The Truth About Gynecomastia

By Paul Rosenberg MD

There are many myths, misunderstandings, and misinformation about the causes of male breast enlargement, and this is the perfect forum to honestly set the record straight. The information I share in this blog derives from the combined 36 years of experience by the physicians at the New Jersey Gynecomastia Center in treating this condition.

Importance of a Thorough Examination

A thorough history and physical examination are critical in determining the most likely cause in a particular patient. Only then can the proper treatment be provided. Several key questions need to be asked and answered in order for the treatment to be successful.

If you are a patient being seen at a consultation for gynecomastia and are not asked certain basic questions – many of which I describe below – I strongly recommend that you consider finding an alternate clinic or physician where a more comprehensive evaluation is likely to be provided.

Keep this in mind: A missed question by a physician can lead to a missed opportunity for a cure.

Broad Patient Base and Referrals

Our patient base is broad, spanning all ages, ethnicities, and body types:

• Endocrinologists often refer adolescents whose parents are concerned about their son’s hormonal condition.
• Psychologists often refer patients suffering from body image difficulties due to hypertrophy of glandular tissue, especially in adolescents.
• Internal medicine physicians send patients with this condition as a result of necessary medication, where one of the unfortunate side effects is breast enlargement.
• Urologists treat prostate disease, including prostate cancer and a condition called BPH, with medications that secondarily cause gynecomastia.
• Athletes, personal trainers, coaches, and bodybuilders often seek surgical remedies for this condition, usually due to one or more performance-enhancing drugs.

Importance of a Comprehensive Evaluation

In future blog posts, I or one of our team members will delve deeper into the physiology and biochemistry underlying each of the major causes of gynecomastia. For now, I will simply present a list of the most common presentations.

The science behind abnormal breast tissue growth can be confusing, irrelevant, or even quite frankly a bit boring if this is not the cause of your condition. But, as we have found over the years, once we have identified the root cause of the condition for a particular patient, suddenly the science behind its cause has new meaning. It makes for very interesting reading and conversation with your doctor.

There is a great deal to know and understand, with subtle differences between each patient that can affect the outcome. It starts with a complete evaluation, more often than not requires surgery with anesthesia, and close postoperative follow-up combined with long-term surveillance to guarantee excellent results and patient satisfaction.

That is why, when it comes to our gynecomastia patients, we consider ourselves “their very breast friend.” Please forgive the pun, but in truth, many of the patients previously suffering from gynecomastia stay in touch for decades because of the life-altering results from the treatment.

Key Factors Contributing to Gynecomastia

What is presented here is based on a combination of understanding the literature on the topic, a vast experience of seeing patterns in affected patients over three decades, known and declared side effects disclosed by pharmaceutical companies, and also just plain common sense.

Types of Enlarged Breast Tissue

Enlarged breast tissue can take the form of:

• Adipose tissue (i.e., fat)
• Glandular tissue
• A combination of both

Conditions such as obesity, which involves increased deposition of free fatty acids into existing fat cells (lipocytes), are clearly one of the most common causes of the condition. Obesity, when combined with growth in the number of fat cells (adipocytes) during puberty, is an accelerating factor in adolescent boys.

Hormonal Influences

During this period of pubescence, hormones such as testosterone, estrogen, and progesterone play a key role in stimulating gland growth and hypertrophy. Sources of these hormones include:

• The adrenal glands
• The pituitary gland
• Fat cells throughout the body

This explains in part how obesity both contributes to and exacerbates this condition. Sometimes asymmetric breast growth in boys resulting from benign or occasionally malignant soft tissue tumors can be mistaken or misdiagnosed as gynecomastia. Testicular malignancies are also a cause, although uncommonly, of gynecomastia in the youngest age group suffering from this condition.

The Impact of Cannabis Use

Next on the list is cannabis. There is a well-established relationship between frequent (usually daily) use of marijuana, habitual use of THC vape pens, and even orally ingested forms of cannabis such as gummies, hash brownies, and the like.

Age-Related Clues to Gynecomastia

• Teenage Years: Gynecomastia arising in the teenage years of a patient is most likely due to hormonal stimulation to the existing breast tissue, obesity, or cannabis.
• Twenties to Forties: Gynecomastia arising de novo in the twenty to forty-year-old age group can usually be attributed to new-onset obesity, prescription medications, and performance-enhancing medications. These include:
  • Anabolic steroids
  • Adderall and other ADHD medications
  • Certain antibiotics when used over long-term periods
• Fifties and Beyond: In patients experiencing new-onset gynecomastia in their fifties and beyond, the most likely cause aside from obesity is again drug-related, most commonly due to:
  • Certain chemotherapy drugs
  • Certain medications used to treat prostate enlargement, which disrupt the normal balance between male and female sex hormones
  • Certain cardiac medications
  • Certain medications used to treat GERD (gastroesophageal reflux), gastritis, and ulcers

Conclusion

Determining the most likely cause of gynecomastia in a given patient will lessen the likelihood of recurrence of the condition. It also permits the patient to take control of his health and contribute to improved self-esteem, general well-being, and improved quality of life.

We hope you found this overview useful into what gynecomastia is all about. If you have any questions or concerns, feel free to schedule a consultation. Let’s get you started in the right direction together.