Gynecomastia, the medical term for male breast growth, is a disorder that can affect men at any stage of life.
Puffiness behind the nipple, excess fat deposition, and loss of muscle in the chest area characterizes the disorder. In more severe cases, men with breasts affected by gynecomastia may have a chest that looks like a woman’s.
While most cases are a result of weight gain, there are other factors that can lead to the development of gynecomastia. Whatever the cause or severity, gynecomastia treatment is a top priority for those who suffer from it.
But, where can you start? What options are available to you if you have male breast enlargement?
In this article, we’ll go over the cause of gynecomastia and the best of the best in treatments.
What Causes Male Gynecomastia?
Male breast enlargement is a result of a hormone imbalance. When estrogen increases in ratio to testosterone, it can cause breast tissue to grow by stimulating cell proliferation in sensitive tissues. The rapid growth of breast tissue can not only be embarrassing but painful, too.
There are many factors that can contribute to increased estrogen levels. Some include weight gain, alcohol, anabolic steroids, and even certain medications. While some of these are unavoidable, a healthy diet and lifestyle are usually enough to prevent breast enlargement. However, in some people there is likely a genetic predisposition to form excessive breast tissue.
Treatments for prostate cancer that counteract male hormone activity can also lead to an increase in estrogen relative to testosterone. As a result, these medications can lead to gynecomastia in some cases. If you are being treated for prostate cancer and are experiencing male breast enlargement, it’s important that you work with a doctor to figure out the best treatment for you.
Male breast growth can also occur with a condition called hypogonadism. This results in decreased testosterone production. As a result, the delicate testosterone to estrogen balance gets disrupted.
Less commonly seen is gynecomastia that follows medication use. Anti-androgen drugs are for various conditions and can lead to male breast growth, as well as some anti-depressants and heart medications. However, for most people the cause is unknown.
Some cases of gynecomastia will resolve spontaneously. But, others may need treatment.
The medical treatments listed below require a diagnosis and prescription from a doctor to use them.
Androgen therapy is a form of hormonal therapy where medications bolster androgen levels. The term “androgen” represents a wide range of male hormones, including testosterone. Beyond their standard functions in the body, androgens help counteract estrogen activity.
Now, how does all of this relate to gynecomastia?
As mentioned previously, the growth of breast tissue is a result of excess estrogen activity. By boosting androgen levels, androgen therapy can rebalance the estrogen-to-testosterone ratio. This can prevent the development of breast tissue growth in men.
A specific androgen is used to treat gynecomastia: dihydrotestosterone (DHT). This type of testosterone cannot convert to estrogen like regular testosterone can. Because of this, DHT therapy won’t impact estrogen levels.
DHT therapy isn’t without its side effects, though. High levels of this potent hormone have been known to impact hair loss, especially in men. DHT can also increase sebum production in the skin which could lead to acne.
It’s important to note, though, that androgen therapy often doesn’t result in a full reversal of the breast growth. In fact, the efficacy of any medication treatment for gynecomastia is largely poor and unpredictable with side effets out weighing any potential benefit.
Anti-estrogen therapy has gained popularity over recent years because of its effectiveness for gynecomastia. Research shows that two forms of anti-estrogen therapy, Tamoxifen and Raloxifene, can help reduce breast size in men if there is a clear, underlying relationship between excessive estrogen production and breast growth. However, in the large majority of patients this is not the case.
Tamoxifen is a pill which quickly reduces breast pain from breast enlargement. It’s also successful in rebalancing the estrogen-to-testosterone ratio, resolving the underlying cause of gynecomastia. Tamoxifen is a fairly reliable treatment with a robust body of evidence to support it in a very seect sub group of men who may be producing too much estrogen.
But, Tamoxifen doesn’t always fully resolve gynecomastia and is largely useless in most men who preent with enlarged breasts
Side Effects of Tamoxifen
Although tamoxifen is usually well-tolerated and non-toxic, there are side effects associated with its use.
These adverse effects include:
- Skin rashes
- Hot flashes
- Loss of sex drive
Raloxifene, administered in pill form, is an alternative to Tamoxifen.
Where it differs from Tamoxifen is its effectiveness. In one study, the average reduction in breast size with Tamoxifen was 2.1 cm, whereas Raloxifene reduced breast size by 2.5 cm. The data summary showed that patients given Tamoxifen experienced a 41% decrease. Those who received Raloxifene had an 86% decrease. In all subjects, no adverse effects were present.
In this study, Raloxifene is seemingly more effective compared to Tamoxifen. However, there need to be more studies done comparing their efficacy. And the subgroup of patients for which this medication may be useful is small since most cases of gynecomastia are not strictly a result of excessive estrogen production.
Side Effects of Raloxifene
Despite raloxifene’s potential to treat gynecomastia, there are some adverse effects that have occurred.
Here are some of the side effects:
- Joint pain
- Hot flashes
Aromatase inhibitors are a novel class of drugs used for gynecomastia treatment.
In the body, testosterone converts to estrogen by an enzyme called aromatase. By reducing aromatase activity, aromatase inhibitors can indirectly lower estrogen levels.
Anastrozole is a potent aromatase inhibitor shown to effectively reduce estrogen levels in men. It’s most frequently prescribed to gynecomastia that occurs during puberty.
However, there isn’t a ton of data available on the efficacy of aromatase inhibitors in every population. There’s also a lot of information missing on how it might impact pain associated with breast tissue growth. So, it’s not always the first line of treatment for male breast growth.
Side Effects of Aromatase Inhibitors
Because aromatase inhibitors have the potential to reduce estrogen levels, they can impact bone health. Another side effect may be hair loss, aggression, and possible risks of cardiovascular events.
Cosmetic surgery is the only fully effective and reliable treatment for gynecomastia. In contrast to medication-based treatments, gynecomastia surgery removes all excess breast tissue.
Unlike drugs used to treat male gynecomastia, cosmetic surgery doesn’t have any negative side effects. You’ll only need three to five days before you can start being active again.
Plus, almost anyone can have this procedure done. Unlike medications, there are relatively little contraindications that would prevent you from having gynecomastia surgery.
Although more expensive when compared to other treatments, you can’t put a price on self-confidence.
How to Find a Plastic Surgeon for Gynecomastia Surgery
If you opt for effective cosmetic surgery for your gynecomastia treatment, you want to ensure you are being operated on by a qualified doctor.
Below are some tips for finding a great plastic surgeon.
Get a Referral
Don’t take a friend’s recommendations lightly. If someone you know has a had a great experience with a plastic surgeon, it’s worth keeping them on your radar.
Reviews don’t lie. Look for verified reviews on websites like Yelp from real people. Some practices will also proudly display customer testimonials on their website. Before and afters are always a good idea to take a look around for, too.
Check Out Their Credentials
Although credentials don’t always speak to experience, it’s good practice to check in on your doctor’s credentials. These can usually be found on the prospective doctor’s website or with a quick search of their name on Google.
Choose a Doctor Who Specializes in Gynecomastia Surgery
A doctor who specializes in the surgery you’re looking to have done ensures you’ll get the results you’re looking for. A doctor will usually state their specialties on their website.
Schedule a Consultation
The best way to get a feel for the right plastic surgeon is by getting a consultation. By sitting with them face-to-face and asking questions, you’ll be able to get a better idea of whether or not they’re the right surgeon for you.
Gynecomastia Can Be Treated Successfully
There are so many options available for gynecomastia treatment. However, they differ in effectiveness. Although medication-based treatments can’t fully reverse gynecomastia, cosmetic surgery can.
If you choose to opt for plastic surgery, choosing the right doctor is key. You’ll want to look for experience, credentials, and good reviews from previous patients. Knowing someone who has used the doctor prior is a bonus.
Dr. Neavin from Artisan of Beauty is the top-rated gynecomastia surgeon in the Los Angeles area. Besides his high achievements in school, he was also recruited to one of the most prestigious plastic surgery training programs available in the US. In addition to these accolades, he has authored and co-authored publications on plastic surgery. No matter the procedure, you can trust Dr. Neavin.
Interested in having your gynecomastia treated by Dr. Neavin? Book an appointment for a consultation today.