Causes of Gynecomastia in Men

Gynecomastia is the swelling of the breast tissues, either one or both sides, in boys or men triggered by hormonal imbalance. In this article, we delve deeper into the most common gynecomastia causes, how it’s diagnosed and treated, and when a gynecomastia surgery is necessary. 

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Most Common Gynecomastia Causes

Testosterone and estrogen are important sex hormones that control many critical functions in the body. Testosterone, the male hormone, plays a huge role in regulating libido or the sexual drive, muscle mass and bone mass distribution, and sperm production. Estrogen, on the other hand, stimulates breast tissue growth. 

Contrary to popular belief, both men and women have these two sex hormones in the body. Men also produce estrogen but only in minimal quantities. However, when a man has significantly high estrogen levels that are out of balance with the testosterone levels present, there’s a possibility that he’ll develop gynecomastia and even erectile dysfunction. 

Several contributing factors can make this happen, either by blocking the effects of testosterone, reducing the amount of testosterone, or boosting estrogen levels in the male body. Below are some conditions that can wreak havoc on the body’s natural hormone balance, which can potentially be considered gynecomastia causes.

Natural Hormonal Changes 

It’s natural for hormones to fluctuate as the body goes through significant changes. Let’s take a look at possible hormonal causes of gynecomastia at the different stages of a person’s life:

• Gynecomastia in Newborn Babies: Over half of baby boys born have noticeably enlarged breasts because they still have the effects of their mother’s estrogen from inside the womb. It’s nothing to worry about, though, because it goes away on its own, usually within two to three weeks postpartum.
• Gynecomastia in Adolescent Boys: In their teenage years, boys will hit another growing up milestone called puberty, which calls for another round of natural hormonal changes. While it can be a cause of major embarrassment among peers, gynecomastia during puberty will resolve on its own without any treatment necessary. It’s temporary and will last anywhere from six months up to two years.
• Gynecomastia in Grownup Men: The condition can also develop well into adulthood. Studies show that at least 1 in 4 men between the ages of 50 and 69 can experience swelling and tenderness of the breasts. However, unlike during infancy and puberty, more triggers have to be checked to rule out the specific gynecomastia causes. This time, it may not dissipate without treatment, and if the person wants to do something about it, gynecomastia surgery may be necessary.

Long-Term Prescription Drug Usage 

Taking certain medications for a long time can cause many side effects that can affect the body’s hormones. Some known prescription drugs that have been linked to gynecomastia include the following:

• Anti-androgens: Anti-androgens are generally used for the treatment of prostate cancer and managing enlarged prostate. They work by blocking androgens, such as testosterone, to slow down the spread of cancer cells or shrink existing tumours. Examples of anti-androgen medications are flutamide, finasteride (Proscar, Propecia) and spironolactone (Aldactone, Carospir).
• Anabolic steroids: Anabolic steroids are synthetic hormones that resemble testosterone. Doctors prescribe them to people suffering from a kind of anemia or testosterone deficiency. They are never prescribed to young, healthy men. Unfortunately, anabolic steroids are abused and taken as performance-enhancing drugs by male athletes to cheat their way into boost strength and weightlifters who want to bulk up fast.
• AIDS medications: HIV-positive men have a higher risk of developing gynecomastia if they receive highly active antiretroviral therapy (Indinavir) to manage the symptoms of their condition. Compared to other AIDS medications, Efavirenz (Sustiva) is more commonly linked to gynecomastia causes.

According to Stanford Healthcare, gynecomastia can also be caused by common medications, such as:

• Steroids, such as prednisone or dexamethasone
• Medicines used to treat ulcers, such as cimetidine (Tagamet HB)
• Medicines are used to treat epilepsy, such as (Dilantin).
• Digitalis used to treat congestive heart failure
• Heart medications, such as digoxin (Lanoxin), calcium channel blockers (verapamil, nifedipine, diltiazem), and ACE Inhibitors (captopril, enalapril)
• Chemotherapy drugs, such as alkylating agents, methotrexate, Vinca alkaloids, and Imatinib
• Antianxiety drugs, such as diazepam (Valium)  
• Tricyclic antidepressant drugs 

Alcoholism and Substance Abuse 

Gynecomastia is also prevalent ire heavy alcohol drinkers who abuse highly addictive recreational drugs, such as amphetamines, heroin, methadone, and marijuana.

Underlying Health Issues 

Many health conditions can also interfere with the body’s natural hormone balance. Illnesses that have been implicated with gynecomastia in men include:

• Thyroid problems, such as hyperthyroidism and hypothyroidism
• Hypogonadism causes testosterone insufficiency in men
• Obesity increases estrogen levels and accumulates excess fat that makes the breasts appear bigger
• Tumours that develop around the testes, adrenal glands, or pituitary gland can cause hormonal imbalance
• Kidney failure, liver failure, and cirrhosis are identified as gynecomastia causes because of their influence in hormones and the prescription drugs taken to manage these conditions.

Symptoms and Diagnosis of Gynecomastia

The typical signs of gynecomastia are swelling and tenderness of one or both breasts. The condition is diagnosed through a physical exam and medical history evaluation. Often, further medical tests are no longer required. However, if the lump is incredibly large, hard, painful when touched, or there’s a discharge coming out, your doctor may request a biopsy to rule out male breast cancer and other serious illnesses. This is especially crucial if your medical history reveals that you’ve had anyone in the family with breast cancer. 

In addition, your doctor will most likely refer you to an endocrinologist to understand how your hormones are affecting your body. If gynecomastia causes are underlying medical conditions, you will be advised to seek a specific specialist who will address it accordingly. 

How Is Gynecomastia Treated?

Generally, gynecomastia is harmless on its own. The majority of cases improve in time without treatment. However, this isn’t always the case, especially in adult men. If you are bothered by gynecomastia, your doctor may prescribe some form of medication to resolve the hormonal imbalance that’s causing the breast enlargement. Gynecomastia surgery is another viable treatment option.

Gynecomastia Surgery

Gynecomastia surgery is also known as male breast reduction or mammoplasty. It is performed to reduce the breast size, flatten, and improve the chest contours in the chest area. Liposuction is typically conducted to get rid of the fat tissues surrounding the breasts. This cosmetic surgical procedure involves inserting a small tube through a 3 to 4-millimetre-sized incision, which will literally suck out the fat deposits.  

In extreme cases, the breast tissue’s excess weight can cause sagging and stretching of the areola in the nipple area. Excision may be done when there’s too much tissue and skin to be removed. Your surgeon can surgically reposition and resize the areola to enhance its appearance and remove excess granular tissue. There are also some cases when both liposuction and excision is done.

Gynecomastia surgery is an outpatient surgical procedure. It can be done under oral sedation and local anesthesia or general anesthesia. To guarantee the success of your gynecomastia surgery, seek only a qualified plastic surgeon with years of professional medical experience.

Recovery After Gynecomastia Surgery

Patients who go through gynecomastia surgery may almost have a similar experience to those who have female to male or FTM top surgery. 

• First 24 to 48 Hours: This is the most crucial period since you will still feel sore all from the operation, but the anesthesia is already starting to wear off. Your movement will be extremely limited. It’s best if you arrange for a loved one or a professional caregiver to stay with you during this time.
• Medical Drains: If excision were done to remove your gynecomastia, you would most likely be sent home with medical drains attached to the incisions to collect fluid, blood, or pus. They’re going to promote faster wound healing and prevent air from getting into the chest area, which can potentially add volume. You’ll have to wear drains for several days up to a week until your follow-up appointment with your surgeon. 
• Compression Vest: You will be required to wear a compression vest to help manage the pain, swelling, and bruising in your chest area. 

Healing may take six weeks or longer, depending on your personal circumstances and the natural recovery process. There are minimal complications from gynecomastia surgery, but there’s a risk of uneven contouring, visible scarring, inverted nipple, or loss of nipple sensation. All of which can be avoided if you’ll work with a qualified surgeon with remarkable expertise and experience. 

Dr. Hugh McLean is a notable plastic surgeon in Mississauga, specializing in breast reduction and chest masculinization surgery like gynecomastia surgery in men. Experience the highest quality treatment in the comfort and privacy of our clinic. 

For more information on gynecomastia surgery and book a free appointment with Dr. McLean, contact McLean Clinic today!