Why Do I Have Gynecomastia?

Article Links:

1. What is Gynecomastia?
2. Types of Gynecomastia
3. Surgical Treatment for Gynecomastia

Some enlargement of male breast tissue commonly occurs during puberty, and the incidence of noticeable (transient) pubertal breast enlargement has been reported to be as high as 60 percent. For most males this hormone-related breast enlargement is temporary, but for a few individuals the breast tissue will persist and, in some cases, proliferation of breast tissue will continue.

For the majority of men with gynecomastia, no clear cause can be identified. It is thought that some cases of gynecomastia may relate to an imbalance between circulating levels of estrogens, which stimulate breast tissue development, and androgens, including testosterone, which counteract estrogen effects. Because this phenomenon may be associated with endocrine (hormone) disorders, testicular tumors and the use of some medications/drugs, it is important that you discuss the condition with your primary care physician prior to considering surgery. Testosterone deficiency (TD) is actually quite common, and it is now well understood that testosterone levels tend to decrease significantly in most men at or around the age of 50 (sometimes called ‘andropause’ or ‘male menopause’). I have had a number of patients begin testosterone replacement therapy (TRT), under the direction of their primary care physician, either prior to or following their consultation appointment for gynecomastia. While TRT can improve energy level, mood and libido in patients with TD, it unfortunately does not appear to reverse or improve gynecomastia.

Male breast enlargement can occur as a result of significant weight gain, in the absence of actual breast tissue proliferation. This is sometimes referred to as ‘pseudogynecomastia,’ which implies that the breast has enlarged due to the accumulation of fatty tissue only.  While I certainly agree that male breast enlargement, in some cases, is primarily due to relative obesity/excess body mass, it has been my observation that many patients who appear to have ‘pseudogynecomastia’ turn out to have a significant proliferation of fibrous breast tissue. This is not surprising, I think, considering that it has been shown that the condition of being overweight can upset the balance of estrogens and androgens in favor of estrogens (sometimes called a ‘pro-estrogenic state’), which is a setup for the development of true gynecomastia.

Male breast enlargement associated with excess body mass/obesity may improve with weight loss. In many men, however, the feminized appearance of the breast will persist due to underlying true gynecomastia, incomplete regression of breast area fat, persistent skin excess after weight loss or a unique combination of these three factors.

Recently I have evaluated and treated a number of male patients who developed gynecomastia after using ‘prohormone’ and anabolic steroid supplements as part of a bodybuilding regimen or to improve their performance for athletic competition. While the goal of using these products is to increase muscle mass, strength and athletic performance, some of these agents and supplements can be converted by the body into estrogen-like compounds. Additionally, supplemental androgens may suppress the production of natural androgens by the testes. These factors can tip the balance of androgens and estrogens in favor of the estrogens, which then stimulates the proliferation of breast tissue and results in visible breast enlargement. This form of breast enlargement generally persists even after the use of supplements is discontinued, requiring surgical intervention.