The cause of gynecomastia is multifactorial:

Idiopathic

many cases A DEFINITE cause is elusive. Idiopathic causes are the most common (25%). Most authorities attribute the condition to stimulation of breast tissue by excess circulating estrogens or estrogen-like substances;or a defect in androgen receptors Decreases in the androgen-to-estrogen ratio have also been associated with development of gynecomastia.

Developmental/Physiological Gynecomastia

Neonatal: In newborn baby because of maternal circulating hormone. It is self limiting condition. Go by itself in few months

Pubertal: More than 2/3 of the adolecent boys have small to severe gynaecomastia relative excess of plasma estradiol compared with testosterone is believed as the cause of pubertal gynecomastia

Aging: Increasing the plasma estrogen-to-androgen ratio at old age leads to breast enlargement .plasma testosterone levels decline and peripheral conversion of testosterone to estrogen (peripheral aromatization) occurs,

Hypogonadism (decreased androgen synthesis or increased androgen resistance):

Primary

Acquired (trauma, infection, torsion,radiation exposure, mumps, chemo therapy)

Congenital

Secondary

Hypogonadotropic hypogonadism

Kallmann’s syndrome

Pituitary failure (infarction, infection, neoplasm)

Tumors (increased estrogen production):

Steroid-producing (adrenal, testis)

HCG-producing (testis and others)

Aromatase-producing (testis)

Bronchogenic carcinoma

Systemic:

Thyrotoxicosis (altered testosterone/estrogen binding)

Renal failure (acquired testicular failure)

Cirrhosis (increased substrate for peripheral aromatization)

Adrenal (ACTH deficiency or congenital adrenal hyperplasia)

Congenital Disorders:

Klinefelter’s syndrome

Enzyme defects of testosterone synthesis (may be late onset)

Vanishing testis syndrome (anorchia)

Androgen resistance syndromes

True hermaphrodism and related conditions

Increased peripheral tissue aromatase

Familial:

HIV

Chest wall trauma

Psychological stress

Spinal cord injury

Malnutrition: When your body is deprived of adequate nutrition, testosterone levels drop, but estrogen levels remain constant, causing a hormonal imbalance.

Herpes zoster infection

Cystic fibrosis

Alcoholism

Myotonic dystrophy

Medications

These include antidepressants, cancer treatment, antibiotics, AIDS medications; substance abuse like alcohol or drugs and many more. While consulting with the physician, it is important to discuss the usage of the medicine so that the doctor can provide accurate treatment.

Health Conditions

Hypothyroidism

Hyper thyroidism/ thyrotoxicosis

kidney disease

liver failure and cirrhosis

Adrenal dysfunction

Note: Medical treatment of associated condition is necessary buy they hardly succeed to reduce developed male breast. Only surgery is the definitive solution for gynaecomastia.

Consistancy Of Gynaecomastia

Gynaecomastia contain glandular tissue and fatty tissue in various proportion. Usually gland is felt as soft rubbery mass beneath areola. When glandular tissue is predominant, it is hard. And when it is mostly made of gland tissue it is called glandular gynaecomastia usually it is mix of both tissue when fat is predominant it is soft when practically no gland and gynaecomastia is composed of fat only it is called pseudogynaecomastia. It reduces with weight loss like the diet and exercise.

Associated risks of male breast cancer

The occurrence of male breast cancer is 1 in 400 to 1 in 1000. One percent of all breast cancer occurs in males. However, patients with klinefelter’s Syndrome have up to a 60 times greater risk of developing breast cancer. Many studies reviewing males with gynecomastia have demonstrated no increased risk of breast cancer compared with The normal male population. Thus in all non-klinefelter’s patients it is reasonable to Treat gynecomastia surgically with both liposuction and excisional techniques.