The primary cause of gynecomastia is an imbalance of hormones. Although many people don’t realize it, men produce estrogen just like women do. In general, the potential feminizing effects of their estrogen is counter-balanced by their dominant sex hormone, testosterone. Under various conditions, where there is either an excess of estrogen or too low of a level of testosterone, enlargement of the breasts can occur.
This happens most commonly around time of puberty when hormones are in a state of flux. Some reports state that up to 60% of teenage males develop some breast enlargement; some more than others. In many of these cases, the growth is relatively small and not very noticeable. In some, however, it can be significant enough to cause embarrassment and limit social activities such as swimming without a shirt on. In the majority of these cases, as hormones go back to normal levels, the excess breast tissue recedes to normal. This can take a couple of years.
There are a variety of medications for the treatment of high blood pressure, certain heart conditions, kidney disorders, antibiotics and drugs to treat HIV as well as steroids that can contribute to the development of gynecomastia. Some of the more common drugs include spironolactone, digitalis, nifedipine, captopril, ketoconazole, metronidazole, ranitidine, cimetidine, omeprazole and diazepam. There are many others as well. If you are concerned that a medication that you are taking could be causing excess breast tissue growth, look up its side effects but consult your physician before stopping any medication that has been prescribed for you.
Common abuse drugs such as alcohol, heroin and marijuana have also been implicated in the enlargement of male breasts. Prolonged excess alcohol abuse can result in cirrhosis of the liver, which interrupts the metabolism of hormones causing an imbalance, which can also contribute to the condition. Less common causes include diseases of the male sex organs including cancer and certain chromosomal abnormalities.
Males that are overweight have a much higher incidence of gynecomastia compared to those who of normal weight. Teenagers that are significantly heavier than their ideal body weight not only are at greater risk for pubescent breast enlargement, their chance of it resolving on its own is considerably smaller. Obese men with gynecomastia typically require more than just liposuction or a small removal of breast tissue to treat their condition. These patients generally have excess skin and sagging of the breasts as well, which requires skin removal in addition to repositioning of the nipple and areola to resolve the issue and create a smooth contour to the chest. Unfortunately, this also results in more scarring than when it is treated with liposuction alone.
In many cases, there is no identifiable reason for the development of excess breast tissue and in these cases, it is called idiopathic; meaning that there is no known cause. If the cause can be identified, removing the source such as alcohol or marijuana can result regression of gynecomastia in many cases, which may allow the patient to avoid surgery.