Nipple discharge in men, medically referred to as galactorrhea when milky, is the unexpected release of fluid from the breast duct system. While this symptom is far more common in women, its appearance in a man causes significant concern. Male breast tissue contains the same basic structures, including milk ducts, which can be affected by hormonal changes or localized issues. Although many causes are benign, the presence of any discharge warrants medical attention to accurately determine the source.
Characteristics of the Discharge
Observing the nature of the discharge provides medical professionals with crucial information about the underlying cause. Discharge varies significantly in color, consistency, and whether it affects one or both sides. Milky, white, or greenish discharge appearing from multiple ducts in both nipples often suggests a systemic or hormonal issue. In contrast, spontaneous discharge—leaking without being squeezed—or discharge limited to a single duct in one nipple is generally considered more significant. Clear, watery, or bloody discharge from one side raises higher concern for a localized duct issue. Discharge that only appears when squeezed is often related to benign causes like manipulation or hormonal fluctuations. The consistency ranges from thin and watery to thick and sticky. For instance, thick, sticky, multicolored discharge is sometimes associated with a benign condition called duct ectasia.
Common Benign Causes
The most frequent reasons for male nipple discharge are non-cancerous and typically involve disruptions to the body’s endocrine system. Elevated levels of the hormone prolactin, which stimulates milk production, lead to a condition known as hyperprolactinemia. This hormonal imbalance often results in a milky discharge from both nipples. Certain medications are a common external factor that can trigger hyperprolactinemia and subsequent discharge. These compounds interfere with the brain’s regulation of prolactin release.
These medications include:
- Antipsychotics
- Some antidepressants
- Certain blood pressure medications
- Opioids
Physical manipulation or minor trauma to the chest area can also induce discharge. Excessive squeezing, friction from tight clothing, or repeated stimulation may cause a temporary, benign discharge. The presence of gynecomastia, the enlargement of male breast tissue, may also be associated with minor discharge.
Serious Underlying Conditions
While less common than benign causes, several concerning conditions can manifest as nipple discharge, usually involving a localized problem within the breast duct. Persistent, spontaneous, or bloody discharge often indicates a pathological process requiring thorough investigation.
A key systemic concern is a prolactinoma, a non-cancerous growth on the pituitary gland that produces excessive prolactin. This tumor causes hyperprolactinemia, often leading to bilateral milky discharge, sometimes accompanied by headaches or vision changes.
Localized issues within the breast ducts include duct ectasia (inflammation and blockage of the ducts) or intraductal papilloma (a small, non-cancerous growth inside a milk duct). Both can cause discharge, sometimes bloody, and are typically confined to one breast. Male breast cancer, while rare, is a possibility, as nipple discharge is a presentation in a significant portion of cases. The discharge associated with cancer is most often clear, watery, or bloody, originates from a single duct in one breast, and is frequently accompanied by a palpable lump or skin changes.
Seeking Medical Evaluation
Because nipple discharge in men can be the only sign of a serious underlying condition, any occurrence requires a prompt medical evaluation. The most concerning signs, often referred to as red flags, include discharge that is clear or bloody, occurs spontaneously without squeezing, or is associated with a new lump, skin dimpling, or nipple inversion.
Diagnostic Process
During the initial consultation, the physician gathers a detailed history of the discharge, including the characteristics noted by the patient, such as color, frequency, and whether it is unilateral or bilateral. This information directly guides the diagnostic process. Diagnostic procedures typically begin with blood work to measure hormone levels, particularly prolactin, to check for systemic causes like hyperprolactinemia.
Imaging tests are then performed, with a diagnostic mammogram and a breast ultrasound being standard procedures to visualize the breast tissue and ducts. In cases where a single duct is the source of the discharge, a sample of the fluid may be collected and sent for cytology to check for abnormal cells. Treatment is entirely dependent on the final diagnosis, ranging from simple monitoring to medication adjustments or surgical intervention for localized lesions.