Enlarged Breasts in Men: Gynecomastia Is No Laughing Matter

Topics like males growing breasts may cause most men to snicker, but it can be a terrifying reality for those who suffer from testosterone imbalance. Nobody likes to think of their body becoming something they don’t recognize.

Gynecomastia, the medical term for enlarged breasts in men, is caused by a significant decrease in the amount of testosterone in a man’s system compared with estrogen—a decrease often caused by certain medical conditions that block the effects of testosterone, reduce testosterone, or cause increases in your estrogen level.

Overweight man with a beard and white t-shirt looks at the camera with a concerned face. Along with obesity, gynecomastia can affect men with poor hormone health.

Hormone Imbalance and Gynecomastia

Estrogen is another sensitive topic in men, who often believe testosterone is the only sex hormone that circulates through their bodies. However, men do produce small amounts of estrogen naturally, and it’s critical to the healthy functioning of a number of systems in men’s bodies, including:

  • Erectile function
  • Libido (sex interest)
  • Balancing your body’s fat mass and lean mass
  • Cognitive functions
  • Maintenance of bone health
  • Skin health

(More information on the role of estrogen in men can be found here.)

Male estrogen levels that climb too high or fall out of balance with testosterone levels can lead to gynecomastia. The reverse also is true—when testosterone levels fall too low, estrogen runs somewhat amuck, causing changes to a man’s system. Lastly, driving estrogen levels down with the aggressive use of aromatase inhibitors can cause a rebound hypersensitivity. If estrogen levels are too low for too long and estrogen receptors become increasingly sensitive, even low levels of estrogen can then cause high estrogen symptoms.

This imbalance can occur during puberty, caused by hormone changes during this season of life. Though frightening and often the subject of ridicule, it is fairly common. Luckily, the enlarged breast tissue usually disappears without treatment within six months to two years as the body settles into a natural testosterone-heavy (compared to estrogen) balance.

Researchers believe the rate of gynecomastia occurrence in men aged 50 to 80 begins at 24% and increases to near 70%.  

Gynecomastia and Health Challenges Related to Male Hormone Balance

Medical conditions that can cause a disruption to your hormone production and affect their delicate testosterone-to-estrogen balance and result in gynecomastia include:

  • Hypogonadismthe medical term for Low T
  • Klinefelter’s syndrome (pituitary insufficiency)
  • Obesity
  • Tumors of the testes, adrenal glands or pituitary gland
  • Kidney failure
  • Liver failure and cirrhosis
  • Malnutrition and starvation—testosterone production decreases dramatically while estrogen production remains virtually unchanged

Medications can also hinder testosterone production or increase estrogen production, leading to what is effectively low testosterone, and cause gynecomastia. The Mayo Clinic lists a number of these medications:

  • Anti-androgens used to treat an enlarged prostate, prostate cancer and other conditions, such as:
    • flutamide
    • finasteride (Proscar and Propecia)
    • spironolactone (Aldactone and Carospir)
  • Anabolic steroids and androgens used to treat hormone deficiencies, delayed puberty, or muscle loss from another disease
  • AIDS medications—especially Efavirenz (Sustiva)
  • ADHD medications that contain amphetamines, like Adderall
  • Anti-anxiety medications, such as diazepam (Valium)
  • Tricyclic antidepressants
  • Some antibiotics
  • Ulcer medications containing cimetidine (Tagamet HB).
  • Chemotherapy treatments
  • Heart medications, such as:
    • Digoxin (Lanoxin)
    • Calcium channel blockers
  • Stomach-emptying medications—metoclopramide (Reglan)

Those who use drugs and alcohol recreationally are also at risk, as many of these have properties that alter a man’s healthy hormone balance. Examples of these are:

(Learn the circumstances that can facilitate alcohol causing damage to your testosterone levels here.)

Is Gynecomastia Harmful?—The Symptoms

Gynecomastia itself isn’t dangerous, but commons symptoms include:

  • Pain (frequently occurring in adolescents with gynecomastia)
  • Swollen, tender breast tissue
  • Nipple sensitivity when rubbing against clothes

The primary issue is that it’s embarrassing to many men, challenging their beliefs about their masculinity, which is understandable. Nobody likes to have their self-image turned upside down. Treating it may even require surgical intervention, which is costly and won’t necessarily correct the problem from recurring.

Low Testosterone and Gynecomastia: When to See Your Medical Provider

If you’re experiencing unexplained growth of glandular breast tissue, you should consult your doctor as soon as possible to determine the underlying causes and begin treatment before the problem progresses. Catching the gynecomastia-causing hormone imbalances early can increase your chances of resolving the problem successfully.

If you’re worried about the symptoms of low testosterone and are considering TRT (Testosterone Replacement Therapy), you need to make sure you’re talking to an expert on the subject.

Testosterone issued without proper supervision (or no supervision at all in the case of PEDs) can lead to increased testosterone. Counter to common thinking, high testosterone levels can also cause gynecomastia.

How can too much testosterone lead to an estrogen-heavy balance? An excellent, and common, question. Your body metabolizes testosterone into estradiol, a form of estrogen.

What that means is this: 

Excess testosterone can become excess estrogen, which can cause or contribute to a hormonal imbalance, in turn leading to enlarged breast tissue, leading to the term testosterone-induced gynecomastia and the rumors that TRT can cause “man-boobs.” Obviously, the gym locker room is a terrible place to conduct self-regulated testosterone supplementation.

However, when you’re under the care of a medical provider who specializes in hormone replacement therapy, you’re unlikely to experience gynecomastia (or any other rumored side effect).

Since you’re seeing a qualified expert, they understand the importance of monitoring your levels carefully. Prevention measures, which includes the proper dose of estrogen-blocking medication, can not only prevent a harmful rise in estrogen levels, but may also help to reverse weight gain and thereby stop a cycle of excess estrogen production (fat tissue is actually an estrogen factory).

Being treated for low testosterone by a professional is critical, because once gynecomastia becomes established, simply treating the root cause will no longer reverse the present existance of male breast tissue.

Surgical removal of the breast tissue may be your only option at that point.

TRT and the Prevention of Gynecomastia: Maintaining a Healthy Overall Hormone Balance

As we increase the level of testosterone to treat your Low T symptoms, it’s critical to carefully monitor the reaction of your other hormones to ensure efficacy and safety.

Frequent professional screening is part of our therapy process at Testosterone Centers of Texas (TCT).

The expert staff at any of our TCT locations look forward to helping you improve your quality of life, while keeping your overall health as our top priority.

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(Augie) Juan Augustine Galindo Jr. MPAS, PA-C

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C started his career in healthcare as a fireman/paramedic in West Texas where he served on the Midland Fire Department from 1998-2004.   He became interested in testosterone treatment after seeing how hormone replacement doctors helped those suffering from low testosterone.   After graduating from the Texas Tech Health Sciences Center Physician Assistant Program, he moved to DFW where he currently lives with his wife and three children.

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