HOUSE CALLS By Dr. Gerald Deas
Women seem to worry about having small breasts and men are distressed when they have too much breast. Usually, small breasts in women are not related to any particular hormonal condition but is most likely genetic, or could be due to a decrease in estrogen production. However, when men begin to develop extra breast tissue, it could be a sign of several medical conditions, which interfere with the production of testosterone and lead to an overproduction of estrogen, a female hormone.
When you see a man strutting down the beach with an overhanging abdomen and hanging, enlarged breasts, you can bet that those large breasts are due to excess fat and are a sign of overeating. On the other hand, elderly men may also appear to have large breasts due to a decrease in total body fat, which causes the breast to appear enlarged.
Enlargement of the breasts in men is called gynecomastia (gyne-co-mas-tia). This condition occurs in 30 percent to 50 percent of healthy men over a period of time; however, when it occurs in younger boys or men, the cause should be investigated. It can occur in boys at puberty as early as ten years of age and disappear by the age of fourteen. Gynecomastia usually occurs in the left breast, for unknown reasons. The tissue is usually dense and has the appearance of a woman’s breast. A fatty breast, on the other hand, may be soft and less structured.
Gynecomastia is due to an imbalance of estrogen (a female hormone), and androgen (a male hormone). Often, when men are treated for prostate cancer with an estrogen-like drug, enlargement of the breast will take place. Certain tumors of the testicles, which are capable of producing a female hormone, will also cause breast enlargement. There are certain tumors of the lungs, liver and stomach that are capable of stimulating the testicles to produce excess female hormones. Other causes that decrease the concentration of testosterone are mumps, tuberculosis of the testicles, trauma, adrenal tumors, poor development of the testicles known as the Klinefelter Syndrome, cirrhosis of the liver, hyperthyroidism and even stressful life events. There is a host of drugs that may lead to breast enlargement, such as certain drugs that treat hypertension, calcium channel blockers, central nervous system agents (anti-depressants), marijuana and anti-cancer drugs.
For an adequate diagnostic work up, the following should be considered:
• How long the breast has been enlarged and whether it is painful or tender.
• A list of drugs the patient is taking for other medical conditions. Bring your bag of drugs to the doctor, which will include over-the-counter drugs as well as herbal and nutritional products.
• A full physical examination should be conducted to determine testicular size or testicular mass.
• A breast exam to rule out malignancy.
• A laboratory screening, which should include kidney function, liver enzymes, thyroid function and a host of tests determining levels of hormones produced in the body that can cause breast enlargement.
The treatment of gynecomastia will be determined upon the findings of the above tests. Most of the time, medications will help to alleviate this condition, however, surgery may be necessary.
If you have more or less breasts, consult your physician, who will put your mind to rest by doing adequate tests!
This article originally appeared in the May 29, 2013 print edition.