Gyno in older males

[Raider Fan]

I just posted this on the main discussion page, but then found this forum for addressing questions specifically to doctors.

I just joined and haven't really found a discussion of the things I'm wanting to know.  I'm in my mid 50's and started having trouble with pain under my left nipple about a month ago.  It felt like a prickling type pain, like a sticker was under the skin.  I thought I had scratched my nipple or something, but then the pain continued.  Over the next 4 weeks, I have begun to actually feel a lump under my left nipple and it's very disconcerting.  The left breast is noticeably swollen and is very painful.  I also have burning and shooting type pains around the chest area and especially in both armpits.  Is this a symptom of gynecomastia?  I haven't seen anyone else speak of this. 

In fact, PAIN is my main complaint with this condition, and from the things I've read about it, pain doesn't usually seem to be the main complaint from men who have it.  Most everything I have read on the subject, men mainly complain about the size of the breast itself, and not so much the pain. 

I went to my doctor about this a couple of weeks ago and he ordered a mammogram.  It came back that I had gynecomastia on both sides, which surprised me because my right breast has no symptoms.  I asked the radiologist what to do about it and she said "nothing".  She said most of the time it's related to medication. 

I went back to my doctor to discuss the results with him and to discuss what to do now.  We went over my medications and the only one he thought might have a chance of causing my problem was Prevacid (for heartburn/GERD).  That medicine, and others like it, are on the list of meds that can cause gyno.  But I have been taking this medicine for several years now and you would think that if it was going to give me gyno, it would have done it long ago.  Is it possible to develop gyno YEARS after being on a certain medication? 

My doctor also started me on another medicine only 3 weeks before I started having gyno symptoms.  The medicine is Welchol (for high cholesterol).  He really didn't think my problem could be related to the medicine because not only is gyno not listed as a side effect of Welchol, it's also not absorbed systemically.  It's not a statin and does not affect the body the way the statins do.  However, since my problem started only 3 weeks after beginning this medicine, he told me to stop taking it for 6 weeks to see if my gyno symptoms went away or improved.  He also took some blood to check my hormone levels, but I don't have the results yet. 

So my questions are.....how common is SIGNIFICANT and ONGOING pain with gynecomastia?  I know "tenderness" is listed as a symptom, but mine HURTS, and nothing seems to help it. 

Anyone else think they might have developed gynecomastia as a result of their heartburn/GERD medicine?  Is it possible that Prevacid could be causing my problem even though I've taken it for several years?

What about cholesterol lowering meds?  Are they known to cause gyno?  I know there is a direct relationship between our hormones and cholesterol, so if you mess with the cholesterol, it seems like it could throw our hormones out of whack, too.  Am I grasping at straws here? 

I also had a shot of Celestone (cortisone) for stopped up ears a couple of months ago.  Could this have triggered the gyno? 

Should one consider having surgery if they have only had the condition for a month?  How long should you live with gyno before surgery should be considered?  Would there be any problem with having the surgery if you're still having acute symptoms related to it (i.e., pain, noticeable feeling of fullness in the breast, active growing of breast tissue with swelling), or would it be better to see if the pain goes away and see how much swelling I'm left with?

How long should the acute symptoms of gyno last after the initial onset?  I read all the time that it will "go away," but I'm not a teenager, I'm a middle aged guy.  How long should I expect acute symptoms to last and will the unpleasant symptoms go away?

I've read that in older males, the cause of gyno is unknown only 25% of the time.  So that means 75% of the time, the cause IS known.  What IS that cause most of the time in a middle aged male who doesn't use steroids or pot? 

Is it possible that initiating an exercise program and/or lifting weights could trigger a gyno outbreak?  My son is a health nut and is semi into body building.  He thinks gyno can run in families and he has had intermittent problems with gyno over the years.  He says if he has laid off the weights for awhile and then starts them up again, he gets a flare-up of gyno.  He takes Tamoxifen for it to shorten the course of it.  I don't know where he gets it and I would be afraid to take it unless it was prescribed by my doctor.  (My doctor just rolled his eyes when I asked about taking Tamoxifen for it.)  Anyway, I thought it was odd that my son would ask me if I had recently started a weight program, because I had, indeed, done just that about a month prior to my symptoms.  I had begun lifting barbells in my spare time. Anyone heard of weight lifting spurring a gyno flare-up?

Is it okay to exercise when you have gynecomastia?  I'm talking about lifting weights and walking/light jogging?  If weight lifting is what caused the problem, it would seem logical not to do it, but I've read that building the pectoral muscles can make the gyno not so noticeable. 

Sorry this was so long, but I'm obsessed and worried about myself. 

Thanks!

[DrBermant]

I just posted this on the main discussion page, but then found this forum for addressing questions specifically to doctors.

I just joined and haven't really found a discussion of the things I'm wanting to know.  I'm in my mid 50's and started having trouble with pain under my left nipple about a month ago.  It felt like a prickling type pain, like a sticker was under the skin.  I thought I had scratched my nipple or something, but then the pain continued.  Over the next 4 weeks, I have begun to actually feel a lump under my left nipple and it's very disconcerting.  The left breast is noticeably swollen and is very painful.  I also have burning and shooting type pains around the chest area and especially in both armpits.  Is this a symptom of gynecomastia?  I haven't seen anyone else speak of this. 

In fact, PAIN is my main complaint with this condition, and from the things I've read about it, pain doesn't usually seem to be the main complaint from men who have it.  Most everything I have read on the subject, men mainly complain about the size of the breast itself, and not so much the pain. 

I went to my doctor about this a couple of weeks ago and he ordered a mammogram.  It came back that I had gynecomastia on both sides, which surprised me because my right breast has no symptoms.  I asked the radiologist what to do about it and she said "nothing".  She said most of the time it's related to medication. 

I went back to my doctor to discuss the results with him and to discuss what to do now.  We went over my medications and the only one he thought might have a chance of causing my problem was Prevacid (for heartburn/GERD).  That medicine, and others like it, are on the list of meds that can cause gyno.  But I have been taking this medicine for several years now and you would think that if it was going to give me gyno, it would have done it long ago.  Is it possible to develop gyno YEARS after being on a certain medication? 

My doctor also started me on another medicine only 3 weeks before I started having gyno symptoms.  The medicine is Welchol (for high cholesterol).  He really didn't think my problem could be related to the medicine because not only is gyno not listed as a side effect of Welchol, it's also not absorbed systemically.  It's not a statin and does not affect the body the way the statins do.  However, since my problem started only 3 weeks after beginning this medicine, he told me to stop taking it for 6 weeks to see if my gyno symptoms went away or improved.  He also took some blood to check my hormone levels, but I don't have the results yet. 

So my questions are.....how common is SIGNIFICANT and ONGOING pain with gynecomastia?  I know "tenderness" is listed as a symptom, but mine HURTS, and nothing seems to help it. 

Anyone else think they might have developed gynecomastia as a result of their heartburn/GERD medicine?  Is it possible that Prevacid could be causing my problem even though I've taken it for several years?

What about cholesterol lowering meds?  Are they known to cause gyno?  I know there is a direct relationship between our hormones and cholesterol, so if you mess with the cholesterol, it seems like it could throw our hormones out of whack, too.  Am I grasping at straws here? 

I also had a shot of Celestone (cortisone) for stopped up ears a couple of months ago.  Could this have triggered the gyno? 

Should one consider having surgery if they have only had the condition for a month?  How long should you live with gyno before surgery should be considered?  Would there be any problem with having the surgery if you're still having acute symptoms related to it (i.e., pain, noticeable feeling of fullness in the breast, active growing of breast tissue with swelling), or would it be better to see if the pain goes away and see how much swelling I'm left with?

How long should the acute symptoms of gyno last after the initial onset?  I read all the time that it will "go away," but I'm not a teenager, I'm a middle aged guy.  How long should I expect acute symptoms to last and will the unpleasant symptoms go away?

I've read that in older males, the cause of gyno is unknown only 25% of the time.  So that means 75% of the time, the cause IS known.  What IS that cause most of the time in a middle aged male who doesn't use steroids or pot? 

Is it possible that initiating an exercise program and/or lifting weights could trigger a gyno outbreak?  My son is a health nut and is semi into body building.  He thinks gyno can run in families and he has had intermittent problems with gyno over the years.  He says if he has laid off the weights for awhile and then starts them up again, he gets a flare-up of gyno.  He takes Tamoxifen for it to shorten the course of it.  I don't know where he gets it and I would be afraid to take it unless it was prescribed by my doctor.  (My doctor just rolled his eyes when I asked about taking Tamoxifen for it.)  Anyway, I thought it was odd that my son would ask me if I had recently started a weight program, because I had, indeed, done just that about a month prior to my symptoms.  I had begun lifting barbells in my spare time. Anyone heard of weight lifting spurring a gyno flare-up?

Is it okay to exercise when you have gynecomastia?  I'm talking about lifting weights and walking/light jogging?  If weight lifting is what caused the problem, it would seem logical not to do it, but I've read that building the pectoral muscles can make the gyno not so noticeable. 

Sorry this was so long, but I'm obsessed and worried about myself. 

Thanks!

Male breast glands under hormonal stimulation can have Gynecomastia Symptoms of discomfort that vary from slight tenderness to significant pain. There can be other reasons of discomfort such as infection or tumor that need investigation and evaluation by an experienced doctor. Some Medications that Cause Gynecomastia may start problems a long time after starting the drug. It can be quite difficult discovering a specific cause, but getting the problem stabilized first is critical. Surgery will not stop gynecomastia breast pain and if there is an underlying problem not corrected, recurrence most likely will happen.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Raider Fan]

Thanks for your reply, doctor.

You said: "There can be other reasons of discomfort such as infection or tumor that need investigation and evaluation by an experienced doctor."

I don't know about an infection, but wouldn't a tumor have shown up on the mammogram that I had?  What about an infection?  Is it possible for a male to have an infection in the breast, and would that show up on a mammogram? 

How does one diagnose an infection in a male breast?  I've been to my doctor twice now and he hasn't said anything about an "infection".  Do you think I need to go to some specialist? 

[Raider Fan]

I was recently diagnosed with gynecomastia after a mammogram.  My main symptom is pain in the left breast, followed by enlargement of glandular tissue that I can feel even when I'm not touching it.  It feels like I have a marble in my chest, even when I'm just sitting in a chair or walking around.  Is this common?  

I know in adolescent boys, gyno is common and usually goes away within 3 years.  But what are the expectations in older men where the cause of the gyno is idiopathic, or unknown?  

I am currently having my hormone levels checked and looking at medications that could be causing my sudden condition.  But in all probability, there's going to be no apparent reason for my condition.  

When the cause of gyno is not known in older males, what is the prognosis?  Is the condition expected to eventually calm down (as it does in young boys)?  If so, how long?  

Or, in older males, does the condition never really improve?  Will pain and tenderness tend to improve with gyno in older males, or not really?  I'm just wondering if this condition can go away as easily as it begins, and if so, how long does it typically take in older males?  

I'm old enough now that I think I could live with the increased breast size, but I can't live with the pain and feeling of fullness all the time.  It's just too uncomfortable at this time.  But should the discomfort improve?  Will the acute stage of my gynecomastia ever die down and "go into remission" if you will?  

Does idiopathic gyno tend to recur?  If so, how often and for how long?  And are there any thoughts on what might trigger an episode of idiopathic gynecomastia?  

Lastly, is there any known increase in breast cancer in males with diagnosed gynecomastia?  Should males that have it have a mammogram every year like women do?  

Thanks.

[Raider Fan]

It can be quite difficult discovering a specific cause, but getting the problem stabilized first is critical. Surgery will not stop gynecomastia breast pain and if there is an underlying problem not corrected, recurrence most likely will happen.

Dr. Bermant, I've seen you say many times that it's critical to correct the cause of gynecomastia before considering surgery, because if the problem is not dealt with, recurrence is likely.  I'd like to ask you (and the other doctors) some questions about this, and I would appreciate just getting your written opinion without links to your website.  I've looked at your website many times, but my specific questions (below) are not addressed. 

I know gynecomastia in young males is common and typically resolves itself within 3 years.  But I am a middle aged man with a sudden onset of painful gynecomastia.  I would like to know what the "typical" prognosis is for men like me, where the "cause" of the gyno is NOT known, and cannot BE known.  I have searched the internet endlessly for answers to this question, but I cannot find any information on it. 

As many men that you've seen with this problem, doctors, I know you must have seen many other middle aged men where the cause of the problem could not be determined.  Literature on this topic shows that of the 25% of men who develop gyno in their later years, no cause is ever determined. 

I've read many times that doctors tell older men with this problem not to worry, and that it will "go away".  Why should breast pain for no reason not be worried about? 

In a case of idiopathic gynecomastia like mine, what do you generally see?  What might I expect?  Should I expect it to "go away" at some point, or should I expect the problem never to resolve completely?  As I said, I am not a boy and the cause of my gyno is not known.  I have had a mammogram and have been diagnosed with gynecomastia of both breasts.  Hormonal and medication reasons have been ruled out. 

Just as a young girl initially experiences pain when she is "budding," I assume I am experiencing the same type of thing.  But in a young girl, that pain/tenderness is normal and eventually goes away.  But what about in middle aged men?  What is the usual outcome when gyno just comes out of the blue? 

In your experiences doctors, will idiopathic gynecomastia in an older male usually resolve with time, or not?  And if so, how long does it usually take to stabilize? 

And if it does resolve, does it come back again for brief periods in the future?  If so, is surgery never an option, since the "cause" of the problem cannot be found? 

Please answer these questions, as I have read everything I can find on the internet and this message board, and I cannot find anything that deals with these questions for older men with this problem. I've read so much on this topic that I feel like an expert on it, but I have seen no information on what I am asking.

Thank you.

[DrBermant]

It can be quite difficult discovering a specific cause, but getting the problem stabilized first is critical. Surgery will not stop gynecomastia breast pain and if there is an underlying problem not corrected, recurrence most likely will happen.

Dr. Bermant, I've seen you say many times that it's critical to correct the cause of gynecomastia before considering surgery, because if the problem is not dealt with, recurrence is likely.  I'd like to ask you (and the other doctors) some questions about this, and I would appreciate just getting your written opinion without links to your website.  I've looked at your website many times, but my specific questions (below) are not addressed. 

I know gynecomastia in young males is common and typically resolves itself within 3 years.  But I am a middle aged man with a sudden onset of painful gynecomastia.  I would like to know what the "typical" prognosis is for men like me, where the "cause" of the gyno is NOT known, and cannot BE known.  I have searched the internet endlessly for answers to this question, but I cannot find any information on it. 

As many men that you've seen with this problem, doctors, I know you must have seen many other middle aged men where the cause of the problem could not be determined.  Literature on this topic shows that of the 25% of men who develop gyno in their later years, no cause is ever determined. 

I've read many times that doctors tell older men with this problem not to worry, and that it will "go away".  Why should breast pain for no reason not be worried about? 

In a case of idiopathic gynecomastia like mine, what do you generally see?  What might I expect?  Should I expect it to "go away" at some point, or should I expect the problem never to resolve completely?  As I said, I am not a boy and the cause of my gyno is not known.  I have had a mammogram and have been diagnosed with gynecomastia of both breasts.  Hormonal and medication reasons have been ruled out. 

Just as a young girl initially experiences pain when she is "budding," I assume I am experiencing the same type of thing.  But in a young girl, that pain/tenderness is normal and eventually goes away.  But what about in middle aged men?  What is the usual outcome when gyno just comes out of the blue? 

In your experiences doctors, will idiopathic gynecomastia in an older male usually resolve with time, or not?  And if so, how long does it usually take to stabilize? 

And if it does resolve, does it come back again for brief periods in the future?  If so, is surgery never an option, since the "cause" of the problem cannot be found? 

Please answer these questions, as I have read everything I can find on the internet and this message board, and I cannot find anything that deals with these questions for older men with this problem. I've read so much on this topic that I feel like an expert on it, but I have seen no information on what I am asking.

Thank you.

There is always a Cause for Gynecomastia. There has to be something causing the Symptoms of Gynecomastia such as mechanical trauma or hormonal imbalance. Discovering that cause can be quite difficult with the natural variation of hormones that occur during the day. For my patients with such issues, I refer them to a tertiary Endocrinologist who often can discover such issues. When that is cleared, then that is the best I have been able to figure out to date. With that methodology, we have picked up many "idiopathic" problems that just were not well understood by less experienced individuals and our recurrence rate has been very rare.

More specific answers to any one patient's questions are what consultations are for. The internet does have its limitations unless a doctor wants to establish a doctor patient relationship without the appropriate foundations that exist during a consultation.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Raider Fan]

There has to be something causing the Symptoms of Gynecomastia such as mechanical trauma or hormonal imbalance. Discovering that cause can be quite difficult with the natural variation of hormones that occur during the day. For my patients with such issues, I refer them to a tertiary Endocrinologist who often can discover such issues. When that is cleared, then that is the best I have been able to figure out to date. With that methodology, we have picked up many "idiopathic" problems that just were not well understood by less experienced individuals and our recurrence rate has been very rare.

So if I go to the doctor and he does blood work that shows no hormone problems, are you saying I should still go to an endocrinologist because there could STILL be a hormone related problem? 

What is "mechanical trauma?"

What is a "tertiary" endocrinologist and are they hard to find?  How does one know which endocrinologists qualify as "tertiary"?

Are you saying there's no such thing as "idiopathic" gynecomastia?  Do you not believe the information that's out there that says that in 25% of the gyno cases, no cause can be found.  Do you just not think they are looking hard enough?

But back to my main question, if no cause can be found, does gynecomastia in an older male ever just "go away," or with time, resolve itself on it's own?  Do you think my painful gynecomastia could last forever if a "cause" is not found? 

[Raider Fan]

Are my questions too tough?  I guess when you ask them 3 or 4 times and they are completely ignored, they are darn good questions.  Looks like I've stumped even the professionals.  

It appears that if you don't ask questions which are eligible for a canned response, there IS no response here.  I expected more. 

[Paa_Paw]

I'm not a Doctor, but I think I can answer your last question.

Yes. Even if your regular Doctor does not see a problem, it may be beneficial to see an Endocrinologist.

The problem with the tests for levels of different hormones is that each may be within the "normal range" but there could be yet a problem in the way they relate to each other.

The various hormones do not each perform a solo part, their actions more accurately resemble a performance by a full orchestra. Analysis of the actions and interactions of the hormones is often beyond most general practitioners.