Patient's question:
BR> I am a male, but why are my breasts larger than those of most other men, which is causing me great distress. It has been over 10 years now. I visited a local hospital, and they said it's nothing to worry about, but I still feel uneasy. I avoid going shirtless in the summer and feel quite uncomfortable. I have also taken some medications: methyltestosterone, which didn't work, and injections (I think it was something like 11), which also didn't help. I sincerely request your help. Thank you in advance.Doctor's answer:
Enlarged breasts in men are generally caused by excessive estrogen secretion or insufficient androgen secretion. There are three major categories of causes:1. Drug-induced gynecomastia: The drugs that can cause breast development include the following categories:
(1) Hormones and related drugs—estrogen, gonadotropins, oral contraceptives, adrenal cortical hormones, spironolactone, spiroolactone, etc.
(2) Central nervous system drugs—reserpine, methyldopa, phenytoin, amphetamines, tricyclic antidepressants, phenothiazine drugs (e.g., chlorpromazine), etc.
(3) Other drugs—isoniazid, ethambutol, digitalis, cimetidine, busulfan, methadone, etc.
2. Systemic diseases:
(1) Liver cirrhosis or liver cancer leading to reduced estrogen metabolism.
(2) Renal failure or uremia or kidney tumors.
(3) Intersex conditions.
(4) Pituitary tumors.
(5) Hyperthyroidism or hypothyroidism.
(6) Diabetes.
(7) Lung cancer.
(8) Leukemia or lymphoma.
(9) Breast enlargement due to nipple irritation caused by chest lesions, surgery, or shingles.
(10) Head trauma, spinal cord disorders, or paraplegia.
3. Physiological gynecomastia in newborns and adolescent males: After excluding the above causes, breast enlargement in newborns and adolescent males is usually physiological.
Treatment:
(1) Physiological gynecomastia does not require treatment and will resolve on its own.
(2) Gynecomastia caused by diseases or drugs should be treated accordingly, with symptomatic management for those experiencing symptoms.
Given your 10-year history of significant breast enlargement, it is recommended that you visit a hospital to determine the underlying cause for proper diagnosis and treatment.