Sometimes It’s Normal, Sometimes It’s Not… How to Tell
As many as two-thirds of older men have some enlargement of the breast tissue (the medical term for this is gynecomastia). While potentially embarrassing, this condition is nearly always benign — but many men, understandably, prefer not to just live with it. What, if anything, can be done?
According to Glenn Braunstein, MD, chairman of the department of medicine at Cedars-Sinai Medical Center in Los Angeles, growth of male breasts is actually likely to occur during major changes in natural hormone levels at three different times in the life of a male: right after birth, at puberty and between ages 40 and 70. The reason? An imbalance between estrogen and testosterone. “Estrogen stimulates male breast tissue,” Dr. Braunstein explained. Just as females produce low levels of testosterone, males produce estrogen too — the key is keeping the relative effects of the two in proper proportion to one another. For instance, said Dr. Braunstein, when a boy passes from childhood to puberty, the testes may produce relatively more estrogen before testosterone reaches adult levels. At this stage, breast tissue enlargement typically lasts just six months or so then disappears in all but a small percentage of cases.
COMMON CAUSES FOR GYNECOMASTIA
According to Dr. Braunstein, the following factors may contribute to the development of breast tissue in men:
- Body fat. In adulthood, the condition is often linked to body fat. “Lean body mass goes down and fat mass goes up as we get older,” Dr. Braunstein explained. Fat contains an enzyme called aromatase that converts some existing testosterone into estrogen. “This adds to the imbalance,” he said. Not surprisingly, there is a progressive increase in the volume of breast tissue that correlates with an increase in body mass index (BMI). Also, with age, the testes produce less testosterone, which further increases the imbalance.
- Drugs. Some medications, such as the anti-ulcer drug cimetidine (Tagamet) or the anti-hypertensive spironolactone (Aldactone), may block the action of testosterone in tissue, allowing estrogen to work unopposed.
- Hormone problems. Hyperthyroidism (overactive thyroid) or hypogonadism (a clinically significant lower production of testosterone as measured by a blood test) can affect the ratio of estrogen to testosterone, and also impact the activity of these hormones at their tissue receptors.
- Tumor growth. Though rare, some tumors — particularly testicular or adrenal — can cause gynecomastia.
- Tea tree and lavender oils. Recent research has found that these have some estrogenic and anti-androgenic properties. When products containing them are used in large quantities, this can contribute to gynecomastia as well, said Dr. Braunstein.
WHAT TO DO?
If the onset of gynecomastia is sudden and recent and the tissue feels tender and painful, Dr. Braunstein advises seeing your doctor and requesting a review of hormone levels, especially testosterone. Some doctors will treat a recent case of gynecomastia with a three-month course of Tamoxifen, but remember — all drugs have side effects, including this one. The drug is unlikely to make any difference at all if the problem has existed a year or more.
Weight loss, of course, is a better solution but… as women will attest, the result may not be exactly what you hoped for. Plastic surgery can be an option, but that’s hardly without risks.
Daily Health News contributing medical editor Andrew L. Rubman, ND, suggests a consultation with a naturopathic physician who specializes in endocrinology. “Often simple changes in diet, lifestyle and nutrition can slow progression of gynecomastia,” he says. In Dr. Rubman’s view, naturopathic medicine should be a first-line attack if you are concerned about gynecomastia — the likelihood is the problem can be significantly reduced without drugs or surgery. “Getting your MD and ND to work together can provide the safest and most effective solution,” he says.