Causes of Gynecomastia 2019

Gynecomastia is caused due to an imbalance in hormones in boys or men. As boys grow through puberty, hormonal imbalance causes gynecomastia. Same is the case with older men; hormonal imbalance can cause swelling in breast tissue around the nipple. This swelling makes the tissue look like, female breast.

Breast tissue around the nipple are not painful but sometimes can be painful. Gynecomastia is not a serious issue, but research in past indicated that gynecomastia might be linked to men breast cancer, but it was not evident. Sometimes this hormonal imbalance corrects itself or with some hormonal therapy.

Treatment for gynecomastia is necessary because enlarged male breast can lead to social embarrassment and can lead to a psychological problem. If the swelling does not go away with time, surgical intervention is required to correct the shape and size of breast tissue.

Gynecomastia surgery is considered a cosmetic procedure and performed by a qualified plastic surgeon.

Causes of Gynecomastia

Man and women are both born with mammary glands, androgens in man do not inhibit mammary gland growth while estrogens in female strongly inhibit mammary gland growth, This is the reason behind females having big breasts.

Imbalance in androgens and estrogens in male causes mammary gland growth and results in male breasts. Imbalance in hormones can affect both breasts evenly or unevenly.

Sex-Hormone-Binding-Globulin (SHBG): estrogens bind less with the SHBG compared to testosterone. Estrogen is a female hormone and testosterone is a male hormone.

Hyperthyroidism and chronic liver diseases: Due to these conditions, Level of SHBG increases and so as the level of free estrogens compared to the level of testosterone.

Medication or Drugs: Many medications and drugs manipulate the level of SHBG, causing an increased level of SHBG, and thus increasing the level of estrogens in the body causing gynecomastia. Some drugs are anti-androgens and hence reduce the level of testosterone and some increases the level of estrogens without manipulating SHBG causing gynecomastia.

Anti-Androgens: Medication used to treat prostate enlargement or prostate cancer are also one of the causes of gynecomastia.

Increasing the level of estrogens and taking anti-androgens to reduce androgens is a successful method in male to female hormonal therapy to increase the breast size before male to female sex change surgery

Steroids and Protein Powders: Very often gym trainers and bodybuilders use steroids and protein powder to enhance the body structure and strength, These steroids increase the mass bulk but suppress the production of testosterone. Moreover, excess testosterone is converted into oestradiol, and increased level of estrogens may cause gynecomastia.

Some common drugs which causing gynecomastia condition are:

Hormones: Aromatizable androgens, hCG, Estrogens, Human growth hormone, Anabolic steroids, GnRH agonists/antagonists
Anti-androgens: Flutamide, bicalcutamide, Finasteride, dutasteride, Spironolactone
Antibiotics: Isoniazid, Ketoconazole, Metronidazole
Anti-ulcer medications: Cimetidine, rantidine, Proton pump inhibitors
Chemotherapeutic medications: Alkylating agents, Methotrexate, Vinca alkaloids
Cardiovascular medications: Digitoxin, Verapamil, diltiazem, nifedipine, Amiodarone, Captopril, enalapril
Psychoactive medications: Diazepam, Antipsychotics, Antidepressants
Drugs of abuse: Marijuana, Alcohol, Amphetamines, Heroin, methadone
Others: Metoclopramide, Phenytoin, HIV medications (protease inhibitors), Statins, Theophylline

It is not necessary that only allopathic medicine is responsible for causing gynecomastia, In the evaluation phase, we have to rule out any use of homoeopathic or herbal medicine manipulating free estrogens and hence causing an imbalance in the hormonal levels.

Medication is not the only culprit for gynecomastia; Some medical conditions are also responsible for the gynecomastia condition. Some common medical conditions are stated below:

Klinefelter’s syndrome: One of the main reason behind the enlarged male breast is this syndrome, In K’s syndrome there is a combination of XXY chromosomes in males, which results in small testicles and infertility, low level of testosterone. It is always necessary to have a proper diagnosis done before the treatment of the syndrome.

Aging: Hormones level do changes with time and ageing is also one of the common factor leading to gynecomastia, In most of the cases, enlarged breast settles down, and hormonal level comes to level, However, if nothing happens with time, medical intervention is necessary either in the form of Gynecomastia Surgery or medicines.

Tumours, Hyperthyroidism, Kidney Failure, Liver Failure, Malnutrition are among the common causes of gynecomastia.

Alcohol and ill-Legal Street Drugs: Alcohol, Marijuana, Heroin, Methadone are some common drugs associated with an enlarged breast condition. It is better to avoid the consumption of street drugs and keep the intake of alcohol minimum.

Before Treating proper diagnosis is necessary and the patient should be open to the surgeon or doctor about lifestyle habits or any medical condition, medication or drugs habit.

Consult Dr Kaushik about Gynecomastia Surgery in Delhi through the contact form on the site.

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MayoClinic Org
https://www.mayoclinic.org/diseases-conditions/gynecomastia/symptoms-causes/syc-20351793

Martin, S. J., Sherley, M., & McLeod, M. (2018). Adverse effects of sports supplements in men. Australian prescriber, 41(1), 10-13.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828928/

Fnu Deepinder & Glenn D Braunstein (2011) Gynecomastia: incidence, causes and treatment, Expert Review of Endocrinology & Metabolism, 6:5, 723-730, DOI: 10.1586/eem.11.57