Gynecomastia: Causes, Symptoms, and Treatment Options

Gynecomastia

Hello Doctor, I have been overweight since childhood (100 kg).
I worked hard to lose weight and have managed to shed about 20 kg, bringing my weight down to 80 kg.
While I have lost fat all over my body, my chest size remains the same as it was when I was younger.
I believe I have at least a C or D cup size, which makes it frustrating for me to wear thin clothing.
I have never participated in swimming due to this issue.
Additionally, I am facing the prospect of military service in the coming years, which adds to my distress.
I would like to ask if I might have symptoms of low testosterone levels, as I have very little body hair and a significant amount of fat in my chest area.
If my physical examination reveals related symptoms, would I be eligible for alternative service or an exemption from military duty? Thank you.

Xiao Chen, 20~29 year old female. Ask Date: 2015/09/07

Dr. Zhou Jiazhen reply Breast and Thyroid

1.
If chest issues significantly impact daily life, particularly on a psychological level, it is recommended to consider surgical intervention and liposuction in the plastic surgery department.
2.
If there are concerns about male hypogonadism, one can seek assistance for evaluation and diagnosis in the endocrinology department.

Reply Date: 2015/09/07

More Info

Gynecomastia is a condition characterized by the enlargement of breast tissue in males, which can be a source of significant psychological distress and embarrassment. Understanding the causes, symptoms, and treatment options for gynecomastia is crucial for those affected by this condition.

Causes of Gynecomastia
Gynecomastia can arise from a variety of factors, often related to hormonal imbalances. The primary cause is an imbalance between testosterone and estrogen levels in the body. While testosterone is the dominant male hormone, estrogen is present in lower levels. When the balance shifts, it can lead to the development of breast tissue. Here are some common causes:
1. Hormonal Changes: Puberty, aging, and certain medical conditions can lead to fluctuations in hormone levels. For instance, during puberty, many boys experience temporary gynecomastia due to hormonal changes.

2. Obesity: Excess fat can lead to increased estrogen production, which may contribute to gynecomastia. In your case, despite losing weight, localized fat deposits in the chest area can persist.

3. Medications: Certain medications, including anti-androgens, anabolic steroids, and some antidepressants, can cause gynecomastia as a side effect.

4. Health Conditions: Conditions such as liver disease, kidney disease, hyperthyroidism, and tumors affecting hormone-producing glands can also lead to gynecomastia.

5. Substance Use: Alcohol, marijuana, and other drugs can influence hormone levels and contribute to breast tissue growth.

Symptoms of Gynecomastia
The primary symptom of gynecomastia is the enlargement of breast tissue, which may be accompanied by tenderness or sensitivity in the breast area. In some cases, the condition can lead to psychological issues, such as anxiety, depression, or low self-esteem, particularly in social situations like swimming or wearing fitted clothing.

Diagnosis
To determine if you have gynecomastia, a healthcare provider will typically conduct a physical examination and may order blood tests to check hormone levels. They may also review your medical history and any medications you are taking. If there is a suspicion of an underlying condition, imaging tests such as ultrasound or mammography may be performed.

Treatment Options
Treatment for gynecomastia depends on the underlying cause and the severity of the condition. Here are some common approaches:
1. Observation: In cases where gynecomastia is mild and not causing significant discomfort, a "watchful waiting" approach may be recommended, especially if it is related to puberty.

2. Medications: If hormonal imbalances are identified, medications that adjust hormone levels may be prescribed. For example, selective estrogen receptor modulators (SERMs) can help reduce breast tissue.

3. Surgery: For persistent or severe cases, surgical options such as liposuction or mastectomy may be considered to remove excess breast tissue. This is often the most effective long-term solution for those who are significantly affected by the condition.

Psychological Considerations
It’s important to address the psychological impact of gynecomastia. Many individuals experience embarrassment or anxiety related to their condition. Counseling or support groups can be beneficial in helping individuals cope with these feelings.

Conclusion
In your case, the presence of excess breast tissue despite weight loss, along with minimal body hair, may suggest a hormonal imbalance, potentially indicating low testosterone levels. It is advisable to consult with a healthcare provider who can evaluate your symptoms, perform necessary tests, and discuss potential treatment options. If you are concerned about how this may affect your military service, it is essential to communicate openly with your healthcare provider about your situation.

Remember, gynecomastia is a common condition, and many men experience it at some point in their lives. Seeking help and understanding your options can lead to effective management and improved quality of life.

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