The hidden meaning of “male” words: the troubles of big-breasted boys

Author: Guo Liang, Chief Physician, Zhongnan Hospital, Wuhan University

Reviewer: Chen Xiaosong, Chief Physician, Union Hospital Affiliated to Fujian Medical University

Male breast development, also known as male breast hyperplasia or gynecomastia, refers to the phenomenon of unilateral or bilateral breast hypertrophy in men at different ages due to various reasons. Its clinical manifestations include: breast pain, disc-shaped nodules can be felt under the areola, and some patients may have atypical symptoms such as nipple inversion (i.e. nipple retraction) and nipple discharge. What's more, the appearance of the breasts of some patients is quite similar to that of female breasts.

Figure 1 Copyright image, no permission to reprint

1. The impact of male breast development on physical health

The impact of male breast development is multifaceted. In addition to the psychological barriers caused by appearance problems that may affect social interaction, work and quality of life, the impact on physical health is also significant.

1. Skin problems: Excessive enlargement of breast tissue may cause friction and moisture between the skin in the chest area, which may lead to skin inflammation and various discomforts.

2. Shoulder and back pain: Enlarged breasts may put extra pressure on the shoulders and back, causing pain and discomfort in these areas.

3. Distending pain and discomfort: Abnormal development of breast tissue will cause the breast volume to increase, the areola to darken, and may be accompanied by symptoms such as distending pain and tenderness of breast tissue. These changes may make patients feel uncomfortable and affect their daily life.

4. Increased risk of breast cancer: Although the probability of men developing breast cancer is relatively low, breast development may be the result of abnormal proliferation of breast cells. This abnormal proliferation increases the possibility of breast cell malignancy, thereby increasing the risk of breast cancer.

5. Fertility and sexual dysfunction: Endocrine system disorders caused by hormone imbalance may affect sperm production and quality, thereby reducing fertility. At the same time, the imbalance of the ratio of estrogen to androgen in the body will disrupt the normal physiological function of the reproductive organs, thereby affecting erectile function and ejaculation control ability, and may be accompanied by problems such as impotence and premature ejaculation.

Figure 2 Copyright image, no permission to reprint

2. Factors causing male breast development

The causes of male breast development are complex and diverse, mainly including two categories: physiological factors and pathological factors.

1. Physiological factors

① Infancy: During this stage, male infant breast development is usually due to transient changes in hormone levels (especially maternal hormones) after birth and will generally disappear on its own within 2 to 3 weeks.

② Puberty: It is more common in adolescent boys aged 13 to 14. During this period, due to excessive estrogen secretion in the body, the breast develops too quickly. Usually, the symptoms will gradually subside after the age of 18.

③ Middle-aged and elderly: more common in middle-aged and elderly men aged 50 to 80. With age, the level of androgen in the body gradually decreases, leading to breast development. Generally, the symptoms will naturally subside after the hormone level stabilizes within one year.

Figure 3 Copyright image, no permission to reprint

2. Pathological factors

① Abnormal hormone levels: Abnormally elevated estrogen levels in men are one of the important pathological factors leading to breast development. This change in hormone levels may be caused by a variety of diseases, such as liver disease, pituitary adenoma, etc., which can directly or indirectly promote the increase of estrogen levels, thereby stimulating the development of breast tissue.

② Drug factors: Certain drugs, especially those containing sex hormones, may cause breast development. For example, long-term and large-scale use of antihypertensive drugs such as reserpine and ramipril may cause abnormal breast development. In addition, although certain drugs for treating prostate hypertrophy (such as finasteride) do not directly cause breast development, after stopping the drug, due to the disorder of hormone levels in the body or the potential effect of the drug on the breast, the breast may return to the state before the drug use, or even become more enlarged.

③Other diseases: In addition to the above-mentioned liver diseases and pituitary adenomas, many other physical diseases such as lung cancer, renal failure, etc. may also lead to hormone disorders in the body and cause breast development.

④ Idiopathic causes: After excluding all known diseases, there are still some cases of male breast development where the specific cause cannot be determined. This type of situation is called idiopathic male breast development.

If a male patient finds that his breasts are significantly larger than those of his peers, he should remain calm, not panic, and seek medical attention in time to find out the specific cause and provide targeted treatment.

3. Evaluation of Gynecomastia

Plastic surgeons will conduct a comprehensive assessment and diagnosis of patients to determine the cause and extent of breast development and whether it is accompanied by other symptoms. This usually includes a detailed medical history, a careful physical examination, necessary laboratory tests (such as hormone level determination), and imaging tests (such as breast ultrasound or mammography).

Figure 4 Copyright image, no permission to reprint

Treatment of Gynecomastia

The treatment of male breast development should be personalized according to the specific situation of the patient. For physiological breast development, no special treatment is generally required, and regular observation is sufficient. For pathological breast development, the primary disease should be actively treated, such as adjusting the dosage of drugs or changing drugs, treating tumors, etc. At the same time, surgical treatment can be considered for patients whose breast enlargement seriously affects their appearance or is accompanied by obvious symptoms.

The treatment of male breast development mainly depends on the patient's specific situation, including the cause, duration of the disease, accompanying symptoms, breast size and other factors to choose the appropriate treatment method.

1. General treatment

① Eliminate the cause: If male breast development is caused by medication, such as certain antihypertensive drugs or drugs for treating prostate hypertrophy, the dosage of the drug should be adjusted or the type of drug should be changed under the guidance of a doctor. For breast development caused by other physical diseases, the primary disease should be actively treated.

② Lifestyle adjustment: Maintain good living habits, avoid staying up late, avoid overwork, etc. Exercise appropriately, control weight, and avoid obesity, because obesity may lead to increased estrogen levels in the body. Pay attention to balanced nutrition in diet, avoid excessive intake of high-fat, high-sugar, high-salt foods, especially foods with high estrogen content, such as fried chicken, hamburgers, etc.

2. Medication

① Androgen drugs: Androgen drugs can increase the level of androgen in men to antagonize the effects of estrogen, thereby alleviating the symptoms of breast development. Common androgen drugs include testosterone propionate, testosterone undecanoate, testicle tablets, etc.

②Anti-estrogen drugs: They can relieve the symptoms of breast hyperplasia or development by inhibiting or weakening the effects of estrogen. Common drugs include clomiphene, tamoxifen, clomiphene citrate, etc.

③Aromatase inhibitors: Aromatase inhibitors can inhibit the production of estrogen, thereby reducing the estrogen level in the body and helping to promote recovery from the disease. Common aromatase inhibitors include anasazole, letrozole, exemestane tablets, etc.

3. Surgery

① Liposuction: For breast development that is mainly composed of fat tissue, doctors can use liposuction to remove excess fat tissue to improve the appearance of the breasts. This method is less invasive and has a quick recovery, but it may not completely remove excess fat tissue.

② Sharp surgical excision: For breast development that is mainly breast tissue, doctors need to use sharp surgical excision to remove the proliferative breast tissue. This method can completely remove the proliferative breast tissue, but the trauma is relatively large and the recovery time is also longer.

③ Liposuction combined with sharp surgical excision: For mixed breast development with hyperplasia of both breast tissue and fat tissue, doctors may use a combination of liposuction and sharp surgical excision to treat it. This method can effectively remove excess fat and breast tissue and achieve better treatment results.

Figure 2 Copyright image, no permission to reprint

④ Laparoscopic minimally invasive surgery for male breast development: It is a minimally invasive surgical technique. Compared with traditional chest incision surgery, it has the advantages of less trauma, faster recovery, and less scar. It is suitable for patients who need surgical treatment but hope to reduce scars.

4. Psychotherapy

Male breast development may have a certain impact on the patient's psychology, such as inferiority, anxiety, etc. Therefore, psychotherapy is also one of the important symptomatic treatment measures. Commonly used psychological treatment methods include cognitive behavioral therapy, psychological analysis, etc., to help patients reduce their psychological burden and enhance their self-confidence.

5. Tips

Regular physical examinations: Men should undergo regular physical examinations and pay attention to breast health.

Healthy lifestyle: Maintain a healthy lifestyle, including a balanced diet, adequate exercise, and avoiding excessive obesity.

Seek medical attention promptly: If you find abnormal breast development or are accompanied by obvious symptoms, you should seek medical attention promptly.