Q. My breasts have become large and I’m embarrassed. What can I do?

This question came from a man in his 60s. Breast enlargement in males is common. So is the embarrassment. About 30 percent of older men have this condition, which can be caused by hormonal changes or simple weight gain. It can occur in one or both breasts.

When the usual balance of the female hormone estrogen and the male hormone testosterone in a man shifts, he can get “gynecomastia,” which is derived from two Greek words that mean “woman” and “breast.”

Estrogen controls female traits including the growth of breasts. Testosterone dictates male traits such as muscle mass and body hair.

Males normally produce small quantities of estrogen to regulate bone density, sperm production and mood. Natural hormonal changes that lead to gynecomastia occur not only in old age but also during infancy and adolescence. Gynecomastia can be caused by a health problem such as liver, kidney or thyroid diseases. This condition can also result from drinking alcohol or taking drugs such as steroids, marijuana, amphetamines and heroin.

There are medications that can cause gynecomastia. These include: anti-androgens such as finasteride that are used to treat prostate cancer; AIDS medications such as efavirenz or didanosine; anti-anxiety medications such as Valium; tricyclic antidepressants; antibiotics; ulcer medications such as cimetidine; chemotherapy drugs, and heart medications such as digitalis and calcium channel-blockers.

Some additional symptoms of gynecomastia include tenderness, swelling and nipple discharge. If you have enlarged breasts, see your doctor for a check-up. Enlarged breasts can be a symptom of breast cancer or a testicular tumor.

There is a condition called “pseudogynecomastia.” This occurs when a male just has a lot of chest fat that enlarges his breasts. You can tell the difference between false gynecomastia and the real thing by examining the breasts. In the examination, a healthcare professional spreads a thumb and forefinger and places them (opposing each other) on the circumference of the breast. The fingers are then squeezed gently toward the nipple. Gynecomastia is diagnosed if there is enlarged glandular tissue that feels like a rubbery disk. Often, this tissue can be moved around. Gynecomastia usually will go away without treatment. This condition is often treated with drugs. Sometimes, enlarged breasts are reduced surgically.

Medications used to treat breast cancer and other conditions may be helpful for some men with gynecomastia. These drugs include anti-estrogen medications such as raloxifene and tamoxifen.

Two types of surgery are used to treat gynecomastia: liposuction and mastectomy. Liposuction removes breast fat, but not the breast gland tissue. Mastectomy removes the breast gland tissue.

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