Causes of Gynecomastia

Potential pathologic causes of gynecomastia are: medications including hormones, increased serum estrogen, decreased testosterone production, androgen receptor defects, chronic kidney disease, chronic liver disease, HIV, and other chronic illness.

Gynecomastia as a result of spinal cord injury and refeeding after starvation has been reported.

In 25% of cases, the cause of the gynecomastia is not known.

Medications cause 10-20% of cases of gynecomastia in post-adolescent adults. These include cimetidine, omeprazole, spironolactone, finasteride and certain antipsychotics. Some act directly on the breast tissue, while others lead to increased secretion of prolactin from the pituitary by blocking the actions of dopamine (prolactin-inhibiting factor/PIF) on the lactotrope cell groups in the anterior pituitary.

 

Androstenedione, used as a performance enhancing food supplement, can lead to breast enlargement by excess estrogen activity. Medications used in the treatment of prostate cancer, such as antiandrogens and GnRH analogs can also cause gynecomastia.

Marijuana use is also thought by some to be a possible cause, but this is controversial.
 

Increased estrogen levels can also occur in certain testicular tumors, and in hyperthyroidism. Certain adrenal tumors cause elevated levels of androstenedione which is converted by the enzyme aromatase into estrone, a form of estrogen. Other tumors that secrete hCG can increase estrogen. A decrease in estrogen clearance can occur in liver disease, and this may be the mechanism of gynecomastia in liver cirrhosis.

Obesity tends to increase estrogen levels.

 

Decreased testosterone production can occur in congenital or acquired testicular failure, for example in genetic disorders such as Klinefelter Syndrome. Diseases of the hypothalamus or pituitary can also lead to low testosterone.

Abuse of anabolic steroids has a similar effect.

Although stopping these medications can lead to regression of the gynecomastia, surgery is sometimes necessary to eliminate the condition.
 

Diagnosis

The condition usually can be diagnosed by examination by a physician. Occasionally, imaging by X-rays or ultrasound is needed to confirm the diagnosis.

Blood tests are required to see if there is any underlying disease causing the gynecomastia.

Prognosis

Gynecomastia is not physically harmful, but in some cases can be an indicator of other more dangerous underlying conditions.

The enlarged breast tissue is often tender or painful.

Furthermore, it can frequently present social and psychological difficulties for the sufferer.

Weight loss can alter the condition in cases where it is triggered by obesity, but for many it will not eliminate it as the breast tissue remains.

 Treatment

Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Patients should stop taking medications which can cause gynecomastia.

Selective estrogen receptor modulator medications, such as tamoxifen and clomiphene, or androgens can be used. Aromatase inhibitors such as Letrozole are another treatment option, although they are not universally approved for the treatment of gynecomastia.

Endocrinological attention may help during the first 2-3 years.

After that window, however, the breast tissue tends to remain and harden, leaving surgery (either liposuction or reduction mammoplasty) the only treatment option.

 

Most American insurance companies will deny surgery for gynecomastia on the grounds that it is a cosmetic procedure. Radiation therapy is sometimes used to prevent gynecomastia in patients with prostate cancer prior to estrogen therapy.

Living With it

Men who do choose to live with having breasts will in many cases choose to wear a bra. It is becoming more and more common for a man to wear a bra also. A man will wear a bra because they may feel they have to because of their breasts, to get support, to relieve back pain, to hide nipples from poking out, or because they may like it. Some men will go to great limits to achieve a bra so that they don't need to be publically humiliated because of buying one.

They may order one online, but will most likely take one from a wife, financee, mother, sister, or girlfriend because of easy accessibility. Men may also choose to just live with their breasts, without a bra or constraint vest.