Abnormal changes in the body should never be ignored, as addressing them early can prevent complications. One such change is the sudden development of breast tissue in men, a condition medically known as gynecomastia, often referred to as 'man boobs.' Gynecomastia usually occurs when there is an imbalance between the hormones oestrogen and testosterone, causing the breast tissue to enlarge. However, it can result from various factors and sometimes can also indicate health conditions like a fatty liver.
Man Boobs Or Gynecomastia: What Is It?
In an interaction with the OnlyMyHealth team, Dr Ajay Jhaveri, Consultant Gastroenterologist Jaslok Hospital and Research Centre, Mumbai, describes gynecomastia as the benign enlargement of the male breast, which can occur unilaterally or bilaterally, meaning it can either occur in one breast or both.
It is typically caused by a hormone imbalance, leading to an increase in breast gland tissue. Clinically, gynecomastia is characterised by the presence of a rubbery or firm mass extending concentrically from the nipple. According to Dr Jhaveri, the condition should be distinguished from pseudogynecomastia (or lipomastia), which occurs due to fat deposition without glandular proliferation, typically seen in individuals with obesity.
Gynecomastia occurs across different age groups, with three major peaks of prevalence: infants (60–90%), pubertal and young adults (4–69%), and ageing males (24–65%), according to a 2020 study published in the Journal of Clinical Endocrinology and Metabolism.
At birth: This is due to the high levels of oestrogen in the mother's bloodstream, which usually resolves within a few weeks after birth.
At puberty: The condition may arise due to a rapid increase in oestrogen levels compared to testosterone. This form generally resolves within 6 to 24 months.
In males over 50 years of age: This can result from medications or a natural decline in testosterone levels in the body.
Can Gynecomastia Be A Sign Of Fatty Liver?
Gynecomastia can sometimes be a sign of advanced fatty liver disease, particularly as the condition progresses to cirrhosis, says Dr Jhaveri. He explains that fatty liver disease, especially in its later stages, can disrupt normal liver function, leading to an imbalance in sex hormones. The liver plays a key role in metabolising hormones like oestrogen and testosterone; when impaired, it can cause elevated oestrogen levels relative to testosterone, resulting in the development of gynecomastia.
Additionally, medications commonly used to manage complications of cirrhosis, such as spironolactone (for treating ascites), can further contribute to gynecomastia as a side effect, the doctor adds.
If gynecomastia is accompanied by other symptoms of liver dysfunction, such as jaundice or abdominal swelling, it is essential to consult a healthcare professional for evaluation and appropriate management.
Also Read: Man Boobs: Possible Causes Of The Condition Called Gynaecomastia
What Else Could Cause Gynecomastia?
It is important to note that many other factors can lead to gynecomastia.
According to Dr Jhaveri, certain medications, such as anabolic steroids, spironolactone, ketoconazole, finasteride, digoxin, and even substances like amphetamines and marijuana, can cause gynecomastia in men. Additionally, fatty liver disease is often associated with health issues like obesity, diabetes, hypertension, and increased risks of cardiac arrest and stroke. These conditions highlight the importance of addressing lifestyle factors that contribute to both gynecomastia and fatty liver disease.
Red flag signs in men with gynecomastia that warrant further medical evaluation include a breast size exceeding 5 cm, painful or tender swelling, or the presence of a lump, Dr Jhaveri notes, adding that concerning symptoms include signs suggestive of cancer, such as nipple bleeding or discharge, a hard, fixed lump, or swelling accompanied by enlarged lymph nodes.
Diagnosis And Management
The diagnosis of gynecomastia involves a detailed examination, including assessing the size and consistency of breast tissue, checking for nipple discharge, and signs of axillary lymphadenopathy. A testicular examination is performed to identify any abnormalities like nodules or asymmetry and signs of feminisation. Doctors also check for symptoms of chronic liver disease, thyroid dysfunction, renal disease, male hypogonadism, or inherited conditions like Klinefelter syndrome. Additionally, they investigate possible tumours in the adrenal glands, pituitary, or testes.
It’s crucial to differentiate true gynecomastia (glandular tissue growth) from pseudogynecomastia (fat accumulation). For asymptomatic or physiologic cases, such as pubertal gynecomastia, no immediate tests are needed, but reevaluation is recommended in six months.
If your gynecomastia is due to a fatty liver, it is crucial to maintain a healthy diet (ideally plant-based), exercise regularly, and avoid consuming high-fat foods. Incorporating unprocessed fruits and vegetables into your diet can be beneficial.