Hi himynameisben,
Please note the disclaimer at the bottom of this page.
"Important Disclaimer: Answers and comments provided on Google Answers
are general information, and are not intended to substitute for
informed professional medical advice."
I can only provide you with general information - your family
physician will be able to counsel and advise you on what is best for
you.
The condition is called Male Gynecomastia - (Male Breast Enlargement)
Simply put it is excessive development of the breast in the male.
The Male Puffy Nipple from Gynecomastia
http://www.plasticsurgery4u.com/procedure_folder/male_breast/male_puffy_nipple.html
"A puffy nipple, although a common patient description of this
problem, is not an accurate. The area swollen includes the nipples,
areola, and surrounding region. In this male patient, the swelling was
diffuse through the chest."
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THE ANALYST - Male Gynecomastia
http://www.digitalnaturopath.com/cond/C676545.html
"Gynecomastia is a common disease of the male breast where there is a
benign glandular enlargement of that breast at some time in the male's
life. It usually consists of the appearance of a flat pad of glandular
tissue beneath a nipple which becomes tender at the same time. The
development may be on one or both breasts. There is rarely a continued
growth of the breast tissue; ordinarily the process is of brief
duration and stops short of the production of permanent enlargement of
the breast.
Gynecomastia is found only in males, and the signs can appear any time
in a male's lifetime. It is the leading breast disorder in males and
it accounts for 60% of all disorders of the male breast. About 85% of
male breast masses are due to gynecomastia and 40% of the cases affect
pubescent boys.. Approximately 40% of normal men and up to 70% of
hospitalized men have palpable breast tissue. Active gynecomastia in
autopsy data is between 5 and 9%. In one study, more than 80% of
hospitalized patients with a body mass index (BMI) of 25 or greater
had gynocamastia. About 70% of pubertal males required no treatment.
If the threshold for judging that the breast is enlarged is set at 2cm
in diameter, the incidence is 32 to 36% in normal aged men 17 to 58
years.
Recommendations for Male Gynecomastia:
Diet Alcohol Avoidance Several studies indicate a potential role
for prolactin and estrogen in the pathogenesis for feminization. Male
alcoholic patients frequently show evidence of feminization that is
manifested by gynecomastia, spider angiomata, palmar erytherma and
changes in body hair patterns. Alcoholic men show a positive
association between the presence of clinically apparent gynecomastia
and elevated circulating levels of prolactin. The gynecomastia found
in alcoholic patients is characterized by a proliferation of the
stroma and ducts that are known to be estrogen-positive.
Hormone
Estrogen-balancing Medications Males with gynecomastia often have
an elevation of plasma levels of estrogen which is believed to be due
to peripheral conversion of weak adrenal androgens to estrogen.
Testosterone Gynecomastia is a common condition in athletes who use
steroids or testosterone to build muscle. The condition is caused by
the aromatization of testosterone into estrogens. Gynecomastia may be
avoided through the use of dihydrotestosterone instead of other forms
of testosterone. It can actually even be applied as a treatment for
gynecomastia. A further advantage of dihydrotestosterone is that
increased levels of the hormone are correlated to increased sex drive
and increased sexual function.
Not recommended:
Melatonin One case of painful gynecomastia has been reported
involving a 56 year old man who had been suffering from amyotrophic
lateral sclerosis and was taking 1 to 2mg melatonin per day over a 1
1/2 year period. As the gynecomastia disappeared after melatonin use
was discontinued, it was suspected that the melatonin caused this side
effect.
Surgery/Invasive
Surgery Often no cause is found for the disorder and the
gynecomastia may not resolve on it's own. In these cases, surgery is
frequently the best solution."
Further information on this subject can be found here.
http://www.digitalnaturopath.com/data/Gynecomastia.html
"Gynecomastia is a common disease of the male breast where there is a
benign glandular enlargement of that breast at some time in the male's
life. It usually consists of the appearance of a flat pad of glandular
tissue beneath a nipple which becomes tender at the same time. The
development may be on one or both breasts. There is rarely a continued
growth of the breast tissue; ordinarily the process is of brief
duration and stops short of the production of permanent enlargement of
the breast.
Gynecomastia is found only in males, and the signs can appear any time
in a male's lifetime. It is the leading breast disorder in males and
it accounts for 60% of all disorders of the male breast. About 85% of
male breast masses are due to gynecomastia and 40% of the cases affect
pubescent boys.. Approximately 40% of normal men and up to 70% of
hospitalized men have palpable breast tissue. Active gynecomastia in
autopsy data is between 5 and 9%. In one study, more than 80% of
hospitalized patients with a body mass index (BMI) of 25 or greater
had gynecomastia. About 70% of pubertal males required no treatment.
If the threshold for judging that the breast is enlarged is set at 2cm
in diameter, the incidence is 32 to 36% in normal aged men 17 to 58
years.
Many who suffer from this disease have a disturbance in the proper
ratio of androgen and estrogen levels. The normal ratio of the two
hormones in plasma is approximately 100 to 1. The etiology of
gynecomastia in patients with a known documented cause appears to be
related to increased estrogen stimulation, decreased testosterone
levels, or some alteration of the estrogens and androgen so that the
androgen-estrogen ratio is decreased. From this information it was
discovered that there is also a lower ratio of weaker adrenal
androgens (delta 4 androstenedione and dehydroepiandrosterone [DHEA])
found in youths with this disease. It was once believed that there was
an imbalance in the ratios of testosterone to estrogen or estradiol,
but this is now known to be untrue.
There are three areas the can be attributed to the cause of
gynecomastia: physiologic, pathologic and pharmacologic. Enlargement
of the male breast can be a normal physiologic phenomenon at certain
stages of life or the result of several pathologic states.
In the case of physiologic gynecomastia the disease can occur in a
newborn baby, at puberty or at any time in a man's life. In the
newborn, transient enlargement of the breast is due to the action of
maternal and/or placental estrogens. The enlargement usually
disappears within a few weeks. Adolescent gynecomastia is common
during puberty with the onset around age 14. It is often asymmetrical
and frequently tender. It regresses so that by the age of 20 only a
small number of men have palpable vestiges of gynecomastia in one or
both breasts. Gynecomastia of aging also occurs in otherwise healthy
men. Forty percent or more of aged men have gynecomastia. One
explanation is the increase in age in the conversion of androgens to
estrogens in extra-glandular tissues. Drug therapy and abnormal liver
functioning can also be causes of gynecomastia in older men.
When the disease is pathologic the patient can have increased estrogen
secretions, increased conversion of androgens to estrogens or
decreased androgen activity due to a failure in protein receptors.
Increased estrogen secretions are found in such diseases and disorders
as Hermaphroditism, Kleinfelter's syndrome, congenital adrenal
hyperplasia, and adrenal carcinoma or testicular tumors. In the second
case some examples are adrenal carcinoma, liver disorders,
malnutrition and thyrotoxicosis. Decreased androgen activity can be
found in complete testicular feminization, incomplete testicular
feminization and Reifenstein's syndrome.
Many drugs can cause gynecomastia by several mechanisms. The drugs can
either act directly as estrogens or cause and increase in plasma
estrogen levels. Boys and young men are particularly sensitive to
estrogen, and can develop gynecomastia after the use of dermal
ointments containing estrogen or after the ingestion of milk or meat
from estrogen-treated animals. There have been examples where the
mother prepared sandwiches for her boys after applying estrogen cream
to her skin. Small amounts of estrogen were consumed by the boys and
reversible gynecomastia resulted. Some examples of drugs that may have
cause gynecomastia include Cannabinoids (methane and marijuana),
Psychotropics (phenothiazine, butyrophenone and reserpine),
Antihypertensives (reserpine, alphamethyldopa and spironolactone),
Cardiac (digitalis), Gastrointestinal (cimetidine, metoclopramide and
domperidone), Antituburculous (isoniazid), Cytoxic (cyclophosphamide,
mustine, vincristine and mitotane) and Hormonal (sex steroids,
gonadotropins and antiandrogens). Use of these drugs, however, will
rarely cause gynecomastia. In some instances, the feminization is due
to effects of drugs on liver functions.
Signs may appear at any time in a male's life, although the most
common time of onset is during puberty. At the first indication of the
disease the patient will feel pain and tenderness in the breast area
due to the rapid development of the breast. The breasts grow because
of the enlargement of the glandular tissue. The concentric arrangement
of the connective tissue around the ducts is a characteristic feature
of the active phase of gynecomastia. The enlargement of the breast is
usually bilateral but some cases have unilateral enlargement. In the
case of unilateral enlargement, induration, fixation, or bloody
discharge should raise the possibility of cancer.
It may be hard to distinguish true breast tissue from masses of
adipose tissue without true enlargement (lipomastia). In such cases, a
real case of gynecomastia can be distinguished by mammography or by
sonography.
A satisfactory diagnosis can be made in only half or less of patients
referred for gynecomastia. This is a result of insufficient diagnostic
techniques, causes that are still undefined or difficult to diagnose,
or in some instances, gynecomastia may be normal rather than due to a
pathologic state. This disease should only be investigated carefully
if there is a negative drug history, if the breast is tender
(indicating rapid growth), or if the breast mass is larger than 4cm in
diameter. A decision to perform an endocrine evaluation depends on the
clinical context. An example would be gynecomastia associated with
signs of under androgenization.
Obesity can often be confused with gynecomastia. To prevent this, the
doctor can palpate the breast to see if there is a lack of glandular
elements that would indicate only obesity.
Once the signs become evident, the doctor needs to assess the patient
with a number of test to give a proper diagnosis since many other
diseases and disorders are commonly involved. This can be done with a
physical examination. The head and neck area may show signs of a
pituitary tumor or goiter which is found in Graves disease. The skin
and abdomen may reveal signs of liver failure and the testes should be
examined for asymmetric enlargement in Klinefelter's syndrome. Other
diseases related to gynecomastia include: testicular tumors,
hypothyroidism and hyperthyroidism, Cushing's disease, cirrhosis,
spinal cord lesions, Hodgkin's disease, enzymatic defects in androgen
synthesis and androgen resistance syndromes, and many others.
The evaluation of patients with gynecomastia should include a careful
drug history, measurement and examination of the testes, evaluation of
liver function and endocrine evaluation to include measurement of
serum androstenedione or 24 hour urinary 17ketosteriods, plasma
estradiol and HCG, and plasma luteinizing hormone (LH) and
testosterone. If LH is high and testosterone is low, the diagnosis is
usually testicular failure. If LH and testosterone are both low, the
diagnosis is usually increased estrogen production. If they are both
high, the diagnosis is either an androgen resistance state or a
gonadotropin secreting tumor. In true gynecomastia these tests would
prove to be unnecessary because the symptoms would regress.
When the primary cause can be identified and corrected, breast
enlargement usually diminishes until it usually disappears. For
example, androgen replacement therapy may produce dramatic improvement
in men with testicular insufficiency. However, if the gynecomastia is
of long duration (and fibrosis has replaced the original ductal
hyperplasia), correction of the primary defect may not be followed by
resolution. In this case, surgery would be the only effective
treatment. Candidates for surgery include those with several
psychologic or cosmetic problems, continued growth, or a suspected
malignancy.
Conventional Treatment
The treatment selected for this disease is related to how the patient
was affected by the disease. The treatment for a person who contracted
the disease through certain drug use will be treated different from a
person who is affected from a related disease. If gynecomastia is
contracted through drug use, the patient will need to discontinue the
medications that are associated with the disease. The only exception
is when there is a life threatening illness involved, and there is no
alternative medication available.
For those suffering from gynecomastia, the doctor may prescribe
antiestrogens such as clomiphene citrate or tamoxifen to eliminate
tenderness of the breast. The non-aromatizable androgen
dihydrotesosterone also has been reported to reduce gynecomastia by
reducing testicular secretion of estradiol, by decreasing peripheral
conversion of precursors to estradiol and by increasing circulating
levels of androgen. In patient with painful gynecomastia and who are
not candidates for other therapy, treatments with antiestrogens such
as tamoxifen may be used.
When other related diseases are the cause for the onset of
gynecomastia, treatment of these diseases will often cure
gynecomastia, too. The removal of a sex steroid producing tumor or
treatment of thyrotoxicosis are two examples. Testosterone treatment
of androgen deficiency will also cause great improvement in this
condition. Prophylactic radiation of the breasts prior to the
institution of diethylstilbestrol therapy is effective in preventing
gynecomastia and has a low complication rate in elderly men.
In most cases of true gynecomastia the signs and symptoms should
regress in about a year. However, in the case of severe gynecomastia
where the breast has an increase of fibrous tissue stroma the patient
will require a surgical reduction mammoplasty. Once this has been done
the tissue is sent to a lab to be examined. The results should show
elongated circular ducts imbedded in cellular fibrous tissue with a
rubbery fatty quality. From these laboratory tests it can be
determined if there is any cribiform epithelial hyperlasia or a case
of carcinoma. Although the relative risk of cancer of the breast is
increased in men with gynecomastia, it is rare nevertheless.
There are so many causes and factors that lead to the disease
gynecomastia that it is very difficult for researchers to try to agree
upon one main factor. So many of the cases differ from one another,
and, perhaps, no one cause will ever be agreed upon as the leading
factor of the disease. As long as there is no other underlying disease
or disorder, gynecomastia is not a life threatening disease.
Experimentation with hormone therapy is the main research being tested
at this time."
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Drug Side Effects - Gynecomastia Male Breast Enlargement
http://www.plasticsurgery4u.com/procedure_folder/male_breast/gynecomastia_causes.html
There are many possible reasons for male breast growth. If caused by a
medical problem, this should be corrected first. Such issues can be
investigated by your internist or an endocrinologist. In most cases
there is no known cause. A complete discussion of the many possible
causes for gynecomastia is beyond the scope of this introduction.
These drugs (according to the Physician Desk Reference) can cause
gynecomastia as a side effect. The risks are generally very low for
male breast enlargement from these medications, but breasts in men can
be a cause for embarrassment. Some medications may be important for
your other medical problems. There are other causes of gynecomastia
male breast enlargement.
(see long list from A - Z)
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Gynecomastia Types and Treatments by James J. Romano, MD
http://www.jromano.com/text/gynecomastia.html
"Gynecomastia is usually strictly defined as the visible or palpable
development of breast tissue in men. The term comes from the Greek
words gyne meaning "woman" and mastos meaning "breast." In practical
terms, this means abnormally large breasts on men. This is often
related to the occurrence of excess fat or overdeveloped muscles.
The condition is relatively common in adolescent boys, and 90% of the
time symptoms disappear in a matter of months, or, as adolescence
wanes, a few years later. But the remaining 10% are burdened with a
social handicap that causes a deep and complex shame, and often puts a
man?s relationship with his body at risk
Drugs, medications, hormonal imbalance, genetic conditions, and
exogenous hormones can all cause gynecomastia. During puberty it is
normal for most boys to develop some proliferation of breast tissue.
Ordinarily this condition is self-limited and subsides within 6 to 18
months. When this gynecomastia persists, it is often embarrassing and
psychologically debilitating. Removal of the excess breast parenchyma
is the only effective treatment. This condition can be accentuated if
the patient is overweight. Marijuana usage is commonly linked to
gynecomastia. Men who are taking estrogen's or testosterone inhibitors
because of prostate cancer or patients with liver disease who have a
hormonal imbalance are also susceptible to this condition.
Gynecomastia can develop as a result of taking anabolic steroids to
enhance athletic performance or bodybuilding. Appropriate diagnostic
studies are necessary prior to treatment, particularly in individuals
taking anabolic steroids. These patients should also be evaluated for
liver and cardiac disease prior to correction the gynecomastia.
Gynecomastia can be emotionally devastating. Feelings of shame,
embarrassment and humiliation are common. Men often do not feel
masculine in a society where masculinity is exalted. Lack of
self-confidence commonly threads itself through many aspects of the
individual's life. A man or boy with gynecomastia struggles with
anxiety over such simple acts as taking off his shirt at the beach or
participating in gym classes in grade school or high school. Men often
have a very difficult time talking about their breasts to anyone, but
it is the first step toward relief. Realizing that they are not alone
and that there is a cure offer powerful remedies and a major
advancement toward healing.
CLASSIFICATIONS OF GYNECOMASTIA
Gynecomastia has been divided into four types: Type I is known as
pubertal or benign adolescent breast hypertrophy. This refers to the
quite common situation seen in pubertal males. It is usually present
between the ages of 10 to 14. The incidence may be as high as 60-70%.
It is typically a firm, tender, subareolar mass anywhere from 1-5 cm
in diameter. These young men frequently complain of pain in the
breasts to the touch or when wearing tight clothing. It usually
spontaneously resolves within 2 years or less.
Type II is the condition where there is natural gynecomastia without
evidence of underlying disease, or with evidence of organic disease
(including the use of certain drugs). This type refers to a
generalized, nonpainful breast enlargement. In this type it is helpful
to differentiate between naturally occurring gynecomastia versus
breast enlargement due either to an abnormal (pathologic) process or
to the use of certain drugs. Careful history taking regarding the time
of onset, family history, duration of enlargement, history of systemic
illness, weight change, and drug or medication use, is important.
Physical examination should include height, weight, blood pressure,
breast size, and careful palpation of both breasts and genitals, in
addition to a neurological assessment.
Type III gynecomastia is general obesity simulating gynecomastia or
the occurrence of excess fat in and around the breast or chest area.
This is probably the most often seen type.
Type IV is hypertrophy of the underlying pectoral muscle."
CLASSIFICATION OF CAUSES OF TYPE II GYNECOMASTIA
I. Idiopathic (no known cause)
II. Familial causes
a. Associated with anosmia (lack of smell) and testicular hypertrophy.
b. Reifenstein?s syndrome (male pseudohermaphroditism secondary to
partial androgen insensitivity).
c. Associated with hypogonadism and small penis.
III. Specific illnesses or syndromes
a. Kleinfelter
b. Male pseudohermaphroditism
c. Testicular feminization syndrome
d. Tumors
e. Leukemia
f. Hemophilia
g. Leprosy
h. Chronic glomerulonephritis
IV. Miscellaneous drugs
a. amphetamines
b. anabolic steroids
c. birth control pills
d. cimetidine
e. diazepam
f. corticosteroids
g. digitalis
h. estrogens
j. human chorionic gonadotropin
k. insulin l. isoniazid and other TB drugs
m. ketoconazole
n. marijuana
o. methadone and other narcotics
p. reserpine
q. tricyclic antidepressants
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Enlarged breasts in adult men - Health Information provided by MayoClinic.com
http://www.ohiohealth.com/healthreference/reference/7BB5F30F-8628-4876-B280D38A83B9965B.htm
"In adult males, the most common cause of gynecomastia is hypogonadism
(testosterone deficiency). Gynecomastia also may occur as a result of:
Use of some medications such as estrogens, spironolactone or digitalis.
Marijuana use, which causes male breast enlargement due to effects on
hormone receptors.
Chronic liver disease, which can upset the normal balance between male
and female sex hormones in men.
Rare tumors of the endocrine glands that may produce female hormones.
Breast cancer.
Breast cancer is rare in men. It occurs at about one percent the
frequency that it does in women. It's not certain if gynecomastia
increases the risk of breast cancer in men. Breast cancer should be
considered if:
Breast enlargement is only on one side.
Breast tissue feels hard.
The nipple area is deformed.
Blood comes from the nipple.
When gynecomastia occurs in adult males, it requires medical evaluation."
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On the following two links... See illustrations and move your cursor
over the purple arrows and the drawing will demonstrate the various
common types of gynecomastia anatomy.
Anatomy of the Enlarged Male Breast - Gynecomastia
http://www.plasticsurgery4u.com/procedure_folder/male_breast/gynecomastia_anatomy.html
Skin
Fat
Muscle
Gynecomastia Anatomy Fat Only (default view)
Gynecomastia Anatomy of Fat with some Threads of Gland
Gynecomastia Anatomy of Fat with More Glandular Tissue
Gynecomastia Anatomy of Some Fat and Large Gland Mass
The gland is usually centered under the areola and is often attached
to the nipple as shown on these drawings. When the skin is tightened
over the mousse, the mass of gland may protrude.
Treatment of gynecomastia depends on the problem"
*****
Anatomy of the Male Chest and Gynecomastia
http://www.plasticsurgery4u.com/procedure_folder/male_breast/anatomy_chest.html
Nipple can lie flat or protrude from the areola.
Areola is the colored area around the nipple.
Fat - there is a normal amount of fat between the skin and muscle.
Excess fat can accumulate along the lower breast and can give a
feminine appearance to the male chest.
Gland - tissue is located just behind the nipple and areola.
The normal male breast has a contour made by muscle, fat, and skin.
There can be glandular tissue that can range from a very small to
quite large mass. Contour of the chest comes from the underlying
elements. Muscle shape is important for the shape of the breast,
exercise can be important to improve the "male look" by improving the
tone of the muscles.
Excess fat or gland especially along the lower breast can make the
chest have a "female" contour. Diet and exercise can help with
generalized fat, but cannot be directed to the specific shape of the
chest fat. Neither diet nor exercise will help with glandular tissues.
As the muscle size increases, fat and gland are pushed further towards
the surface making them more obvious.
Surgical contouring can address the localized fat and gland. There are
many pages of details about cosmetic male chest contouring options.
However, the best place to explore your concerns is during a
consultation. Dr. Bermant and his staff will be glad to help you
better understand your options during a consultation after an
evaluation."
Keyword search:
male enlarged breast
male puffy nipples
male chest and gynecomastia
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Best regards,
tlspiegel |
