Some of the various problems that can cause - Gynecomastia Male Breast Enlargement
There are many possible reasons for male breast growth. If caused by a medical problem, this should be corrected first. Such issues can be investigated by your internist or an endocrinologist. In most cases there is no known cause (idiopathic). A complete discussion of the many possible causes for gynecomastia is beyond the scope of this introduction.
Male breast enlargement comes from the same factors that cause female breast growth. Mammals, both male and female have a gland and fat component at birth. Hormones can stimulate the gland to grow in both. Weight gain and or hormonal stimulation can increase the fat content of the breasts.
Weight Gain
Men
tend to put extra fat first on their chest and bellies. Typical excessive body fat distribution in men results in female like breasts. . Pseudogynecomastia is a poor term some use for a fatty male breast.
Estrogen Androgen Balance
Hormones Estrogen and Androgens like Testosterone control male and female organ dev elopement, body contours, and sexual characteristics. Both are present in all humans. In men, estrogen is normally present in small quantities and helps control bone density, sperm creation, and mood. Excessive estrogen can stimulate male breast growth, other female body fat contour, and other characteristics.
Developmental
- At Birth
A mother's estrogen transferred in the womb results in swollen breasts in more than half of all male babies. This is usually transient and resolves within a few weeks.
- Puberty
The imbalance of hormones resulting in male breast growth during puberty is very common. Even small breasts (Puffy Nipple Gynecomastia) in the adolescent male can cause great emotional stress as his body is evolving. The comparison of his chest to that of young women raises tension. For most, this growth will resolve within a few years. However, what has not resolved by 3 years typically will remain. - Aging
As men age, testosterone production can decrease. Breast growth occurs in over 25% of men over the age of 50.
Hypogonadism (decreased androgens or increased resistance to androgen)
- Primary
- Acquired
(trauma, infection, torsion (twisted testicles), radiation,mumps, chemotherapy) - Congenital
- Acquired
- Secondary
- Hypogonadotropic Hypogonadism
(low testicular function from lack of gonadal stimulating pituitary hormones) - Kallmann Syndrome
An x-linked disorder characterized by a GnRH deficiency with hypogonadotropic hypogonadism and delayed puberty, and smelling deficiencies. - Pituitary Failure
(Loss of blood supply, infection, tumor)
- Hypogonadotropic Hypogonadism
Tumors
- Aromatase Producing
- Bronchogenic Carcinoma
- HCG (Human Chorionic Gonadotropin) Producing
- Prolactinoma Pituitary Tumors (Gynecomastia is rare but can occur.)
- Steroid Producing
Systemic
- Adrenal
(low ACT hormone or Congenital Adrenal Hyperplasia or overgrowth) - Adrenal Genital Syndrome
Cortisone synthesis blocked by missing enzyme can cause major quantities of both Testosterone and Estrogen creating mixed sexual characteristics. - Cirrhosis
(increased materials for peripheral tissue aromatase) - Kidney Failure
(when testicles fail) - Thyrotoxicosis
(estrogen and testosterone binding changed)
Congenital Disorders
- Androgen Resistance Syndromes
(cells are unable to respond adequately to circulating androgens) - Enzyme Defects of Testosterone Production
- Increased Peripheral Tissue Aromatase
- Klinefelter Syndrome
- True Hermaphroditism
- Vanishing Testis Syndrome
(Testicular Regression Syndrome - both testes regress during fetal life)
Familial
Miscellaneous
- Alcoholism
- Chest Wall Trauma
- Cystic Fibrosis
- Herpes Zoster Infection
- HIV
(after years of highly active antiretroviral therapy (HAART)) - Myotonic Dystrophy
(an inherited disorder in which the muscles contract but have decreasing power to relax, become weak and waste away) - Obesity
- Psychological Stress
- Spinal Cord Injury
- Refeeding after Malnutrition
(increased materials for peripheral tissue aromatase)
Idiopathic (unknown cause)
Adapted from Rohrich, RJ et al Plastic Reconstructive Surgery 111:909, 2003
Problems causing continued breast growth are better dealt with before surgery with your medical doctor. Dr. Bermant prefers to sculpt stable breast problems. Surgery does not stop further breast growth.
If you have questions about your medical condition, you should ask your primary care doctor or endocrinologist. As a surgeon Dr. Bermant will be glad to help you explore surgical sculpture options during a consultation or preliminary remote package. You can start with this extensive introduction on the following pages:
 | Gynecomastia |  |
