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Unilateral gynecomastia in 42 year-old male

I am a 42 year-old male who recently realized I have gynecomastia in my left breast. I am 5'11" and about 180 pounds. I recently lost a bit of weight during the pandemic isolation period and realized that the swelling in my chest about which I've been a little self-conscious is more than just excess weight.

I have an allergic disorder called mast cell activation syndrome (MCAS) for which I am treated with H1- and H2-blocker antihistamines. I had been taking ranitidine for a couple of years, but it was recalled last fall by the FDA for being potentially carcinogenic. I replaced it with cimetidine, which I recently learned can cause gynecomastia, including unilateral gynecomastia.

I have done the best version of a breast self-exam I know how to do, not knowing what a lump would feel like. I don't feel anything hard in the breast tissue; however, the tissue just under the nipple is denser/feels a little bit rubbery compared with the fatty tissue surrounding it--which I've read is typical of gynecomastia. The nipple is not inverted, I don't see any kind of discharge from it (I've checked worn shirts and don't see any indication of discharge on them, either.), and I don't have 'orange peel' skin surrounding the nipple. The breast tissue has been sore for the past couple of days, and I presume that is because of the 'groping' I did to feel for lumps. But of course the soreness makes it impossible for me to put this out of my mind.

Given all this, I realize I am likely panicking unduly. But I've read about inflammatory breast cancer, which sometimes involves only swelling and my left breast is unusually swollen--but not only the breast. About a year ago, I posted to the heart disease forum here (link to that post below) that I have unusual swelling and pain in my left arm and someone wrote "I don't see the harm in being evaluated by a cardiologist but also potentially checking for issues from a compression where the extremity is. Breast cancer should be ruled out."

At the time, breast cancer didn't seem likely at all given that I am a 42 year-old male. But now...I'm worried.

I have an appointment for a physical with my primary-care doctor in two weeks. I contacted her about this discovery and she feels that the breast swelling most likely is related to the drug and not cancer but I am honestly a little bit paranoid and so I landed here. Is this something that I should be concerned about waiting another two weeks to follow up on? I've read that inflammatory breast cancer is extremely aggressive and that time is of the essence. My doctor, however, does not feel that it is urgent.

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973741 tn?1342342773
Try not to worry.  I know that's easier said than done.  That your doctor isn't terribly concerned or in a huge hurry may be comforting but ya, makes you worry that they are neglecting a problem.  The odds that it is breast cancer are very low.  More likely a hormone imbalance.  Gynecomastia is actually relatively common in men your age.  One statistic is up to 65% of men middle aged or older!  Seems like a lot, but the static I've read. Your doctor is probably going to have you do a blood test as well as potentially setting you up for a mammogram (welcome to the fun we women have, ha ha).  If you are taking medication linked to this issue, your doctor is going to have you discontinue it, obviously.  Unless it is much needed.  

When can you see your doctor?
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Thank you for responding. I saw my doctor last week...it was a long appointment. This is where we landed:

1. Re the gynecomastia, she said that I actually have bilateral gynecomastia, but noted that the left side is notably more swollen than the right. She felt it and said she doesn't feel a lump or a mass. She had no idea what the rash is, although she discovered another anomaly, which I'll detail below. In sum, she said she doesn't think there's concern for breast cancer. But then when she went away to write prescriptions for lab tests (more below), she came back and said that she reconsidered and would like me to get a mammogram and an ultrasound of the left breast. She said that she would never want to overlook something like breast cancer, however unlikely. The prescription says "L breast - swelling, ??mass."

2. While examining my breast, and when I asked her specifically to look at the rash/itchy discoloration on it, my doctor was most concerned with a varicose vein that runs under my left arm and across my chest. She then realized the discoloration follows roughly the vein and said that the vein may be leaking blood and causing irritation to the skin (typical of varicose veins), and that could be the discoloring and itching. But she was very concerned because she said she had never in her life seen a varicose vein where I have one. She also noticed that my left arm is larger than my right and measured it at 1cm larger--which is something I had told her about. When I exercise, my left arm sometimes swells up to 50% its size. Since I have mast cell activation syndrome, she has thought that that is likely a histamine reaction. The swelling goes down mostly when I cool down.

3. So given the vein issue, plus of course the dilated aortic root that was just discovered on a heart scan reading, she referred me to a cardiologist. The cardiologist said that the longtime pain on my left side sounds to her more like a nerve pain than a heart pain--which was very reassuring. She also thought that the drug I've been taking for my mast cell disorder--cimetidine--likely contributed to or caused the gynecomastia. She looked at the varicose vein and the rash on my chest. She said she has no idea what the rash is but that it looks like it involves nerve fibers and it may be related to the nervous system. She didn't seem overly concerned about the varicose vein, specifically, as my doctor had been. However, she is concerned about the swelling of both my tissue (left arm, breast, as well as the vascular swelling--the varicose vein) and she ordered a CT scan of the blood and lymph vessels in my upper left. She doesn't see evidence of a problem with the heart, but possibly with blood vessels.

So the plan of action now is:

1. Blood tests are scheduled this week. LOTS of them, looking at everything from CBC to inflammatory factors (c4a complement) to hormomes and more.

2. After the blood tests, presuming my kidney is functioning properly, I need to schedule the CT scan of my blood vessels. That report will go to the cardiologist.

3. Sometime in the interim, I need to get a mammogram with ultrasound. By now, I didn't think I would be concerned with stigma and taboo, but I've discovered I have put off scheduling the mammogram for a week because it feels really strange to have to get one as a man. That's terrible, but it's the truth. It's on my to-do list for today.

4. In September, I go back to the cardiologist for an ultrasound of my sternum to get a better look at the dilated aortic root (which my doctor called a 'small aneurysm'), as well as a scan of my abdomen to make sure I don't have an abdominal aortic aneurysm (as my father does). The cardiologist said that she may also do an ultrasound of my left arm during this appointment, depending what the CT scan finds.

5. If she doesn't detect vascular disease obstructing blood and/or lymph flow in the upper left side--which we are hoping she will not--then the cardiologist said she will refer me to an orthopedic neurologist (neurological orthopedist??) to determine whether bone or connective tissue may be obstructing blood flow and causing the pain I have on my left side. The cardiologist seems to suspect this as the root cause based on our initial discussion, but she said we need to rule out heart and blood vessel problems first because they have the most immediate potential for danger, and then if no cause is found, the orthopedist can consider all the labwork done to date and start looking for skeletally based interference with nerves as the potential cause.

So I now have a plan of action and both my doctor and the cardiologist, separately, had exactly the same idea for how to proceed. I'm greatly comforted by that. But still really worried about both the breast and potential blood vessel problems.
Hey there, I dropped off the face of the earth, apologies.  Any further updates? The small aneurysm is a little frightening.  how did that appointment turn out?  How did they discover that to begin with?  Anyway, write me back for what is going on now and I promise I won't be slow to respond!
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