynecomastia is very rare. In a few cases, it has been linked to regular use of lavender or tea tree oil in certain lotions or oils.¹ Gynecomastia can also be caused by an estrogen-producing tumor.

When gynecomastia occurs in adult males, it is usually caused by another condition, such as liver or lung cancer, cirrhosis of the liver, overactive thyroid, or by hormone problems, such as cancer of the pituitary gland, adrenal glands, or testicles. Alcohol, marijuana, methamphetamine, and heroin use also may cause gynecomastia.

Use of certain medicines may also cause gynecomastia, including:

• Steroids, such as prednisone or Hexadrol.
• Medicines used to treat ulcers (such as cimetidine).
• Medicines used to treat epilepsy (such as phenytoin [Dilantin]).
• Digitalis and other heart medicines.
• Chemotherapy drugs, especially alkylating agents, a family of anticancer drugs that interfere with cell DNA and inhibit cancer cell growth.
• Antiandrogen drugs (such as flutamide, cyproterone, and spironolactone).
• Antianxiety and antidepressant medicines (such as diazepam [Valium] and tricyclic antidepressants).
• Products containing tea tree oil or lavender oil.¹

What are the symptoms?

In addition to having enlarged breasts, men or boys with gynecomastia may notice their breasts feel rubbery or firm. Boys may have a breast bud on one or both sides about the size of a nickel or quarter. Breast buds may last up to 18 months but usually go away on their own.

How is gynecomastia diagnosed?

Gynecomastia can usually be diagnosed from a physical examination and medical history. In most cases, tests are not necessary. However, if the breast lump is unusually large, one-sided, tender, or hard and fixed, a biopsy may be done to rule out other problems.

Any man with a one-sided breast lump should let his doctor know if he has close relatives who have had breast cancer (mother, sister, or daughter). If there is any concern about cancer, a lump can be checked with a biopsy or surgery.

How is it treated?

Gynecomastia in babies and teens normally does not require treatment and will usually resolve on its own. If caused by medicine or disease, stopping the medicine or treating the disease will often cure the gynecomastia. If caused by a lack of testosterone and increase in estrogen, hormonal treatment may be prescribed.

Citations

1. Henley DV, et al. (2007). Prepubertal gynecomastia linked to lavender and tea tree oils. New England Journal of Medicine, 356(5): 479–485.