For many men, gynecomastia is more than a physical change. It may influence confidence, clothing choices, participation in sport or swimming, and day to day activities. Understanding what causes gynecomastia is the first step towards determining the most appropriate approach.
Hormonal Imbalance is the Key Underlying Factor
The most common underlying factor in gynecomastia is a change in the balance between testosterone and estrogen, whether due to natural life stages, medications, systemic illness or other causes. Although testosterone is considered the primary male sex hormone and estrogen the primary female hormone, both are naturally present in men.
When testosterone levels decrease relative to estrogen, breast gland tissue can begin to enlarge. This hormonal imbalance may occur naturally during different stages of life or develop as a result of medications, lifestyle factors or certain medical conditions.
Hormonal Changes During Different Life Stages
Puberty
Puberty is the most common time for gynecomastia to develop. As hormone levels rapidly fluctuate during adolescence, many boys experience temporary breast enlargement. In most cases, this resolves without treatment as hormone levels stabilise over months to a few years.
Ageing
As men grow older, testosterone production naturally declines. At the same time, body fat often increases, which can contribute to higher estrogen levels. These age-related hormonal changes make gynecomastia more common in older men.
Medications and Substance Use
Classes of medications and substances that may contribute include:
- Certain anti‑androgen medicines used to treat prostate conditions
- Some medicines prescribed for heart disease, including certain calcium‑channel blockers and other agent
- Some psychotropic medicines (such as particular anti‑anxiety medicines and tricyclic antidepressants)
- Selected antibiotics and other prescribed medicines
- Anabolic steroids and androgenic supplements
- Excessive alcohol use
- Recreational drugs including marijuana and heroin
Not everyone who uses these substances will develop gynecomastia, and the risk varies with dose, duration and individual factors.
Medical Conditions that may cause Gynecomastia
Although gynecomastia itself is often benign, it can occasionally be associated with an underlying medical condition that affects hormone production or metabolism. Conditions that may contribute include:
Hypogonadism
Conditions that reduce or impair testosterone production, including Klinefelter syndrome and other forms of hypogonadism, may lead to enlargement of breast gland tissue.
Liver or Kidney Disease
The liver and kidneys play an important role in processing hormones. Chronic liver disease or kidney failure can disrupt normal hormone balance and contribute to gynecomastia.
Thyroid Disorders
An overactive thyroid (hyperthyroidism) can alter hormone metabolism and increase the likelihood of gynecomastia developing.
Tumours
Although rare, tumours involving the testes, adrenal glands or pituitary gland can affect hormone production and may be investigated where clinically appropriate.
Obesity
Obesity is one of the most significant contributing factors. Fat tissue contains enzymes that convert testosterone into estrogen, meaning higher body fat levels can increase circulating estrogen. Excess weight can also cause fat accumulation within the chest, sometimes leading to a condition known as pseudogynecomastia, where enlargement is due primarily to fatty tissue rather than enlarged breast glands. In some men, both true gynecomastia and excess fatty tissue occur together.
When Should You Seek Medical Advice?
Because gynecomastia can have several different causes, a thorough medical assessment is important before considering treatment.
A doctor may recommend investigating hormone levels, reviewing current medications, assessing lifestyle factors, or arranging additional testing where clinically appropriate to identify any underlying condition.
In many cases, particularly during puberty, it improves without intervention. Others may respond to treatment of the underlying medical cause.
However, when gynecomastia has persisted for an extended period, causes physical discomfort or psychological distress, or is unlikely to resolve naturally, surgical treatment may be considered.
Can Male Breast Reduction Surgery Treat Gynecomastia?
For men with persistent gynecomastia, male breast reduction surgery may be one of the treatment options considered for persistent gynecomastia after appropriate assessment.
The procedure is designed to reduce excess breast tissue and may help create a flatter, more typically masculine chest contour, although results vary between individuals. Depending on the individual, surgery may involve removing enlarged glandular tissue, excess fat, or a combination of both.
The surgical technique is tailored to each patient's anatomy and the underlying cause of the breast enlargement. As with any operation, male breast reduction surgery carries risks such as bleeding, infection, changes in nipple or breast sensation, contour irregularity, scarring and anaesthetic complications. These will be discussed in detail during a consultation so that you can weigh potential benefits against the risks for your situation.
Where glandular tissue is the primary contributor, direct surgical excision may be required. Where excess fatty tissue is also present, liposuction may be used alongside gland removal to improve the overall chest contour.
Every patient's circumstances are different, and the most appropriate surgical approach can only be determined following a comprehensive consultation and examination.
Understanding the Cause is the First Step
While hormonal imbalance remains the leading cause of gynecomastia, there is rarely a single explanation that applies to every individual. Age, medications, body weight, lifestyle factors and underlying medical conditions can all play a role.
If enlarged breast tissue has persisted, is causing discomfort or affecting your confidence, seeking an assessment is the best place to begin. Identifying the underlying cause helps determine the most appropriate treatment, and for some men, male breast reduction surgery can offer longer‑term improvement when other approaches are unlikely to be effective, but outcomes and suitability depend on individual circumstances.
If you would like to learn more about the assessment and treatment of gynecomastia, Dr Alexandra Turner can discuss your concerns and whether male breast reduction surgery may be appropriate for your individual circumstances.
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