Gynecomastia: What is it, Causes, Prevention & Treatment

Gynecomastia is incredibly common among males, affecting about 50-65% of boys and men worldwide according to public health experts. It can affect a man’s confidence and often indicates other serious underlying health conditions that require correction.

Fortunately for affected patients, gynecomastia is highly treatable with smart interventions.

Continue reading to find out what gynecomastia is, what causes it, and how testosterone replacement therapy (TRT) can help patients reverse the condition.

What is gynecomastia?

Gynecomastia is the medical term for abnormally enlarged breast tissue in men. Gynecomastia is often described in everyday language as “man boobs.”

The condition is typically seen to develop in newborns, pubescent boys, and older men. As many as half of all newborn boys have gynecomastia caused by the mother’s estrogen (the female sex hormone).

However, it can present at any age.

The most common culprit for gynecomastia for males of all ages is a hormonal imbalance involving estrogen and testosterone (the male sex hormone).

Causes of gynecomastia

Gynecomastia can develop due to a variety of factors. Often, the cause is a combination of multiple factors and so it’s difficult to pin down to a single source. Let’s survey some of the more common causes of gynecomastia.

The testosterone-gynecomastia connection

The single most common cause of gynecomastia is an imbalance between the male and female sex hormones – testosterone and estrogen, respectively.

Estrogen, the hormone that stimulates breast tissue development, is typically found in relatively small concentrations in men in proportion to testosterone. The ratio of testosterone to estrogen for men’s health is just as important as the absolute level of testosterone.

As a consequence, low testosterone (aka hypogonadism) upsets the balance of testosterone and estrogen, which results in multiple symptoms – including the abnormal growth of breast tissue.

Non-hormonal causes of gynecomastia

Not all cases of gynecomastia are related to low testosterone (aka low T). Other frequently identified causes of gynecomastia include:

• Adrenal tumors
• Alcoholism
• Thyroid disease
• Liver disease
• Kidney disease or kidney failure
• Klinefelter syndrome (an inherited condition)

Pharmaceutical medications may trigger gynecomastia

Multiple popular pharmaceutical drugs are known to contribute to gynecomastia, including but not limited to:

• Risperidone
• Verapamil
• Nifedipine
• Omeprazole
• Alkylating agents
• HIV medications (efavirenz)
• Anabolic steroids
• Alcohol
• Opioids

If you are on any of these drugs and are diagnosed with the condition, ask your doctor how the medications you are taking might be contributing to your gynecomastia, and what adjustments you can make to remedy this issue.

Pseudogynecomastia is a condition in which obesity alone causes the growth of breast tissue due to fat buildup all over the body, but is not a true case of gynecomastia.

What are the symptoms of gynecomastia?

The primary symptom of gynecomastia is the lump, or enlargement, in the breast tissue. It often manifests as a small growth underneath the nipple, which may or may not be visible. It may be sensitive to the touch and move around when touched. The enlargement might be present in one or both of the breasts.

How is gynecomastia diagnosed?

The first step to getting gynecomastia diagnosed is the detection of the enlargement in the breast tissue by a medical provider during a physical examination.

If the doctor finds anything concerning, the next step might be to order lab tests to rule out breast cancer (which often also causes lumps). These clinical tests include:

• Breast ultrasound
• Mammogram

Can testosterone therapy treat gynecomastia without surgery?

Gynecomastia can be corrected without surgery.

Because gynecomastia is so often associated with elevated estrogen:testosterone ratios, testosterone replacement therapy (TRT) for men with hypogonadism can correct this imbalance and effectively treat gynecomastia.

TRT, which introduces bioavailable synthetic testosterone to the body to increase counts in men with low T, is the top therapeutic intervention to treat hypogonadism.

In particular, TRT is one of the three most commonly utilized classes of medical treatments for gynecomastia, in addition to anti-estrogens (clomiphene citrate, tamoxifen), and aromatase inhibitors.

When undergoing TRT, it’s important to take steps to balance E2 (estradiol) levels because the therapy may trigger a rise in estrogen in some circumstances. Experienced endocrinologists have several tools they can use to mitigate rises in E2.

How to prevent gynecomastia?

For patients who don’t have gynecomastia and want to stay free of the condition, there are several steps you can take to reduce or eliminate your risk. Examples include:

• Working out often. Hitting the gym for weightlifting sessions, or doing high-intensity interval training (HIIT) at least a few times a week is more powerful than most medications for keeping your hormones balanced.
• Eating an anti-estrogen diet. Eliminate refined carbohydrates, opt for organic meat and dairy products free from artificial hormones, and limit your alcohol intake to keep your estrogen levels in check naturally.
• Staying away from dangerous and illegal anabolic steroids. Illicit steroid use is strongly tied to the development of abnormal breast tissue in men.
• Prioritizing losing weight to prevent pseudogynecomastia.
• Managing stress levels with mindfulness practices such as yoga and breathing exercises.
• Supplementing with iodine to support healthy thyroid levels.
• Eliminating unnecessary medication (under the guidance of a doctor).

The bottom line on gynecomastia

Gynecomastia is a common condition that can be caused by a list of factors, one of which is testosterone deficiency. For males with testosterone deficiency, the only possible way to treat gynecomastia is testosterone replacement therapy to safely increase T counts.