Men With Large Breasts: When to Worry

See your doctor to pinpoint underlying cause

If you’re a man who has developed swollen or enlarged breasts, it is important to get checked by a doctor. You may have what doctors refer to as gynecomastia.

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“This condition is usually benign and reversible once you stop the cause,” says endocrinologist Ula Abed Alwahab, MD. But, she says it can suggest a hormone imbalance or other underlying problem, so it’s best to see your doctor to get it checked.

First, your doctor will examine you to rule out pseudo-gynecomastia. “What we call pseudo-gynecomastia occurs when someone is obese and simply has fat in that area without the gland actually being enlarged,” says Dr. Abed Alwahab.

If your doctor finds you have true gynecomastia — enlarged breast tissue in the glands that has a root medical cause — he or she will run tests to find the cause.

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Possible culprits

There are many possible causes of gynecomastia. The bottom line is that something is reducing or blocking the male hormone testosterone. This allows the female hormone estrogen to dominate. Sometimes, your estrogen level increases.

Several conditions can upset hormone balance for men and lead to gynecomastia:

  • Kidney disease
  • Liver disease
  • Alcoholism
  • Hyperthyroidism
  • Klinefelter syndrome (a chromosomal condition from birth that usually results in smaller testes and reduced testosterone levels)
  • Testicle removal to treat testicular cancer

“Gynecomastia is not the disease itself, but it is a manifestation of another problem,” Dr. Abed Alwahab says. “So we check the hormones that can be in imbalance, and we check the liver, kidney and thyroid functions and so forth, so we can figure out what’s going on.”

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Medications may also be to blame

A variety of medications can cause gynecomastia. The most common offender is spironolactone. A water-reduction pill, cardiologists use it to treat high blood pressure or heart failure.

Other medicines that may cause the condition include:

  • Anti-androgen therapy (used mainly to treat prostate enlargement and cancer)
  • Anabolic steroids and androgens
  • AIDS medications
  • Anti-anxiety medications
  • Tricyclic antidepressants
  • Ulcer medications
  • Some antibiotics

These drugs can also cause this condition:

  • Alcohol
  • Amphetamines
  • Marijuana
  • Heroin
  • Methadone

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What about cancer?

Depending on test results, if your doctor finds an enlarged gland and hasn’t found another cause, he or she may schedule a mammogram to test for cancer. Men can get breast cancer, though it is fairly rare.

“So, while it’s very unlikely to be malignant, it’s always good to rule out malignancy,” says Dr. Abed Alwahab.

The most concerning signs of possible male breast cancer are:

  • A fast-growing mass that is only on one side of your chest
  • Milky or bloody discharge from your nipples
  • Any skin changes on the breast itself

If you see any of these signs, see your doctor immediately.

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Natural causes in infants and adolescent boys

Many male infants have transient gynecomastia caused by a residue of estrogen from the mother. This condition typically disappears by the end of the first year.

Gynecomastia caused by hormone changes in boys during puberty also is fairly common. In most cases, the swollen breasts will go away without treatment in 6 months to two years.

“During puberty, some young men can also develop benign gynecomastia because there is that same imbalance between male and female hormones, but we don’t have to worry about that,” Dr. Abed Alwahab says. It resolves on its own.

What can you do about gynecomastia?

In as many as a quarter of all cases, doctors don’t find a cause for gynecomastia.

If the condition is not cancerous and doesn’t go away after you rule out all other causes, your doctor may try to reduce breast swelling with drug therapy.

Some men also pursue male breast reduction or cosmetic surgery, Dr. Abed Alwahab says.

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