What Is Gynecomastia?
Gynecomastia is the benign proliferation of glandular breast tissue in males, resulting in visible or palpable breast enlargement. It is distinctly different from pseudogynecomastia (breast enlargement due only to adipose tissue, without glandular proliferation). True gynecomastia involves actual glandular breast tissue development beneath the nipple-areola complex. It is extremely common — present in an estimated 30–60% of males at some point in their lives.
Causes and Hormonal Drivers
Gynecomastia results from an imbalance between oestrogen and androgen (testosterone) effects at the breast tissue level. The male breast contains oestrogen receptors, and when the oestrogen-to-androgen ratio increases, glandular proliferation can occur. Causes include: physiological (neonatal, pubertal, and age-related hormonal shifts); drugs and medications (spironolactone, digoxin, cimetidine, anabolic steroids, opioids, certain antipsychotics); chronic disease (liver disease, kidney failure, hypogonadism); and tumours producing oestrogen or hCG.
Prevalence by Life Stage
Gynecomastia is most common during three life periods: neonatal (60–90% of newborns, caused by maternal oestrogen transfer; resolves within weeks); pubertal (50–70% of adolescent males, typically regressing within 6–24 months); and ageing (24–65% of men aged 50–80, related to declining testosterone and increased peripheral oestrogen conversion in adipose tissue).
Treatment
For physiological or drug-induced gynecomastia, addressing the underlying cause or stopping the causative medication often leads to regression if caught early. Established glandular tissue (fibrotic gynecomastia) does not regress spontaneously. Surgical treatment is excision of the glandular tissue through a periareolar incision, often combined with liposuction for concurrent lipomastia. Medical management with selective oestrogen receptor modulators (tamoxifen, raloxifene) is used in early-stage cases.
