What is Bilateral Gynecomastia?
Bilateral gynecomastia refers to the abnormal swelling of both breasts in boys and men. While male breasts usually have a certain amount of normal protrusion from the chest, especially with strength training exercises, these can also appear nearly feminine in size and shape. In some cases, men can have marked breast enlargement with feminization present.
Even in bilateral gynecomastia, the breast enlargement can be uneven – one breast appears larger than the other – as is the case for female breasts, too. Males from newborns to teenagers and older men may develop it due to a wide range of factors including changes in hormone levels, prescription medications, and street drugs, among others.
While abnormal swelling in both breasts isn’t a serious health issue, boys and men who have them report feeling embarrassed by their condition, especially when their breasts look and feel feminine. Fortunately, there are many ways of treating and coping with bilateral gynecomastia!
Grades of Gynecomastia
According to the American Society of Plastic Surgeons, there are four grades of gynecomastia.
- Grade 1 gynecomastia is a very mild form characterized by a localized button of breast tissue around the areola.
- Grade 2 gynecomastia is a mild to high form with moderate breast enlargement past the boundaries of the areola. The edges are usually indistinct from the chest, too.
- Grade 3 gynecomastia is characterized by moderate breast enlargement with the severity considered as high and visible. Skin redundancy is present and the edges are already distinct from the chest.
- Grade 4 gynecomastia is marked by the feminization of the breast with severe breast enlargement coupled with skin redundancy.
Your choice about seeking treatment will partly be affected by the type of gynecomastia your case falls into. You may, for example, adopt lifestyle measures like wearing a compression vest underneath your regular shirt to reduce the appearance of the swelling in both your breasts (i.e., Grade 1). But you may also consider surgery in case your case falls into Grade 4 gynecomastia, the most severe category.
Symptoms of Gynecomastia
Aside from the swelling in both breasts, boys and men who have been diagnosed with bilateral gynecomastia also report breast tenderness. The tenderness may be felt with or without physical touch.
While bilateral gynecomastia isn’t a cause for concern unless there’s a tumor, men are still strongly advised to see their physicians in case of the following symptoms:
• Pain, swelling and tenderness in the breast area
• Nipple discharge, such as pus-like fluid, from one or both breasts
Your doctor will conduct diagnostic tests, such as medical history, physical examination, and laboratory tests, to determine possible underlying medical conditions for your symptoms. Men can also get breast cancer although it’s more common in women.
Causes of Gynecomastia
At its core, bilateral gynecomastia is triggered by the abnormal imbalance between testosterone and estrogen production in the body. Emphasis must be made that males have higher levels of testosterone (i.e., the male hormone) and significantly lower levels of estrogen (i.e., the female hormone). When testosterone levels decrease by a considerable amount in comparison with estrogen levels, one of its effects is bilateral gynecomastia.
There are several causes for such an abnormal decrease in testosterone production in men including the following:
• Natural changes in hormone production
Males with excessively high levels of estrogen or with estrogen levels out of balance with their testosterone levels are most likely to get bilateral gynecomastia. This can happen in male infants because of their absorption of their mothers’ estrogen but the swollen breast tissues typically resolve on their own 2-3 weeks after birth. Boys who are in their puberty can also get swelling in their breasts due to the changes in their hormone but it usually goes away within 6-24 months without treatment.
Adult men can also have bilateral gynecomastia because of natural hormone changes with men between 50 and 69 years old being the most likely affected. Experts estimate that at least 1 in 4 men 50-60 years old are affected by the condition.
• Prescription medications
Many prescription medications can also cause hormonal changes in the male body as a side effect. These include anti-androgens for the treatment of prostate enlargement (e.g., finasteride and flutamide); anabolic androgens and steroids; AIDS medications especially those used in highly active antiretroviral therapy; tricyclic antidepressants and anti-anxiety medications; ulcer medications; chemotherapy drugs; and heart medications like calcium channel blockers. Even certain antibiotics can cause temporary swelling of the male breast.
• Illegal drugs
Aside from the well-documented adverse effects of street drugs, these can also cause bilateral gynecomastia. These include amphetamines, heroin, marijuana, and methadone.
Other causes of gynecomastia include health conditions (e.g., hypogonadism), tumors in the testes or pituitary gland, and malnutrition. Even certain herbal products, especially plant oils from lavender and tea tree, have also been associated with the male breast condition.
Treatment of Gynecomastia
Before treatment options can be discussed, the doctor and patient must first determine that, indeed, it’s a case of bilateral gynecomastia. This is because gynecomastia also has similar symptoms as fatty breast tissue, breast abscess, and breast cancer thus the need for a definitive diagnosis before treatment, if any, can start.
In most cases, the swelling in both breasts can regress even without medical intervention, such as in the case of infants and pubescent boys. But when bilateral gynecomastia is caused by cirrhosis, malnutrition, or hypogonadism, among other possible underlying health conditions, the treatment of the former should be accompanied by the treatment of the latter. In many cases, the successful treatment of an underlying medical condition result in the resolution of the abnormal swelling of the breast tissue.
Doctors also use the following treatment options for men whose bilateral gynecomastia isn’t resolving by any non-medical methods.
- Prescription medications, such as those used for the treatment of breast cancer and aromatase inhibitors, can be helpful in some men. But these aren’t approved for such use by the Food and Drug Administration (FDA) so caution is advised.
- Surgery can also be applied in removing the excess breast tissue. The choices include liposuction for removing excess breast fat and mastectomy for removing the breast gland tissue itself.
- You can even use Gynexol cream or Gynectrol pills which are proven to be safe and very effective in curing gynecomastia without harming your health.
Keep in mind that surgery for the treatment of bilateral gynecomastia may not be covered by your insurance policy, especially when it’s part of a cosmetic surgery plan. Be sure to ask your insurance provider about coverage and discuss with your surgeon about financing options.