Why it's common after 50
From middle age, testosterone falls slowly, body fat tends to rise, and fat turns more testosterone into oestrogen. The balance shifts, and breast gland grows. On top of that, men over 50 take more regular medicines, and several common ones are known causes.
Medicines to ask about
- spironolactone (a water tablet used for the heart and blood pressure)
- medicines for prostate cancer that block or lower testosterone
- finasteride and dutasteride (used for an enlarged prostate and for hair loss)
- digoxin (a heart medicine)
- some stomach acid medicines, such as cimetidine
- ketoconazole (an antifungal) and some HIV medicines
- some medicines for mental health, and some chemotherapy
- testosterone itself, and other hormones, when the dose or the balance is off
Bring a list of everything you take, including over-the-counter and online products, to your GP or pharmacist. Never stop a prescribed medicine yourself.
Prostate cancer treatment
Treatments that block or lower testosterone for prostate cancer commonly cause breast growth and tenderness. Some men are offered a low dose of radiotherapy to the breast area, or a medicine, to prevent it before it starts. Ask your oncology team about it at the start of treatment, not after.
The checks that matter more after 50
Breast cancer in men is rare, about 30 men a year in Ireland, and it's most common over 60. That's why a GP wants to feel any new lump in an older man, especially one that's hard, painless, fixed or on one side. Expect an ultrasound, and often a mammogram.
Don't wait on these
See your GP within a week or two, and sooner if it is changing fast, if you notice:
- a hard lump, or a lump that is off to one side rather than centred under the nipple
- a lump that is fixed and doesn't move under the skin
- fluid or blood coming from the nipple
- a nipple that has turned inwards, or skin that is dimpled, red or sore
- a swelling or lump in your armpit
- a change on one side only that is getting bigger
Most of the time these turn out to be harmless. They still need a doctor to feel them, because about 30 men are diagnosed with breast cancer in Ireland each year.
Treatment for older men
Once a cause is dealt with and the tissue is shown to be gynaecomastia, many older men choose to leave it. If it's sore or bothers you, the options are the same as at any age: treat the cause, a medicine in some cases, and surgery for tissue that stays. A surgeon will look at your general health and any blood-thinning medicines before planning an operation.
Questions people ask
Is it low testosterone?
Sometimes. A GP can check your testosterone with a morning blood test. Low testosterone has other signs too, such as low energy, low sex drive and poorer sleep.
Can testosterone treatment fix it?
Not always, and sometimes testosterone treatment causes gynecomastia, because some of it is turned into oestrogen.
Am I too old for surgery?
Age alone isn't the deciding factor. Your general health is. A surgeon assesses that at the consultation.
Should I worry about a lump at 70?
Get it checked soon. It's still most likely gynaecomastia, but a lump at that age always needs a doctor to feel it.