Women develop breasts once they attain puberty whereas men form chest muscles and try for six-packs. Sometimes, men’s breasts can enlarge. Mild breast enlargement can be normal in 60 per cent of newborn males, 75 per cent of boys going through puberty and 65 per cent of older men.

Males and females both have the female hormone estrogen and the male hormone testosterone. It is only the ratio between them that is different in the two sexes. If the balance gets skewed, it results in gynaecomastia.

In infancy, gynaecomastia occurs as a result of the mother’s estrogen being transferred across the placenta. The condition spontaneously clears up within 3-4 weeks. The breasts should not be massaged or pressed in an effort to expedite a reduction in size. No medicine is required.

Overweight adolescents are more likely to develop enlarged breasts. It may also be excess fat deposition, giving an appearance of gynaecomastia. Also, in obese people, fat tissue present all over the body acts as an extra estrogen-producing organ. The excess hormone may cause the breast tissue to increase. This gynaecomastia usually disappears by the age of 17. It is likely to disappear faster with a proper diet and exercise.

As age advances, testosterone levels fall. By the age of 80, almost 80 per cent of men have gynaecomastia. Liver and kidney disease can also lead to drop in testosterone levels and produce the same effect in younger men.

Gynaecomastia needs to be evaluated with a complete physical check-up. Any unilateral hard lumps or skin changes over the breast should be viewed with suspicion. The BMI should be calculated. If it is above 27, obesity is present. This in itself can cause bilateral symmetrical breast enlargement, especially below the areola of the nipple. The deposition of fat can cause an appearance of enlarged breasts or “pseudo-gynaecomastia”.

Blood tests to check liver and kidney functions and hormone levels need to be done. The breast tissue may be evaluated with ultrasound scans, mammograms or MRI. If there is a mass, it may require biopsy. Breast cancer is rare in men.

Many medicines can cause breast enlargement as a side effect. Culprits include male hormone antagonists used to treat prostate enlargement, the diuretic aldosterone, steroids taken for medical conditions or to enhance performance in sports, motility agents such as metoclopramide, HIV/AIDS medicines and psychiatric drugs. A list of medications taken needs to be shown to the doctor.

Gynaecomastia itself does not cause complications. But the unsightly appearance can cause psychological problems, especially during adolescence. To prevent male breasts:

• Avoid regular consumption of alcohol and recreational drugs;
• Maintain a BMI of 23-25;
• Do push-ups, sit-ups and dumbbell exercises;
• Check for side effects of the medicines you are taking.

The writer is a paediatrician with a family practice at Vellore and the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in