Introduction
Most of the cases handled by plastic surgeons of gynecomastia or moobs as they are sometimes referred to, are physiologic gynecomastia. Breast enlargement in males can occur during 3 stages of life: neonatal, pubertal and elderly.
Underlying Mechanism – Gynecomastia Cause
To understand the mechanism of male breast development, one should know the mechanism of female breast development as both of them are similar.
During thelarche or development of breasts, the breast bud appears and growth and division of the ducts occur, ultimately giving rise to alveolar buds. The alveolar buds will then aggregate around a terminal duct forming what is known as a Type 1 lobule. These Type 1 lobules will then mature into Types 2 and 3 lobules.
There is a very complex interplay of hormones in breast development. Estrogen promotes ductal growth and progesterone promotes alveolar development. These hormones stimulate breast development in association with other hormones secreted from the brain like GH and IGF-1, which is stimulated by GH.
Without going into the details, it is sufficed to know that the male hormone testosterone has an inhibitory action on the breast tissue. Thus, the development of breast tissue in males happens when the level of testosterone is less compared to the estrogen levels or there is a malfunction of the receptor through which testosterone works. Additionally, too much testosterone can also lead to development of breast tissue in males as the testosterone is converted to estrogen by the enzyme aromatase. Overactivity of aromatase can also lead to gyno in men.
Neonatal Gynecomastia
This occurs in male children shortly after birth. The mother normally secretes estrogen and progesterone and these then enter the fetus which results in high circulating levels of these hormones in the newborn. A milky breast discharge known as “witch’s milk” may also be seen. There are other hormonal factors which will not be elaborated. As the levels of circulating female hormones fade away, so does the breast swelling.
Pubertal Gynecomastia
During puberty, there is another period of hormonal imbalance. Estrogen levels rise in males during puberty. This occurs throughout the day which results in gyno in males in as many as 60% of adolescent boys by the age of 14.
At the same time, however, there is increased secretion of testosterone especially during morning hours. This testosterone then starts countering the effects of estrogen by causing ductal regression. This can occur over a period of 3-4 years, that is why many cases of pubertal gynecomastia would not need surgery and would regress by themselves. Those that remain however, will need surgical correction to get back the ideal male chest.
It has been observed that boys who develop gynecomastia have a decreased androgen to estrogen ratio during pubertal years but this usually does not mandate any active intervention.
Gynecomastia in Elderly Men
36-57% men aged more than 60 years develop some degree of gynecomastia. Male aging results in a decreased secretion of testosterone, increased activity of aromatase because of increased body fat resulting in conversion of testosterone to estrogen and an increase in another hormone known as LH. Additionally, elderly men may take multiple medications which may result in gynecomastia in males.
For more information, check out:
https://gynecomastias.com/gyne-info/
Prof. (Dr.) Souvik Adhikari is one of the best gynecomastia surgeons in Kolkata and India and has successfully treated gynecomastia patients for more than 12 years. If you want to address your gynecomastia problem, you can get in touch with him.