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Why Does Gynecomastia Occur?

March 28, 2013

Gynecomastia, often described as male breast enlargement or puffy nipples, is more common than most men realize. It can affect one or both sides of the chest, creating physical and emotional discomfort. But why does gynecomastia occur in the first place? Understanding the causes of gynecomastia is the first step in taking control of the condition—and finding the right treatment option.

Hormonal Imbalance Is the Most Common Cause

The most frequent cause of gynecomastia is a hormonal imbalance between estrogen and testosterone. While both hormones are present in males and females, even a slight increase in estrogen or a drop in testosterone can stimulate the growth of breast tissue in men.

This hormonal shift can happen naturally during different life stages:

  • Puberty: Temporary gynecomastia is common in teenage boys and often resolves on its own within 6–12 months.
  • Aging: As testosterone levels decline with age, older men may develop gynecomastia.
  • Medical conditions: Hormonal disorders, such as hypogonadism or hyperthyroidism, can also trigger breast tissue growth.

Medications and Substance Use Can Play a Role

Certain medications are known to cause gynecomastia as a side effect. These include:

  • Anti-androgens (used for prostate conditions)
  • Anabolic steroids
  • Antidepressants
  • Anti-anxiety medications
  • Heart medications, like calcium channel blockers
  • Some antibiotics and ulcer medications

Additionally, alcohol, marijuana, and other recreational drugs can disrupt hormonal balance, potentially leading to breast tissue development.

Body Fat and Pseudogynecomastia

While true gynecomastia is caused by glandular breast tissue growth, excess fat in the chest can mimic its appearance. This condition is known as pseudogynecomastia. Although it looks similar, pseudogynecomastia is primarily fat—not glandular tissue—and may respond to weight loss or lifestyle changes.

However, many men with gynecomastia have a combination of both fat and glandular tissue, requiring a more advanced surgical approach to fully resolve.

Health Conditions That May Contribute

The causes of Gynecomastia can also be linked to underlying health issues, including:

  • Kidney failure
  • Liver disease or cirrhosis
  • Tumors affecting hormone production
  • Malnutrition or starvation
  • Klinefelter syndrome (a genetic condition)

If your gynecomastia seems sudden or severe, a full medical evaluation is recommended.

When It Doesn’t Go Away on Its Own

In some cases, gynecomastia does not resolve naturally—even after addressing lifestyle or medication changes. That’s where gynecomastia surgery becomes the gold standard. At our practice, board-certified plastic surgeon Dr. Joseph Cruise specializes in advanced surgical techniques tailored to the specific type of gynecomastia you may have.

We serve men throughout Los Angeles, Newport Beach, and Southern California who are ready to take the next step.

Ready to Get Rid of Gynecomastia?

If you’re tired of hiding your chest or dealing with the emotional toll of puffy nipples and breast enlargement, help is available. Schedule a consultation today and find out if you’re a candidate for male breast reduction surgery. The first step is understanding the causes of gynecomastia, and we’re here to guide you through it.

Plastic Surgeon | Website |  + posts

Dr. Joseph Cruise is a board-certified plastic surgeon with over 20 years of experience. Regarded as one of the top gynecomastia surgeons in the world, Dr. Cruise has gynecomastia-specific content that can be found at lagynecomastia.org. Dr. Cruise has dedicated his career to cosmetic surgery but has also had extensive training in General Surgery, Hand Surgery, and Microvascular Surgery. Dr. Joseph Cruise is also a member of the Rhinoplasty Society as well as the American Society of Plastic Surgeons.

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