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Gynaecomastia is a condition that many men have, but few are comfortable talking about. It is the increase in breast tissue in men and this is rarely mentioned because it brings about embarrassment, shyness, and sometimes serious psychological problems. Because it is often viewed purely as a cosmetic issue, many men choose to hide it rather than seek a doctor's advice. A health issue is never an embarrassment; that thought needs to be changed in people.

Gynaecomastia refers to the enlargement of glandular breast tissue in males. It can occur at any age; it is particularly common during puberty and later in life. The most common reason for its development is hormonal changes. An imbalance between oestrogen and testosterone can cause breast tissue to enlarge. Certain medications, alcohol consumption, obesity, liver or kidney disease, thyroid disorders and other hormonal conditions can also be associated with gynaecomastia.

It is important to distinguish gynaecomastia from excess fat around the chest. Weight gain can cause fat to accumulate in this area, a condition sometimes referred to as pseudogynaecomastia. The two may look similar, but they are different conditions and may require different approaches.

Many men first notice a small, firm lump beneath the nipple. There may be tenderness or sensitivity, particularly during the early stages. IT can affect one or both breasts, and the degree of enlargement may vary. Although gynaecomastia is usually not life-threatening, any new or unusual breast change should be assessed rather than assumed to be harmless.

Checking with your doctor can help one understand what is causing the enlargement. Depending on the patient's age, symptoms and evaluation, the doctor may recommend blood tests, hormonal evaluation or imaging.

An assessment is especially important when:

- The enlargement develops suddenly

- Is associated with significant pain

- Occurs on only one side or is accompanied by other unusual symptoms.

The psychological impact should not be underestimated. Men with gynaecomastia can avoid swimming, changing clothes in front of others or participating in activities where their chest is visible. Teens may be teased and bullied because of this issue, while in adults, this could make them feel embarrassed in social and intimate settings. In later years, it could have an impact on their confidence and quality of life.

The treatment method used will vary depending on the underlying cause of the gynaecomastia and how long it has been occurring. Gynaecomastia that occurs during puberty will resolve itself as hormone levels return to normal. Persistent gynaecomastia that causes physical discomfort or considerable psychological distress require surgical treatment after appropriate evaluation.

One of the most important messages for men is that there is nothing embarrassing about seeking help for gynaecomastia. It is a medical condition, not a measure of masculinity. Trying to conceal it, self-medicate or depend on unproven treatments can delay the identification of an underlying problem.

Breaking the stigma starts with conversation. Men should feel comfortable discussing changes in their bodies with a doctor, just as they would discuss any other health concern. Early assessment will give the man some peace of mind, find out the cause, and help determine the best treatment approach. The man does not have to endure in silence for something he can get answers to and treatment for if necessary.

-This article is authored by Dr. Manoj Maruti Sanap, Senior Consultant & HOD, Plastic, Reconstructive, Microvascular & Aesthetic Surgery, Apollo Adlux Hospital, Angamaly