Nipple discharge in men

Nipple discharge in men, though less common than in women, can be a symptom of various underlying conditions. It is essential to evaluate the characteristics of the discharge (e.g., color, consistency, unilateral or bilateral) and associated symptoms to determine the cause. Below are the primary causes:

1. Physiological Causes

Hormonal Fluctuations: Temporary hormonal changes, such as during puberty or aging, can cause nipple discharge.
Stimulation: Frequent nipple stimulation (e.g., friction from clothing or self-examination) can lead to discharge.

2. Endocrine Disorders

Hyperprolactinemia: Elevated levels of prolactin, often due to pituitary tumors (prolactinomas), medications, or hypothyroidism, can cause nipple discharge.
Hypogonadism: Low testosterone levels may lead to hormonal imbalances, resulting in discharge.
Thyroid Dysfunction: Both hyperthyroidism and hypothyroidism can disrupt hormone levels and cause nipple discharge.

3. Medications

Drugs that Increase Prolactin: Antipsychotics (e.g., risperidone), antidepressants (e.g., SSRIs), and anti-nausea medications (e.g., metoclopramide) can cause nipple discharge.
Hormonal Therapies: Medications containing estrogen or testosterone can lead to hormonal imbalances and discharge.
Recreational Drugs: Marijuana and opioids may also contribute.

4. Breast Tissue Abnormalities

Gynecomastia: Enlargement of male breast tissue, often due to hormonal imbalances, can sometimes cause nipple discharge.
Duct Ectasia: Inflammation or blockage of the milk ducts can lead to discharge, often accompanied by pain or swelling.
Intraductal Papilloma: A benign growth in the milk ducts that can cause bloody or clear discharge.

5. Infections

Mastitis: Infection of the breast tissue, though rare in men, can cause discharge, redness, and pain.
Abscess: A collection of pus in the breast tissue may lead to discharge.

6. Malignancies

Male Breast Cancer: Although rare, breast cancer in men can present with nipple discharge, often bloody or unilateral. Other symptoms may include a breast lump, skin changes, or nipple retraction.
Pituitary Tumors: Tumors in the pituitary gland can secrete prolactin, leading to nipple discharge.

7. Systemic Conditions

Liver Disease: Cirrhosis or liver failure can disrupt hormone metabolism, leading to nipple discharge.
Chronic Kidney Disease: Impaired kidney function can affect hormone levels and cause discharge.

8. Idiopathic Causes

In some cases, no specific cause is identified, and the discharge may resolve on its own.

Evaluation and Diagnosis

Medical History: Assess for medications, hormonal imbalances, or systemic conditions.
Physical Examination: Check for breast lumps, tenderness, or signs of infection.
Laboratory Tests: Measure prolactin, testosterone, thyroid function, and liver/kidney function.
Imaging: Mammography, ultrasound, or MRI may be used to evaluate breast tissue or the pituitary gland.
Cytology: Discharge fluid may be examined for abnormal cells.

When to Seek Medical Attention

Persistent or unilateral discharge.
Bloody or clear discharge.
Associated breast lump, pain, or skin changes.
Symptoms of hormonal imbalance (e.g., fatigue, weight changes, sexual dysfunction).

Conclusion

Nipple discharge in men can result from a wide range of causes, from benign hormonal changes to serious conditions like breast cancer. A thorough evaluation by a healthcare provider is essential to determine the underlying cause and guide appropriate treatment. Early diagnosis and management are crucial, especially if malignancy is suspected.