Also known as gynecomastia, it is when boys or men develop enlarged breasts. The condition can be embarrassing and sometimes even painful.

It is usually the result of a hormonal imbalance and typically occurs during infancy, adolescence, or mid to late life. The condition often goes away on its own, but treatments are available for severe or persistent cases. When gynecomastia is the result of an underlying health problem, treatment of that problem usually improves the gynecomastia as well.

Although people tend to think of androgens as "male hormones” and estrogens as "female hormones,” people of both sexes produce both types of hormones. In males, androgens are by far the predominant hormone, but small amounts of estrogen are also present. Gynecomastia can happen when the balance shifts, with an increase in estrogen or decrease in androgens. This can occur because of expected hormonal changes during puberty or ageing, or because of the use of certain drugs or herbal products.

Pubertal gynecomastia usually occurs in about 70 per cent of all people during puberty and resolves without treatment within six months to two years. The condition most commonly occurs between ages 13 and 14, although can develop by 10 years. In less than 25 per cent of these people, the condition may persist beyond age 17.

Many drugs have been associated with gynecomastia in about 10 to 20 per cent of the people. Drugs most associated with gynecomastia include some drug used to treat high blood pressure (such as spironolactone, nifedipine) and some drugs used to treat stomach ulcers (such as cimetidine). Gynecomastia occurs in up to 75 per cent of men who take drugs called antiandrogens to treat prostate cancer

Gynecomastia in children has been associated with regular use of skin care products (lotions, soaps, and shampoos) containing tea tree oil and lavender oil. These oils contain plant estrogens and can affect the body’s hormone balance. Gynecomastia usually resolves completely after stopping these products.

In about 25 per cent, it is not always clear what causes gynecomastia during mid to late life. As men age, blood testosterone levels (male hormone) decline and the hormone balance changes, favouring an increased level of estrogen. This is thought to account for most of these cases of gynecomastia.

The diagnosis of gynecomastia is usually made by taking history and examining the patient. Gynecomastia should not be confused with breast enlargement which occurs in overweight men due to breast fat deposition (called pseudo gynecomastia). In gynecomastia, it is the breast tissue that enlarges.

At times, breast ultrasound scan or mammogram (a specialised x-ray of the breast) might be done.

In certain situations, blood tests may be ordered to measure the level of hormones. Blood tests are not usually needed if the cause of the gynecomastia (e.g., puberty, drugs) is known.

There are a number of treatments. But treatment is often not needed. The right treatment will depend on one’s cause of the gynecomastia, how long it has lasted, how severe it is, and how much it hurts or bothers them.

In teenage boys, reassurance is usually done as this breast enlargement usually goes away on their own without treatment.

If gynecomastia is caused by one of the drugs that one takes, the healthcare provider might recommend that you stop using the drug or replace it with another drug that is less likely to cause the condition.

There are some medications which can be prescribed for some men with persistent gynecomastia, although this is usually not effective in men who have had the condition for one to two years, or more.

For these men with longstanding bothersome gynecomastia, surgery is an option to reduce the size of the breasts. For adolescents, surgery is generally not recommended until puberty is completed as there may be regrowth of the breast tissue if the surgery is performed before puberty is completed.

 Dr Ian Shyaka , Resident in Surgery, Rwanda Military Hospital,

iangashugi@gmail.com