Examining the Causes of Gynecomastia

By Dr. Ashley Cowan, pediatric resident at CHOC Children’s

Gynecomastia is breast tissue that forms in males.  Males can also have excess adipose (fat cells) tissues in this same region, but gynecomastia is different. Typically, the formation of this breast tissue is caused by an imbalance of estrogen and androgens in the body, which is very common in the early stages of puberty. While it may or may not be noticeable to others, this tissue often will feel like a firm bump, and is sometimes tender. Commonly it occurs on both sides of the chest, but it may also appear on only one side.

This condition is surprisingly common. Up to two-thirds of boys actually develop gynecomastia during puberty, and it’s considered a normal part of adolescent development. For the majority of males it is temporary, usually lasting anywhere from six-12 months. There are three times in a male’s life when breast tissue may form:

  • As a newborn- 60-90 percent of male babies have gynecomastia from exposure to the mother’s estrogen.
  • During puberty- it might develop during early puberty, but usually resolves on its own.
  • Later in life- elderly men often develop breast tissue as the result of a decrease in testosterone levels.

There are some medications that can cause gynecomastia including gabapentin, an anti-epileptic medication; metoclopramide, prescribed for stomach and esophageal problems; ulcer and acid reflux medications like ranitidine or omeprazole, and some antipsychotic medications such as risperidone. In fact, over 300 medications have potentially been associated with the development of breast tissue, usually reversible when the medication is discontinued. Herbal or ‘natural’ medications that contain estrogen also can lead to gynecomastia. Steroids, alcohol, heroin and heavy marijuana use also can stimulate the development of breast tissue.

There are a few rare syndromes and other causes for breast tissue development, which is why it is important to discuss the presence of breast tissue with your primary care provider.  These causes can include:

  • Hyperthyroidism or renal and liver disease. These can affect the balance of hormones in the body.
  • Certain tumors that produce estrogen.
  • Some genetic syndromes that may also lead to altered estrogen and testosterone levels.

If your child has breast tissue development between the ages of 3 months and before puberty has started, if the breast tissue that developed is larger than 4 cm, or if it occurs after puberty has completed, consult your child’s pediatrician. Be sure to let your doctor know if you notice discharge or liquid coming from the nipples or if the breast tissue is not resolving.  Your provider will help determine if any additional testing is needed.

The majority of patients have physiologic (normal) and temporary causes of gynecomastia. Typically, this breast tissue will resolve on its own and no intervention is needed. It can take from a few months up to two years to resolve completely. The breast tissue itself is not harmful and surgery should only be considered for those with significant distress for cosmetic reasons.

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