Being a male, you would nod in agreement that discussing your body image is highly sensitive, especially if it is not in your control. One such issue that doesn’t get discussed often is gynecomastia or an enlarged male breast condition. Even if it is not life-threatening or serious, gynecomastia can negatively impact your mental and physical health. However, the relieving fact is that this condition of enlarged glandular tissue can be treated with gynecomastia surgery to achieve a flat and contoured chest. However, it is essential to understand the causes behind it to make a well-informed treatment approach.
What is Gynecomastia?
Males having abnormal growth of breast tissue develop a common condition called Gynecomastia. Though males have a tiny percentage of breast tissue, they experience abnormal growth due to gynecomastia on one or both sides. Despite being a non-cancerous or non-threatening condition, this condition induced by enlarged male breast tissue can cause psychological distress and affect your self-esteem. Gynecomastia can occur in males at various life stages, from infancy to old age [1].
It is much different than pseudogynecomastia which develops when there is excess fat deposit in the chest without any excess breast tissue enlargement. Gynecomastia might range from a well-pronounced breast enlargement like that of a female to a subtle swelling or lump under the nipple. Such development of glandular tissue in males is often triggered by several factors like hormonal changes, substance usage, obesity, medications, puberty, underlying health conditions, and more. It is essential to get a clear-cut idea about the causes to demystify gynecomastia to manage it effectively with the best treatment option.
Top 10 Causes Of Gynecomastia
Here’s a detailed breakdown of the common factors that contribute to the development of gynecomastia among males of varying age groups.
1. Hormonal Imbalances Leading to Gynecomastia
Gynecomastia condition is usually caused by an imbalance in the proportion of hormones, specifically the balance between testosterone or androgens and estrogen. The role of hormonal imbalance in influencing the occurrence of gynecomastia can be due to:
- Estrogen Dominance: This hormone is responsible for the growth of breast tissue among males and females. When the levels of estrogen are higher than testosterone, it can kindle the enlargement of your glandular tissue. Estrogen levels tend to increase owing to excess aromatase enzyme activity in your body.
- Testosterone Deficiency: This hormone is essential for your body’s development and combats breast tissue development. However, when the levels of testosterone decline, it fails to inhibit glandular tissue growth, making estrogen to become more dominant. There would be low levels of testosterone production when your body develops androgen resistance or due to hypogonadism condition.
2. Medications That Can Cause Gynecomastia
Certain medications can induce gynecomastia condition as a side effect, as some formulations of the drugs might hamper the hormonal balance. The medications that might lead to gynecomastia are:
- Antiandrogen Medications: Medications like finasteride or Flutamide might inhibit androgen activity and might spike estrogen in your body leading to gynecomastia[2]. They can interact with your body’s androgen receptors and lower the production of testosterone production.
- Cardiovascular Medications: Medications for heart-related issues like calcium channel blockers might increase estrogen levels in the body due to their antiandrogenic effects.
- Antipsychotic Medications: Taking antipsychotics like chlorpromazine, risperidone, and haloperidol might block your body’s dopamine receptors causing the pituitary gland to produce more prolactin[3].
- Chemotherapy Drugs: Taking drugs to cure prostate cancer might hinder your hormonal balance leading to enlarged breasts.
3. Impact of Steroid Use
Athletes and bodybuilders taking synthetic substances like anabolic steroids often face the risk of developing gynecomastia. Steroid-induced enlarged glandular tissue is caused by:
- Rise In Aromatase Activity: This enzyme takes care of the conversion of testosterone into estrogen[4]. Regular use of steroids will spike aromatase activity and increase the rate of estrogen conversion.
- Testosterone Production Gets Affected: Steroids are capable of suppressing the production of testosterone by mimicking its effects[5]. So, there would be a deficit in the levels of this hormone and a rise in estrogen activity.
- Activates Estrogen Receptors: Steroids that you use might bind with your body’s estrogen receptors present in breast tissue, thereby increasing the growth rate to cause gynecomastia[6].
4. Obesity and Fat Distribution
Obesity is often ignored as a major cause of the enlargement of glandular tissue in men. Here’s why obesity triggers enlarged breast issues:
- Irregular Fat Distribution: Some men’s bodies might store excess fat in their chest area or upper body, which can lead to enlarged breast condition. Abnormal fat distribution in the chest increases breast volume and makes it look protruded.
- High Aromatase Activity: In obese males, there would be an increase in aromatase activity in their adipose tissue, which causes gynecomastia.
- Metabolic Syndrome: Visceral fat in obese men can trigger metabolic syndrome along with insulin resistance, which in turn disrupts hormone levels. It raises SHBG or sex hormone-inducing globulin and leptin levels by affecting HPG or hypothalamus-pituitary-gonadal activity to cut down free testosterone levels.
5. Alcohol Consumption
Too much consumption of alcohol can hinder the hormone balance in your body. This might cause gynecomastia. Alcohol can cause the following effects on your body:
- It lowers your body’s ability of hormone metabolizing activity, which can lead to liver diseases.
- It increases the levels of estrogen hormones in your bloodstream.
- Cuts down testosterone production to create fluctuations in hormones that cause gynecomastia.
- It causes an increase in aromatase activity, which also affects hormone proportion in your body.
- The presence of phytoestrogens in beer causes hormonal imbalance by mimicking the activity of estrogen in your body.
6. Chronic Health Conditions
Various health conditions will cause disruptions in the hormone levels in your body. These underlying health issues might also be the culprit causing gynecomastia.
- Testicular Conditions: Any injury or tumors present in the testicles might affect the production levels of testosterone, which in turn increases the growth of breast glandular tissue.
- Liver Issues: If you have liver damage, there would be issues with metabolizing hormones, which might trigger the buildup of estrogen.
- Hyperthyroidism: If your thyroid gland is hyperactive, it causes a rise in the level of hormones produced, which might kindle the growth of breast tissue.
- Kidney Issues: Men who have to undergo dialysis treatment for a long term might develop gynecomastia due to hormonal imbalance.
- Hypogonadism: When your reproductive system fails to produce the required level of testosterone, it can affect the ratio of hormones. Such hormonal disruptions would cause enlarged breasts along with symptoms like sexual dysfunction, and hair loss.
7. Puberty-Related Gynecomastia
Pubertal gynecomastia is a common condition that affects boys aged between 10 and 14 years in entering the puberty stage. During adolescence, about 60% of teenage boys develop glandular tissue growth in the chest area owing to temporary fluctuations in testosterone levels.
8. Aging and Hormonal Changes
With age, men often face the risk of developing gynecomastia owing to a fall in the levels of testosterone production, which takes care of inhibiting glandular tissue growth[7]. This ability of the male sex hormone will be affected when there is a rise in estrogen levels. Around 70% of men aged above 50 might develop gynecomastia due to the decline in the production level of testosterone.
9. Drug Use
Using recreational substances can be extremely harmful to your body’s hormones and can cause gynecomastia, especially among young men.
- Marijuana: Substances like marijuana will disrupt the production of hormones leading to glandular tissue enlargement in the breast. The compounds present in it get bound to the receptors of estrogen to stimulate abnormal growth of breast tissue[8].
- Other Substances: Drugs like amphetamines, methadone, and heroin will obstruct the pathways involved in hormone production by causing damage to vital organs that regulate hormones.
10. Genetic Disorders
Though not a common cause, certain genetic disorders might be responsible for your gynecomastia.
- Androgen Insensitivity Syndrome: This genetic condition will impair your body’s ability to respond and accept the activity of the male sex hormone[9].
- Klinefelter Syndrome: It causes your body to produce an extra X chromosome that might improve estrogen levels while declining testosterone activity[10].
Idiopathic Cases with No Clear Cause
Few cases of gynecomastia remain a mystery as the exact cause behind it is unknown, which is why it is called idiopathic gynecomastia[11]. It is estimated that about 25% of gynecomastia cases don’t have the right cause even after a thorough clinical evaluation. Such unexplained enlarged glandular tissue might be a result of subtle variations in hormones, genetic factors, or high sensitivity of breast tissue. Sometimes, exposure to industrial chemicals, pesticides, or plastics might increase estrogen levels leading to gynecomastia. Though such idiopathic gynecomastia condition is not serious, patients dealing with it face psychological distress and have low confidence. However, you can schedule a consultation with the plastic surgeon at Akruti Plastic & Cosmetic Surgery Centre to learn more about gynecomastia surgery to get a well-contoured chest.
Citation
- Dickson G. Gynecomastia. Am Fam Physician. 2012 Apr 1;85(7):716-22. PMID: 22534349. – https://www.aafp.org/pubs/afp/issues/2012/0401/p716.html
- Johnson DB, Sonthalia S. Flutamide. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482215/
– https://www.ncbi.nlm.nih.gov/books/NBK482215/
- Wilson JD. Endocrinology. In Fauci AS, Martin JB, Braunwald E et al (Eds) Harrison’s Principles of Internal Medicine. 14th edition. 1998: International Edition, McGraw-Hill Inc. – https://www.medsafe.govt.nz/profs/puarticles/hyperpro.htm
- Ishikawa T, Glidewell-Kenney C, Jameson JL. Aromatase-independent testosterone conversion into estrogenic steroids is inhibited by a 5 alpha-reductase inhibitor. J Steroid Biochem Mol Biol. 2006 Feb;98(2-3):133-8. doi: 10.1016/j.jsbmb.2005.09.004. Epub 2005 Dec 28. PMID: 16386416. – https://pubmed.ncbi.nlm.nih.gov/16386416/
- Bond P, Smit DL, de Ronde W. Anabolic-androgenic steroids: How do they work and what are the risks? Front Endocrinol (Lausanne). 2022 Dec 19;13:1059473. doi: 10.3389/fendo.2022.1059473. PMID: 36644692; PMCID: PMC9837614. – https://pmc.ncbi.nlm.nih.gov/articles/PMC9837614/
- Segner, Helmut E. – University of Bern, Bern, Switzerland – https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/estrogen-receptor
- Swerdloff RS, Ng JCM. Gynecomastia: Etiology, Diagnosis, and Treatment. [Updated 2023 Jan 6]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279105/ – https://www.ncbi.nlm.nih.gov/books/NBK279105/
- Harmon, J. W., & Aliapoulios, M. A. (1974). Marijuana induced gynecomastia: clinical and laboratory experience. Surgical forum, Vol. 25, 423-425. – https://pure.johnshopkins.edu/
- Gottlieb B, Trifiro MA. Androgen Insensitivity Syndrome. 1999 Mar 24 [Updated 2017 May 11]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1429/ – https://www.ncbi.nlm.nih.gov/books/NBK1429/
- Los E, Leslie SW, Kadam SJ, et al. Klinefelter Syndrome. [Updated 2025 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482314/ – https://www.ncbi.nlm.nih.gov/books/NBK482314/
- Herbert SL, Ergezinger K, Sauer S, Kurz F, Schlaiß T, Wöckel A, Albert US. Prepubertal Idiopathic Unilateral Gynecomastia: Case Report and Literature Review. Breast Care (Basel). 2022 Dec;17(6):573-579. doi: 10.1159/000525096. Epub 2022 May 17. PMID: 36590144; PMCID: PMC9801404. – https://pmc.ncbi.nlm.nih.gov/articles/PMC9801404/
Doctors Timetable
Working Time