Palpable dense and mobile subareolar tissue in the male breast defines the presence of gynecomastia. Gynecomastia is common, being present in 30% to 50% of healthy men. A general medical history and careful physical examination with particular attention to features suggestive of breast cancer often suffice for evaluation in patients without symptoms or those with incidentally discovered breast enlargement. Men with recent-onset gynecomastia or mastodynia need a more detailed evaluation, including selected laboratory tests to search for an underlying cause.

Diagnosis of Gynecomastia - Cause of Gynecomastia
For the hypertension specialist, breast enlargement in men provides a clue to a secondary cause of hypertension or an adverse antihypertensive drug reaction. Hyperthyroidism, chronic renal failure, adrenal hyperplasia or tumors, amphetamine, cyclosporine, and anabolic steroids are secondary causes of hypertension associated with gynecomastia. Reserpine, methyldopa, and spironolactone are older drugs associated with gynecomastia; however, calcium antagonists (more commonly), angiotensin-converting enzyme inhibitors, and alpha1 blockers may also be associated with this finding.

Treatment of Gynecomastia
Treatment depends on the cause and may include observation, withdrawal of an offending drug, therapy of an underlying disease, giving androgen or antiestrogen drugs, or plastic surgery.

Gynecomastia and Prostate Cancer
Gynecomastia is a significant problem in men undergoing hormonal therapy for prostate cancer. It requires prompt recognition, evaluation and management.

Gynecomastia Questions
Q. My stepson, age 44 has a problem that stresses him out. Enlarged breasts. I don't think it's that serious but he does. Is there any alternative supplement that would help him?
   A. We not seen seen any studies with herbs or supplements that have been shown to be effective for gynecomastia.

Q. I found the number of inquiries on Dr. Sahalien’s web site about possible male breast enlargement from the use of saw palmetto interesting due to my personal experience. About six months into the use of saw palmetto I developed painful gynecomastia on one side. After extensive diagnostic efforts including a mammogram and a full endocrine blood work-up (both negative except that testosterone was on the low side of the normal range), surgical removal was suggested by one surgeon. A second surgeon asked about saw palmetto use and suggested discontinuing it. I did so and the problem resolved in about 30 days. The endocrinologist asked about supplements and specifically ruled out saw palmetto as a cause in response to my question. Since I am not biologically trained, and this happened about six years ago, I cannot recall the exact explanation, but the endocrinologist explained his understanding of saw palmetto’s biological mechanisms. When I researched the described mechanisms, it became clear to me that there was a serious academic controversy (albeit with one view in a distinct minority) about the mechanisms. Without fully understanding the debate, I understood enough at the time to understand that depending on who was right, saw palmetto could effect male breast enlargement. In the course of my research I found a re-print of a non-technical publication by an herbalist in the 1950’s who noted that saw palmetto could be used for female breast enlargement and generally for female hormonal imbalances. In light of the number of inquiries, my personal experience, the academic dispute, and the older herbalist publication indicating some folk wisdom on the subject, a warning about possible saw palmetto gynecomastia side effects should be considered.