Gynecomastia: An Examination of Man Boobs

What Causes Gynecomastia?

Gynecomastia is a benign enlargement of breast tissue in males. It is triggered when the body’s balance of oestrogen and androgens changes. Oestrogen, widely thought of as a female hormone, is actually present in small amounts in men as part of normal healthy physiology, but the presence of androgens (male hormones) usually suppresses the expression of oestrogen. An imbalance in the ratio between oestrogen and inhibitive hormones, whether caused by an increase in the former, a decrease in the latter, or both, can lead to the appearance of gynecomastia.

The causes for the hormonal imbalance that leads to gynecomastia have traditionally been divided into the following three categories:

  • Physiological mechanisms
  • Pharmacological mechanisms, and
  • Pathological causes.

Physiological gynecomastia

This form of gynecomastia is, as its name suggests, the development of gynecomastia (or ‘man boobs’) as a result of normally-occurring bodily processes. Most cases of gynecomastia (including asymmetric as well as unilateral gynecomastia) happen as a result of physiological changes that are not in and of them selves harmful.

Newborn male breast enlargement

It’s common to observe physiological gynecomastia in male newborns as an effect of the placenta converting androgens to oestrogen. This form of gynecomastia is temporary and usually subsides in two or three weeks.

Gynecomastia during puberty

Adolescents aged 10-12 are prone to temporary physiological gynecomastia. In boys, this is usually caused by a simultaneous surge in both testosterone and estradiol, with the latter peaking much sooner than the former.

Senescent gynecomastia

As our bodies age, it is not just common but normal to see some amount of muscle converting to fat (about 10%), fat being distributed in different places, and a decrease of testosterone. Fatty tissue can convert androgens into oestrogen as well, compounding the change in the balance of your hormones. Not all cases of man boobs in older men are due to healthy bodily processes though; there is a chance that a pathological process is involved as well.

Pharmacological gynecomastia – can drugs cause man boobs?

Yes, definitely. Over 25% of all diagnosed cases of gynecomastia result either directly or indirectly from drug use, including the use of prescribed medications. Medications that are known to have this side effect include anti-peptic ulcer drugs like cimetidine, calcium channl blockers such as verapamil and amlodipine, gonadotropic hormone releasing analogues, human chorionic gonadotropin (hGH), and ketoconazole. Herbal supplements including Tribulus terrestrius and even lavender oil have also been linked to hormonal imbalances and prostate issues as well as gynecomastia.

Can spironolactone cause gynecomastia?

Spironolactone is a steroidal medication prescribed for heart failure or hypertension, and is the most common legal market drug associated with gynecomastia. Spitonolactone is known to bind to androgen receptors in the body, inhibiting your body’s normal response to circulating androgens.

Will Omeprazole cause gynecomastia?

Omeprazole (also known as Prilosec) is occasionally prescribed for gastric reflux and heartburn. It inhibits the enzymes that normally take care of metabolising stray oestrogen in your body, leading to a build-up of oestrogen blood levels.

Does Risperdal cause man boobs?

Risperdal (also known as risperidone) is an antipsychotic used to treat bipolar disorder, schizophrenia, and even autism. Risperdal affects your dopamine receptors and inhibits the effect of dopamine, leading to increased amounts of prolactin in your system, which as you might recognise from the etymology, is the hormone that promotes milk production. Excess prolactin can cause not just gynecomastia but galactorrhea (a milky discharge), decreased bone density, and infertility.

Other drugs can cause male breast tissue enlargement

Some antidepressants like Zoloft (sertraline) are implicated as a possible cause of gynecomastia, mostly because of their effect on dopamine mechanisms.

Drugs used to treat prostate cancer and benign prostatic hyperplasia can also cause patients to develop breasts. Of this set of drugs, 5-alpha-reductase inhibitors like Dutasteride and Propecia (finasteride) are known causatives, together with antiandrogen treatmenst like oestrogen and bicalutamide therapy.

Propecia, a drug occasionally prescribed to treat male pattern baldness, can cause gynecomastia through the same mechanisms that it uses to prevent hair loss – disrupting you body’s normal testosterone levels.

What causes gynecomastia in bodybuilders?

The vast majority of gynecomastia cases in bodybuilders are the result of anabolic steroid use. Winstrol (stanazolol) increases levels of androgens temporarily, but with such an excess of androgens in your blood and tissues, your body starts metabolising the androgens into oestrogens.

The symptoms of gynecomastia from steroid use become more severe depending on dosage and duration. While human growth hormone is known to cause gynecomastia as a side effect, creatine supplements will not in fact cause true gynecomastia. Creatines cause fluid retention, but not gland enlargement.

How does alcohol cause Gynecomastia?

Alcohol abuse has been linked to gynecomastia. Excessive consumption lowers blood levels of testosterone, promotes the aromatisation of androgens into estrogens, and can cause hypogonadism (reduced testicle size), all of which correlate to gynecomastia.

Adderal and Pathological causes

A pathological condition is one caused by disease or some other abnormal physiological function. Obesity is one pathology that will certainly create the appearance of ‘man boobs,’ though this is often purely fat without any enlargement of the glandular breast tissue that defines true gynecomastia. Other pathological causes include:

Zinc deficiency and gynecomastia

Generally poor diets leading to deficiency can affect your hormones. Zinc deficiency, for example, is known to cause testosterone to aromatise into oestrogen.

Can soy products cause man boobs?

Conversely, consumption of too much oestrogen and phytoestrogen-containing foods may possible cause gynecomastia. These foods include soy products like edamame beans, soy milk and tofu, but also certain meats from animals given artificial hormones or diets of feedstocks unnaturally high in soy.

Disease and disorders that can cause gynecomastia:

  • Kidney failure
  • Cirrhosis or liver failure
  • Testicular tumors
  • hCG-secreting choriocarcinoma.
  • Glandular tumors (pituitary, bronchogenic and adrenocortical)
  • Hyperthyroidism
  • Klinefelter Syndrome

How is gynecomastia treated?

In most cases, gynecomastia can be managed by improving your lifestyle, diet and exercise, and taking other steps to redress a pathological hormone imbalance if one exists. Compression vests are a non-invasive and affordable option that achieves instant, if temporary, results. Beyond this, some medications are being used to treat gynecomastia or at least prevent further growth, and for chronic cases that are not responding well to medication therapy, surgical gland removal may be recommended.