Gynecomastia in very simple terms is enlargement of the male chest caused by excessive growth of breast tissue inside the breast glands. The term gynecomastia comes from the Greek words  gynaik meaning “female” and  mastós meaning breast. So the two words gynaik and mastós joined together forms gynecomastia meaning female breasts. Gynecomastia is usually not life threatening nor does it affect an individual’s health. The real threat of gynecomastia is on the person’s self-esteem and self-confidence making men with this medical condition ashamed of their own body and sense of masculinity.

According to official statistics, 36% of adult young men and 57% of older adult men in the United States have this medical condition in one of the four grades. About 200,000 to 3 million cases of gynecomastia are being reported every single year. So if you have breast enlargement and you think you are an exception, please understand that 1 in 3 young adult men and 1 in 2 older adult men are just like you and have breast enlargement.

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Young Adult U.S Men
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Old Adult U.S Men
An illustration showing the difference between normal male chest and male chest with gynecomastia

What men with gynecomastia feel

Boys and adult men who have gynecomastia are often hesitant to share their plight with family members due to a number of reasons. Sometimes, they are very embarrassed, sometimes they are laughed at and for others, they are asked to suck it up and move on with their life because it is not a life-threatening situation. Another notable reason why the individual’s family is not that forthcoming is that they do not see anything “way” out of the ordinary. For them, Yeah, there is a little bit of breast tissue compared to the other boys but, that’s no big deal. However, gynecomastia that manifest as enlarged breast is a big deal for that poor soul with gynecomastia because it crushes his self esteem, pulls him back from a rich social life, is an insult to his masculine identity acting as a mental barrier for him to approach women and go on dates confidently because, deep in his mind he has this insecure feeling that he is unfit for a full sexual life, will be ridiculed by his partner when he takes his shirt off and most importantly, is not man enough.

When gynecomastia is a normal process

This medical condition can occur at three points during the life span of an individual. The first occurrence is when we are babies, the second at adolescent stage during puberty and finally in late adulthood after 55 years. Gynecomastia during puberty is called pubertal gynecomastia or teenage gynecomastia and is usually temporary. The breast tissue developed during puberty while boys go through adolescence should even out once the chest flattens and boys enter adulthood.

When gynecomastia is not normal

The excess breast tissue that develop in some men during their adolescence stays  even as they enter adulthood and this is when it becomes a genuine and confirmed case of gynecomastia. This is not normal process because the excess breast tissue should have flattened out by this time. In a nutshell, if you are in adulthood and have excess breast tissue, then it is gynecomastia and will not go away naturally. You will have to do something to get rid of it. You have to find out the root cause of gynecomastia and would have to attack and eliminate the offending factor.

Grades or types of gynecomastia

Now this brings us to the next point. Not all gynecomastia are the same and there are different levels or grades  depending upon breast enlargement size as well as feminization of the breast. They are grades 1,2,3 and 4, 1 being the smallest in size and 4 being noticeable in size with higher feminization of the male breast area.

The American Society of Plastic Surgeons have classified gynecomastia into 4 grades based on the following:

  • Size of breast tissue development
  • Severity of the condition
  • Feminization of the breast
Grade or Type Description Severity
 1 A localized button of tissue that is concentrated around the areola Very mild
2 Moderate breast enlargement exceeding areola boundaries
with edges that are indistinct from the chest
Mild to high
3 Moderate breast enlargement exceeding areola boundaries
with edges that are distinct from the chest with skin redundancy present
High and visible
4 Marked breast enlargement with skin redundancy and feminization
of the breast
Severe and visibly feminine
An illustration showing the types or grades of gynecomastia
What causes gynecomastia

What causes gynecomastia

There are a number of causative factors but the main culprits are:

  • Excess estrogen
  • Steroid use
  • Caused by use and abuse of drugs
  • Idiopathic or reason yet to be ascertained

Gynecomastia can be caused due to a number of reasons but usually, the main culprit is an excess presence of estrogen or female hormones in men. Males do have some amount of estrogen already present in their body but in the case of men with gynecomastia, estrogen becomes dominant and as a result, they develop feminine features, the most visible of which is breast enlargement.

Now there are other causes as well and they are wide and varied. Gynecomastia is also seen as a result of drug abuse, use of marijuana, certain medication, as a result of radiation from cancer treatments as well as through long-term consumption of food that are estrogen supportive. For some breast enlargement due to excessive breast tissue growth comes out of the blue for no apparent reason which is referred in medical terms as idiopathic.

There is no one single cause for gynecomastia that can be traced back to every individual with gynecomastia and it depends on a number of elements. This is not an in-depth study of the various causes of gynecomastia but we are attempting at getting a general idea as to what might be behind the excessive growth of breast tissue. A number of factors can cause gynecomastia and some can be controlled without medical help but others would need the guidance of a physician who specializes in the treatment of gynecomastia.

Before mentioning the main causes or causes, it must be noted that studies into the causes of gynecomastia are still in their infancy and in some cases, the cause of gynecomastia is an enigma for the medical field. In such cases, it is referred to as “idiopathic” meaning, the cause is unknown or cannot be found out. There are also only a limited number of studies that have been conducted around what causes gynecomastia. One reason for the low number of studies around this medical condition is that it is not a life threatening condition and treatment of this medical condition is not covered under most insurance packages unless accompanied by a life-threatening situation like the presence of a tumour.

Estrogen

Prevalence of the female hormone estrogen in higher than usual proportion in the male body is one of the identified fundamental underlying causes of gynecomastia. For some individuals, there is naturally a higher amount of estrogen present in their body and this high presence of estrogen leads to the development of feminine characteristics and increased breast tissue growth. Local tissue factors like increased presence of estrogen in the breast area, increased aromatase activity, (conversion of male hormones into female hormones) also contributes to causes of gynecomastia. There have been a number of studies and there is some agreement in the scientific world that a number of the food items that we in North America consumes on a daily basis are high in estrogen or facilitates the production of estrogen.

Steroids

One of the major causes of gynecomastia among body-builders is the use of steroids. Steroids can influence the estrogen levels in the body and gynecomastia among body building professionals is a very common after-effect of not properly planned steroid use. When steroids are used, it changes the testosterone and estrogen balance in the body and as a result, the balance tilts towards estrogens and gynecomastia develops as a result. One of the recurring questions about the causes of gynecomastia comes from body-builders who have developed gynecomastia as a result of steroid use. There are products in the market specifically for bodybuilders or those taking steroids to address the threat of developing gynecomastia. The key aspect here is that prevention is always the best thing you can do if you are using steroids because, once the breast tissue is developed, it takes much more work to get rid of.

Klinefelter Syndrome

Another cause of gynecomastia is Klinefelter syndrome and is a chromosomal abnormality. Individuals with this condition will have an extra “X” chromosome and to put things in perspective for you, X and Y chromosomes in our body determines our gender and men usually have “XY” combination whereas women have “XX” combination. However, in the case of men with Klinefelter syndrome, they will have an additional “X” chromosome leading to an abnormal “XXY” combination. According to studies on this medical condition, men with Klinefelter syndrome has a 20 fold chance of breast cancer than others and gynecomastia is a common symptom among men with medical condition.

Hyperthyroidism

The thyroid gland is one of the hormone producing glands in our body and controls a number of crucial functions like heartbeat rate and how fast we burn calories. When the thyroid gland become over-active, it produces more thyroid hormones than required and this leads to a medical condition known as hyperthyroidism. Hyperthyroidism is predominantly found in women but men can also have this medical condition and this is considered one of the causes of gynecomastia.

Ageing

When men get older, the testosterone levels either become dormant or retards from their earlier levels and this can lead to a dominance of the female hormone estrogen that is already present in relatively few numbers. As mentioned above breast development occurs during three phases of life and the last one is during older adult age.

Idiopathic

According to some studies, up to 25% of all cases of gynecomastia have no apparent cause. This in itself does not mean that there is no underlying reason but could be because of the lack of studies or research on this medical condition. The medical community for lack of a better word, simply does not know what is causing gynecomastia for a subset of the gynecomastia patient population.

Drugs

In almost 20-25 % off all cases, the causes of gynecomastia can be traced back to the use and sometimes abuse of drugs. A number of drugs can directly or indirectly increase the amount of estrogen or catalyze its production. Estrogen is a female hormone that gives women their bodily features and when this hormone is produced more and more, it leads to breast tissue growth. Below is a limited list of drugs that have been found to contribute directly or indirectly towards gynecomastia.

Diagnosis of gynecomastia

The diagnosis of gynecomastia can be done by your family doctor but it is best left to a doctor specializing in the diagnosis and treatment of gynecomastia. Below is one of the classic ways doctors would make sure that the underlying mass is gynecomastia. There are also advanced diagnostic tests like scanning that can be done.

The patient lies flat on his back with his hands clasped beneath his head. Using the separated thumb and forefinger, the examiner slowly brings the fingers together from either side of the breast. In patients with true gynecomastia, a rubbery or firm mound of tissue that is concentric with the nipple–areolar complex is felt, whereas in patients with pseudogynecomastia, no such disk of tissue is found.

A doctor diagnosing a patient for gynecomastia

Gynecomastia treatment

There are three main options for the treatment of gynecomastia with each one of them having their own advantages and disadvantages. It also depends upon factors like how bad you want to get rid of it, who are you most concerned with seeing it, whether you are looking for a temporary or permanent solution and most importantly, how much you are willing to spend. I am using the word “treatment” in a pretty wide sense and I am including what might not be classified under conventional treatment options.

Gynecomastia Shirts

Gynecomastia shirts are the cheapest of the options in masking gynecomastia and is in no way a permanent solution. The main advantage for using a compression vest is that the effect is quite immediate. The cost of a gynecomastia shirt is comparatively dirt cheap when compared to other options like gynecomastia pills and gynecomastia surgery. You can buy a compression vest at the comfort of your home and can have it shipped discreetly within a matter of days. It is also an ideal option if you want to see how your chest will look like if you had no gynecomastia. I recommend you get one just to see the difference.

Gynecomastia Pills

Another choice in terms of treatment for gynecomastia available in the market are gynecomastia pills. Gynecomastia pills are considered cheap when you compare it to shelling thousands of dollars for gynecomastia surgery. Another reason for their popularity is that there is no pain or stitches or scar involved and manufacturers are offering more than 90% guarantee in terms of their effectiveness.

Gynecomastia Surgery

For some men with gynecomastia, nothing else like diet, anti-estrogen supplements or gynecomastia pills will work and their only option to get rid of gynecomastia will be to undergo surgery.  However, before you zero in on gynecomastia surgery as your preferred option, there are a few factors that you have to take into consideration like, the time you will have to take off from work, surgery cost etc. As for the pain and the expenses, you are guaranteed that you will open your eyes with a different chest.

Finally, not all breast enlargement are gynecomastia

Now that you have read quite a bit about gynecomastia, there is the danger of falling into the notion that all breast enlargement in men are caused by excessive growth of breast tissue. All breast enlargement in men are not gynecomastia and it can be caused by accumulation of fat as well. Breast enlargement as a result of fat accumulation is called pseudogynecomastia. Another common type of breast enlargement in men is called mixed gynecomastia where breast enlargement is caused partly by excess breast tissue and fat accumulation. In fact, majority of the cases of breast enlargement in men is a combination of breast tissue and fat. The strict classification is mainly for the sake of clarity and in reality, things are not that black and white or set in stone.