Gynecomastia involves a multifaceted process related to various hormonal changes occurring in the male body. This occurs when the balance of activities of estrogens and androgens on the glandular tissue are affected. Estrogens as steroid compounds effectively stimulate the development of mammary glands. On the other hand, androgens faintly slow down this growth. Other assumptions related to this condition include high levels of estrogen, or free testosterone is low, irregular ratio between testosterone and estrogen, among others. Nevertheless, the causes are not as clear for majority of patients.
Estrogen compounds typically attach more passively to sex hormone-hormone binding globulin (SHBG) as compared to testosterone, a form of androgen. Consequently, different medications may possibly transfer more estrogens in comparison to the amounts of testosterone from SHBG. This affects the balance of estrogen and testosterone levels in the body favoring the estrogen. In the same way, systemic problems like long term liver conditions or hyperthyroidism lead to high concentrations of SHBG. This in turn results to reduced bioavailability of testosterones compared to estrogens.
Hence, different drugs such as chemotherapeutic medications, antibiotics, anti-androgens, hormones, anti-ulcers medications, among others as well as factors in the environment may lead to this condition. A lot of the drugs associated were founded from anecdotes of small series and casual observations. However, these have not gone through thorough cause-effect investigations.
The involvement of decreased levels of testosterone hormones compared to estrogen is very significant in developing gynecomastia. There are other conditions that may impact the balance of hormones. These include as follows:
•Naturally occurring hormonal changes
Infants – fifty percent of male newborns have enlarged breasts related to the effects of estrogen from the mother. The condition may improve weeks following delivery.
Puberty – Hormonal changes in puberty occurs which sometimes affect the appearance of male breasts. This improves after a few months or at the most two years with no medical intervention.
Older adults – The final peak of this condition occurs between the ages 50 to 80 years. One out of four male adults is affected within this age range.
•Drugs
Some drugs can cause enlarged breasts among male individuals. Among these medications are the following:
Anti-androgens – like spironolactone, flutamide, and finasteride for management of prostate enlargement or carcinoma and other health problems.
Anabolic-androgenic steroids and androgens
Medications and cocktails for AIDS – such as highly active antiretroviral therapy (HAART). A typically related medication for HIV that may cause this condition is Efavirenz.
Anti-anxiety drug like diazepam
Antidepressants
Antibiotics
Ulcer meds like cimetidine
Chemotherapeutic drugs like alkylating agents
Drugs for managing heart ailment like digoxin and CCBs
•Other substances
Alcohol, marijuana, heroin, amphetamine, and methadone are other substances that cause enlarged breasts among males.
•Health problems
A number of illnesses or health conditions such as aging, hypogonadism, tumor, hypothyroidism, kidney failure, liver failure and cirrhosis, and severe hunger and malnutrition can lead to enlarged breasts because of the way they affect the balance of hormones in the body.
•Herbs and herbal products
Tea tree and lavender come from botanical plants. They have insubstantial estrogen activity. These substances are incorporated in the manufacture of lotions and soaps which are believed to cause enlarged breasts or gynecomastia.
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