In many cases, Gynecomastia does not require urgent treatment. In pubertal boys the condition resolves by itself.
When the condition is caused due to drugs or other underlying disease, it may resolve when the offensive drug is withdrawn or when the underlying disease is treated.
Although complications of Gynecomastia are rare, sometimes the tissues may undergo scarring which makes treatment difficult.
Also the psychological impact of the condition is large on many sufferers especially young men and adolescents.
In addition, men with Gynecomastia carry a fivefold higher risk of getting breast cancer. Some patients thus may need drugs that block the feminizing hormones or surgery to reduce the breast size.
Treatment procedures include medications, surgery and counselling. (1, 2, 3)
Currently there are no drugs approved by the U.S. Food and Drug Administration (FDA) for treatment of Gynecomastia.
Tamoxifen is an anti-estrogen drug (belonging to a class called selective estrogen receptor modulators). It may be prescribed as 10mg pills twice daily. This is given to patients who develop pain and tenderness. It may also help patients on prostate cancer drugs who develop Gynecomastia.
Testosterone replacement may be tried in some patients who show low levels of the male hormone.
Another group of drugs are Aromatase inhibitors like Anastrozole. This drug prevents formation of Estrogen. Aromatase inhibitors have not been used with much success in Gynecomastia.
There are two types of cosmetic surgery for Gynecomastia.
One is liposuction. In this breast fat tissues are removed but the breast tissues remain intact.
The other form of surgery is mastectomy. This is a cosmetic operation to remove the breast gland tissues.
Small incisions may be made over the side of the breast, in the underarm or near the areola. The breast is operated and removed from these incisions.
This reduces the complications after surgery and hastens the process of healing.
Counselling and support may be offered to patients of Gynecomastia.
There may often be a severe psychological impact of the condition precipitating depression, anxiety, low self esteem and other mental disorders. This may need evaluation, detection, early management with medications and behavioural therapy.
It must be remembered that Gynecomastia may occur without any underlying cause or may be physiological.
At all times, the exclusion of the possibility of breast cancer should be undertaken.
Hormonal imbalances may need treatment in some individuals.
In some cosmetic surgical therapy is needed to help them cope psychologically.
Since drugs, medications and diseases may lead to Gynecomastia, these need to be evaluated and appropriate management needs to be provided.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
What is Gynecomastia?