Unilateral Gynomastia

Gynomastia is a medical condition that results in male breast enlargement. It can sometimes grow unevenly. Most men ask if it can take place on one side only. Yes, it can—unilateral gynomastia, which takes place on just one breast, is not unusual.

Understanding Gynomastia

Man boobs or gynomastia are when the breast tissue of men gets larger. It occurs in boys at puberty and men at a later stage of life. It is not additional fat but glandular tissue under the nipples.

What is Gynomastia?

This condition occurs when there is an imbalance between estrogen and testosterone levels. It causes breast tissue to grow. Genuine gynomastia is real breast tissue in men—not fat.

Common Causes

• Puberty: Endocrine Alterations during Adolescence
  In puberty, there is an extreme variation in the level of hormones—particularly testosterone—in males. At times, the estrogen level could momentarily increase, or the body might not properly control testosterone and estrogen. That hormonal imbalance will trigger the growth of gynecomastia, or male breast enlargement. It is usual in males between the ages of 12 and 16 years and normally disappears on its own within 6 months to 2 years. Treatment is not necessary except when the condition lasts longer or results in emotional distress.https://drshaw.co.za/what-causes-gynecomastia-understanding-male-breast-growth
• Drugs: Some Steroids or Antibiotics
  Some medications interfere with hormone balance, leading to excess estrogen or insufficient testosterone. Some of the prime suspects include:
  • Anabolic steroids (for building muscle or improving performance)
  • Anti-androgens (used for prostate issues or baldness)
  • Some antibiotics (e.g. ketoconazole)
  • Anti-anxiety or antidepressant drugs
  • Chemotherapy medications
  • Heart drugs such as calcium channel blockers or digoxin

They can cause or exacerbate gynecomastia by modifying hormone levels or liver function.

• Health Problems: Thyroid or Liver Issues
  Underlying medical conditions that disrupt hormone metabolism may cause gynecomastia:
  • Liver disease: Since the liver is responsible for breaking down estrogen, diseases such as cirrhosis can result in the accumulation of estrogen.
  • Hyperthyroidism: Increased thyroid hormone speeds up estrogen levels and can decrease testosterone, impacting the hormonal balance.

Kidney failure or tumors (adrenal, pituitary, or testicular) may also distort hormonal signals and lead to the growth of breast tissue.

These disorders also share other symptoms and need to be diagnosed and treated accordingly.

• Aging: Endocrine Changes in the Elderly As a man gets older, his testosterone level goes down naturally. This change can make estrogen relatively more dominant, even though the level of estrogen does not change. The imbalance can lead to mild breast enlargement, particularly in men older than 50. Other aspects of aging—like greater body fat and medications—can also play a role. Mild cases are not unusual, but persistent or noticeable changes need to be assessed for eliminating other causes.

Symptoms to Watch For

Gynecomastia occurs progressively, yet one must not disregard symptoms of hormonal imbalance or enlargement of tissues.

• Swelling Of One Or Both Nipples
  The most common and noticeable symptom is swelling. It may either be a soft, rubbery lump or a thickened tissue directly under the nipple area.
  • Texture: Does not resemble normal body fat—firmer and more glandular.
  • Location: Usually behind the nipple but can radiate outward in late stages.
  • Size: May be pea-sized or slightly larger, creating a palpable mass beneath a t-shirt.
  • Progression: Typically slow-growing; sudden enlargement may require additional workup.

It may develop in both breasts (bilateral) or a single breast (unilateral) and asymmetry is not unusual in early phases.

• Pain or Tenderness
  It is not ongoing pain, but the majority of people report discomfort in the region.
  • Nature: Typically characterized as a dull ache, burning pain, or tenderness instead of sharp pain.
  • When it happens: Tenderness may be exacerbated by pressure, such as with exercise or when lying on the chest.
  • Triggers: Can be exacerbated by hormonal changes, certain medications, or chest injury.
  • Duration: It can last a few weeks or continue for several months, as per the cause.

While generalized tenderness is usual, new or worsening pain is an indication for a clinical evaluation.

• Hard Nodules Under the Nipple
  Firm nodules are an important indication that the condition affects glandular—not merely fatty—tissue.
  • Feel: They are rubbery and firm, and sometimes fixed and immovable unlike soft fat.
  • Size: Normally between 1–5 cm, but can be different.
  • Shape: Round or oval, situated directly beneath or behind the areola.
  • Implication: The existence of a true lump generally establishes true gynecomastia, particularly if a lump is present with tenderness.
  • Firm, irregular, or fast-growing lumps need to be checked right away to eliminate a diagnosis of male breast cancer, which is uncommon.
• Sporadic Nipple Discharge
  Although uncommon, nipple discharge in men is an abnormal result and always needs to be evaluated.
  • Appearance: The fluid can be clear, milky, yellow, green, or blood-tinged. Side: May occur in either or both nipples; unilateral discharge is more foreboding. F
  • requency: Can happen at random or when the space becomes compressed or pinched. Associated symptoms: Can be a sign of infection, hormone-secreting neoplasm, ductal obstruction, or malignancy. If you notice any nipple discharge, especially bloody or persistent, get a check-up immediately.

Why Does Gynomastia Happen?

Gynomastia arises from hormonal changes, medication side effects, or illnesses. Understanding the cause helps address the issue directly.

Hormonal Imbalances

The main cause is hormonal imbalance between estrogen and testosterone. This may occur during puberty, aging, or due to certain illnesses like hypogonadism.

Drugs and Medications That Could Lead to Gynecomastia

Certain drugs can interfere with hormone levels or the metabolism of testosterone and estrogen in the body. Interference with the hormonal balance can cause men to develop breast tissue. The following is how certain drugs are implicated:

Antidepressants (SSRIs)

• Selective Serotonin Reuptake Inhibitors (SSRIs) are widely employed to treat depression and anxiety disorders. They form drugs such as:
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Celexa)

How they assist:

• SSRIs may increase the level of prolactin, a hormone that triggers breast tissue.
• Chronic administration may influence the hypothalamic-pituitary-gonadal axis controlling testosterone.
• Lowered testosterone levels compared to estrogen levels can encourage gynecomastia in certain individuals.

This side effect is not common but is more likely with longer use or larger doses.

Anti-androgens (e.g., for prostate treatment)

• Anti-androgens are utilized in the treatment of prostate cancer, benign prostatic hyperplasia, or cystic acne. Examples include:
• Finasteride (Propecia, Proscar)
• Spironolactone
• Flutamide
• Bicalutamide

How they contribute:

• They block testosterone or stop it from attaching to androgen receptors.
• They can also stimulate estrogen activity, leading to the growth of breast tissue.
• Spironolactone has a very strong association with hormone imbalance and gynecomastia, particularly when used for extended periods.

They should be monitored at regular intervals for hormonal side effects if they are on anti-androgens, particularly older men or polypharmacy patients.

Marijuana or Anabolic Steroids
Recreational and performance-enhancing drugs are both recognized to influence hormone levels:

Marijuana

• Contains phytoestrogens and other chemicals that may mimic or amplify estrogenic effects.
• May suppress testosterone production by influencing the pituitary gland and hypothalamus.
• Chronic, heavy use elevates the risk of gynecomastia, particularly in teenagers and young males whose hormones are still balancing.

Anabolic Steroids

• Normally used in sports performance or bodybuilding.
• Give synthetic testosterone, which is converted to estrogen (by aromatase enzyme) when in excess. Causes estrogen dominance, leading to glandular growth of the breasts—usually large and irreversible. Usually happens in steroid cycles and gets worse if users fail to take estrogen-blocking medications (e.g. SERMs). Once anabolic steroids have induced gynecomastia, it does not always correct itself without surgery.

Underlying Health Conditions

Liver or kidney disease can lead to hormone buildup. Tumors that secrete hormones can also be responsible.

One-Sided Gynomastia: An Overview

Can Gynomastia Occur Unilaterally?

Yes. Unilateral gynomastia affects just one side and may be due to:

• Hormonal effects on one breast’s receptors
• Localized trauma
• Specific drugs or localised growths

Characteristics of One-Sided Cases

Symptoms and Signs

• One-sided swelling
• Palpable mass under nipple
• Nipple inversion or dimpling
• Firm or rubbery texture

Self-Check Steps

Emotional and Psychological Effects

• Self-consciousness
• Avoiding fitted clothes
• Social withdrawal

Diagnosis of Gynomastia

Physical Examination

Doctors check for glandular tissue and compare both breasts. They will ask about symptoms, medication use, and family history.

Imaging Tests and Blood Work

• Mammograms for tissue evaluation
• Ultrasound to differentiate fat from glandular tissue
• MRI to rule out tumours
• Blood tests to assess hormone levels

Treatment Options for Gynomastia

Non-Surgical Treatment

• Watchful waiting
• Hormone therapy (anti-estrogens, testosterone boosters)
• Lifestyle changes (diet and exercise)

Surgical Options

When to Seek Medical Attention

• Rapid growth
• Severe or persistent pain
• Nipple discharge
• Hard mass under nipple
• New asymmetry in older adults

Questions to Ask Your Doctor

• What tests differentiate glandular from fat tissue?
• Are medications contributing?
• Is surgery safe in my case?
• Will insurance cover diagnostics?

Gynomastia vs. Pseudogynomastia

Lifestyle Changes and Management

Diet and Nutrition

• Avoid alcohol and soy
• Eat foods rich in zinc (nuts, seeds)
• Increase leafy greens and cruciferous vegetables
• Reduce sugar and processed foods
• Add flaxseeds for hormone support

Exercise and Weight Control

• Push-ups, bench presses, flyes
• More reps on the smaller side
• Cardio + weight training

The Role of Hormones in Gynomastia

Hormonal Treatments

• SERMs like Tamoxifen
• Aromatase inhibitors
• Testosterone replacement

Psychological Effects

• Lower self-esteem
• Social anxiety
• Body image issues

Coping Strategies

• Support groups and online forums
• Open conversation with friends/partners
• Layered clothing
• Therapy for body image

Alternative Treatments and Remedies

Herbal Supplements

Patient Testimonies

Support and Resources

• Reddit's r/Gynomastia
• Local clinic groups
• Male Breast Cancer Coalition

Getting Professional Help

• Ask for referrals to endocrinologists or surgeons
• Ask about experience with unilateral cases
• Check coverage for scans or surgery

Conclusion

Embracing Self-Confidence

Confidence comes from understanding your options. Lifestyle, therapy, or surgery can all help. Having gynomastia doesn’t diminish your worth.

Importance of Early Intervention

Early action leads to better outcomes. Talk to a healthcare provider and explore your options.

Disclaimer

The information provided in this blog post is intended for general guidelines only and is sourced from various medical websites and medical documents on the internet. Always consult your doctor or a medical professional who specializes in these procedures for personalized advice and information.