Many men who come to my clinic for gynecomastia feel confused or even embarrassed, wondering, “Why did this happen to me?” It’s a question I hear every day.
I want to be very clear: gynecomastia is a medical condition, not a personal failing. It is almost always caused by factors outside of your control, like hormones, medications, or genetics. Understanding the root cause is the first step toward finding the right, permanent solution.
When seeking treatment for gynecomastia, understanding the root cause is the first step toward effective and permanent correction. Male breast enlargement is almost always traceable to fundamental shifts in the body’s chemical messengers.
The Core Mechanism: Hormone Imbalance Drives Glandular Growth
The underlying mechanism of true gynecomastia is a hormonal disparity. The condition is caused by an altered ratio of estrogens to androgens. Estrogens stimulate the proliferation
This imbalance can be an absolute deficiency of androgens, an absolute estrogen excess, or a relative deficiency/excess where both hormone levels are normal but the ratio favours estrogen.
When this balance shifts, the result is the growth of true glandular breast tissue. This is often a medical issue, which is why medical treatments for gynecomastia are sometimes explored, though they are only effective in a very limited timeframe.
The Classification Nuance of Gynecomastia: Glandular vs. Fat
Surgical correction relies heavily on differentiating the type of tissue present, as this determines the surgical plan and permanence of the result.
True Gynecomastia (Glandular)
This is the benign enlargement of the glandular tissue. It is characterised by the presence of a firm, rubbery mass beneath the nipple.
Pseudogynecomastia (Fatty)
This is characterised by the accumulation of adipose (fat) tissue only, often associated with generalised obesity. This specific cause of male breast enlargement is formally classified as Fatty hypertrophy (pseudogynecomastia).
Combination/Mixed Type
The coexistence of excess fat and glandular tissue is the most frequent form of gynecomastia, sometimes referred to as combination type (Fett- und Drüsenhypertrophie). Webster also proposed a classification defining glandular, fatty, and mixed types.
Irreversibility
If the glandular tissue persists for over a year, it often develops dense fibrosis and hyalinization, meaning the glandular hypertrophy cannot regress. For these permanent lesions, surgical therapy is the accepted standard treatment. of breast tissue, while androgens inhibit this growth.
Etiological Categories: Where the Imbalance Comes From
The cause of gynecomastia is often categorised as physiological, pathological, or idiopathic. The prevalence of asymptomatic gynecomastia is high, ranging from 30% to 50% of healthy men, with a lifetime prevalence of up to two-thirds of adult men.
Physiologic Shifts Increase Prevalence by Age
This hormonal fluctuation is not always caused by disease; it frequently occurs naturally during three predictable phases of a man’s life:
- Newborns: Breast development may show shortly after birth due to exposure to maternal estrogen, but this usually resolves in two or three weeks.
- Adolescents (Puberty): This is very common, occurring in up to 70% of adolescent boys. The good news is that pubertal gynecomastia resolves spontaneously within 1 to 3 years in 75–90% of adolescents. This is why the age and timing of gynecomastia surgery is so important; we often wait for this phase to pass.
- Older Adults: This condition is most prevalent in men between 50 and 69. Ageing causes declining testosterone levels and an increase in fatty tissue, which converts androgens to estrogens.
External Factors Exacerbate Hormone Disparity
While hormonal changes are often natural, many cases arise from external factors. About 10–25% of gynecomastia cases result from the use of medications or exogenous chemicals.
A wide array of drugs and substances can interfere with your body’s delicate estrogen-to-androgen ratio.
Pharmaceutical Drugs: Drugs with strong evidence for causing gynecomastia include certain blood pressure medications (like spironolactone), ulcer medications (cimetidine), and anti-androgens. Drug use can cause up to 25% of all gynecomastia cases.
Certain therapeutic agents, such as anabolic steroids, cimetidine, chlorpromazine, diazepam, and illicit drugs, are considered among the causes. Spironolactone, Digoxin, Cimetidine, spironolactone, and anti-androgens are also specifically implicated.
These drugs disrupt the estrogen/androgen equilibrium by favouring increased estrogen synthesis or decreasing androgen synthesis.
Substance Use: This is a very common trigger. Substance use includes anabolic steroids, marijuana, and alcohol. Steroid abuse by bodybuilders is a well-known cause.
Recurrence Risk: If your gynecomastia is caused by substance use, you must stop using the substance. This is critical for guaranteeing permanent results and avoiding recurrence of the condition after surgery.
Chronic Health Issues Create Hormonal Imbalance
Sometimes, gynecomastia may present as a symptom of an underlying chronic disease that is disrupting your hormone metabolism or production. This is why a full medical check-up is mandatory.
A key part of your consultation will be running diagnostic tests to rule out these underlying pathologies:
- Liver Disease and Cirrhosis: Liver failure impairs the body’s ability to properly metabolise hormones like estrogen.
- Kidney Failure: Many kidney failure patients experience a hormonal imbalance.
- Hypogonadism: This condition, caused by damage to the testes or pituitary, leads to a deficiency in androgen (testosterone) production.
- Thyroid Disease: Conditions like hyperthyroidism can cause hormonal imbalance.
- Tumours: Estrogen excess can be because of a variety of causes, including testicular estradiol production (Sertoli or Leydig cell tumours) or hCG-secreting tumours.
Obesity and Heredity Increase Predisposition
Two other common factors significantly influence breast enlargement:
- Obesity: This is a common cause of excess serum estrogens. Fatty tissue contains an enzyme (aromatase) that converts androgens into estrogens. Obesity can also cause Pseudogynecomastia, which is enlargement from fatty deposits, not glandular tissue. We explore this in our guide to the official medical definition of gynecomastia.
- Heredity: Heredity is a factor influencing body shape and fat deposition.
Finally, despite thorough investigation, the cause of gynecomastia is unknown in around 25% of cases.
Your Consultation in Jaipur
Given the diverse range of potential causes, a thorough diagnostic consultation is mandatory. Before I ever recommend surgery, I ensure a comprehensive medical evaluation, including blood tests, is performed to rule out underlying diseases and confirm that surgery is the right, permanent solution for you.
To book your personalised, confidential consultation, please reach out to my team at Kalpana Aesthetics.
- Call or WhatsApp: 7718183535
- Visit Us: Kalpana Aesthetics, 2nd Floor, Jaipur Hospital, Mahaveer Nagar, Tonk Road, Jaipur
Disclaimer: The information provided on this webpage is for educational purposes only and does not constitute medical advice. The causes of gynecomastia are varied and complex. Please consult with a qualified, board-certified plastic surgeon for a full medical and diagnostic evaluation to determine the cause of your specific condition.
English 
Hindi