Gynecomastia - Causes

What are the Causes of Gynecomastia?

Breast tissue naturally grows in all adolescent boys during normal development. It presents as a tender mass beneath the areola (the colored area that surrounds the nipple) that is one to five centimeters in diameter. Frequently adolescents complain of pain in their breasts, particularly when they are wearing binding clothing. One estimate is that as many as 65 percent of teenage boys experience enlarged breast tissue or Gynecomastia. For the fortunate majority of these males, this condition resolves in a matter of months, or with the end of adolescence. For a significant portion, however – an estimated 10 to 15 percent – the symptoms remain throughout life.

Unlike pubertal Gynecomastia, adult-onset Gynecomastia has a range of causes. The potential causes of Gynecomastia in adults include medications, steroids, herbal or growth supplements, natural or synthetic estrogen hormones, marijuana, alcohol abuse, and chronic liver or renal failure. There are also some tumors that secrete female hormones which stimulate breast gland growth. Therefore it is important that newly recognized adult Gynecomastia be investigated by a physician (i.e. endocrinologist) in order to rule out possible serious underlying causes.

Another cause of Gynecomastia which has recently become more prevalent is Obesity. Fat cells, especially in large numbers, convert the male hormone testosterone into female hormone estrogen, which stimulates breast growth.

There is also a syndrome known as "re-feeding Gynecomastia." This was first noted following World War II, when men liberated from prison camps developed Gynecomastia within a few weeks of resuming an adequate diet. The symptoms last between one and two years, and then resolve without treatment. This appears to be similar to the Gynecomastia that resolves spontaneously during puberty.

Another type of Gynecomastia is associated with Dialysis – treatment for renal failure. Studies show that Dialysis-associated Gynecomastia also improves spontaneously in one to two years.

Adult onset Gynecomastia is usually irreversible unless corrected through a variety of surgical treatments such as Male Breast Reduction, Mastectomy, and/or Liposuction.

How Do Natural Changes During Puberty Lead to Gynecomastia?

Often, Gynecomastia is caused by hormonal changes during puberty. Glands such as the thyroid gland and the testes direct hormonal variations throughout the body. An alteration in the intricate balance between the female hormone, estrogen, and the male hormone, testosterone, during teens can cause Pubertal Gynecomastia. An estimated 40-60 percent of adolescent boys are affected by this -- usually by the age of 14.

"A few months ago, I noticed that I was growing breasts, and I was mortified. I wanted to do anything to get rid of them – even take a knife to myself. I don’t even want to go to summer camp, or be anywhere in public, until I get rid of these." — Jeremy, age 14

Generally, this overgrowth of breast tissue in adolescent boys subsides without treatment within two years in 75 percent of boys, and within three years in 90 percent of them. Only 10 to15 percent of adolescents keep their breasts into adulthood.
Not all breast growth in males is considered abnormal. An experienced cosmetic surgeon can determine what is "excessive."

What Causes Adult-Onset or Non-Pubertal Gynecomastia?

Gynecomastia that does not begin during puberty and first develops during adulthood can be caused by a variety of things including:

Anabolic steroid abuse, use of estrogen medications in men who want to develop female features, Chronic Liver Disease including that caused by alcohol abuse, a large variety of medications such as Digitalis and other heart medications, Anti-anxiety and Antidepressant medications, Chemotherapy drugs, Marijuana Use, some diet or "Health supplements", Obesity, Aging, Tumors, Genetic Disorders such as Klinefelter and Gilbert's Syndrome.

Drug-induced Gynecomastia accounts for about one quarter of the cases. In another 25 percent of cases, there is no identifiable cause.

Steroid Abuse-
We've all heard the denials of illegal steroid use by top athletes. Yet, according to the National Institute of Drug Abuse (NIDA), improving sports performance is one of the main reasons that people abuse anabolic steroids- anadrol, oxandrin, dianabol, winstrol, decadurabolin and equipoise. One study cited by the NIDA showed that more than one half of male bodybuilders had Gynecomastia. It is ironic that the same bodybuilders, who abuse steroids in order to develop more masculine features, can instead develop feminine breasts.

Steroid Hormone Supplements in Men-
Steroids such as estrogen are prescribed legally for certain kinds of anemia and for men who are suffering the side effects of very high levels of testosterone. Unfortunately, one of the side effects of hormonal steroid use is the disruption of male hormone production. In men, this disruption occurs when the enzyme aromatase breaks testosterone down into estrogen, a female hormone. The estrogen then stimulates "estrogen receptors" through the man's body, such as the nipples of the breast. This is why men with Gynecomastia are often described as having "Bitch Tits." Some of these side effects are reversible, as in the case of reduced sperm production and the shrinking of testicles. However, one of the irreversible side effects is Gynecomastia.

Medications-
Many medications including some of the following carry a potential side effect for the development of Gynecomastia: Adalat, AdalatXL, Amitriptyline, Anafranil, Carbamazepine, Chlorpromazine, Cimetidine (Tagament), Clonazepam, Elavil, Fluphenazine Decanoate, Humegon, Nutropin, Prostate Cancer Drugs, Protriptyline, Protropin, Spironolactone, Thiothixene, ZANTAC, Zoloft.

Chronic Liver Disease- Cirrhosis-
The human liver plays a central role in the breakdown and metabolism of toxins such as alcohol, as well ask in the production of many of the body's essential proteins used in the synthesis of a variety important hormones. Prolonged damage to the liver tissue referred to as Chronic Liver Disease leads to the irreversible destruction of the liver tissue- Cirrhosis. Although Alcohol is the most common cause of chronic liver disease or cirrhosis, there are also other congenital or infectious causes of liver damage. A severely damaged liver can no longer produce the necessary hormones in males, which can lead to a relative excess of body estrogen levels, thus resulting in the development of Gynecomastia.

Obesity-
Fat cells, especially when in large numbers, convert the male hormone testosterone into female hormone estrogen, which stimulates breast growth.

Aging-
Men after the age of sixty can experience a reduction in body Testosterone levels, leading to the development of excess breast tissue, testicular atrophy, and loss of libido.

Congenital and Genetic Disorders-
Klinefelter Syndrome is a genetic disorder that occurs at conception in males only. These males have two copies of the X chromosome instead of the normal single X chromosome that comes from one or both parents. Symptoms of this syndrome include the abnormal enlargement of one or both breasts in men, hard, tiny testicles that never grow, infertility, an incomplete masculine body build, and, at times, a lack of coordination and ability at athletics. These symptoms are due to the syndrome's impairment of testosterone production that assists in the development of male characteristics, such as facial hair, muscle development, deepening of the voice and the lengthening of the penis.

Other symptoms may include speech and language problems, shyness, hand tremors, difficulties in concentrating, dyslexia, and an arm span that is usually two inches longer than the male's height, decreased libido, female body hair distribution and infertility. However, its most common symptom is Gynecomastia.

Gilbert's Syndrome is a congenital liver disorder, believed to be hereditary, that is found more frequently in males. Characterized by a mild, fluctuating increase in serum bilirubin, a yellow pigment excreted by the liver into bile, it occurs in approximately three to seven percent of the adult population. However, the onset of Gilbert's Syndrome usually occurs in adolescence or early adulthood. While it is considered a relatively benign condition, one of its side effects can be Gynecomastia.

Dr. Younai is a Board Certified Cosmetic Plastic Surgeon who is experienced in the Diagnosis and treatment of Gynecomastia, including Male Breast Reduction and Liposuction. During your consultation he will discuss all details including: if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative instructions, and recovery course, as well as what to expect after surgery. At that time Dr. Younai will also show you before-and-after pictures of other patients who might be similar to you with Gynecomastia and have had Male Breast Reduction.

Dr. Younai serves patients from both southern and northern California, including those from Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Calabasas, Woodland Hills, Thousand Oaks, Westlake, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.

Gynecomastia - Definition
Gynecomastia - Causes
Male Breast Reduction
Surgeon Qualifications
Preparation for Gynecomastia
Gynecomastia - Recovery
Risks & Complications

View Before & After
Gynecomastia Photos