Some enlargement of male breast tissue commonly occurs during puberty, and the incidence of noticeable, transient, pubertal breast enlargement has been reported to be as high as 60%. For most males this hormone-related breast enlargement is temporary, but for some individuals the breast tissue proliferation will persist and even increase in size.
For the majority of men with gynecomastia, no clear causative factor can be identified. It is thought that some cases of gynecomastia may relate to an imbalance between circulating levels of estrogens, which stimulate breast tissue development, and androgens including testosterone which counteract estrogen effects. Because gynecomastia may rarely be associated with endocrine (hormone) disorders, testicular tumors, and the use of some medications/drugs, it is important that you discuss the condition with your primary care physician prior to surgical treatment.
Testosterone deficiency (TD) is actually quite common, and it is now well understood that testosterone levels tend to decrease significantly in most men at or around the age of 50 (sometimes called 'andropause' or 'male menopause'). I have had a number of patients begin testosterone replacement therapy (TRT), under the direction of their primary care physician, either prior to or following their consultation appointment for gynecomastia surgery. While TRT can improve energy level, mood and libido in patients with TD, it unfortunately does not appear to reverse or improve gynecomastia in most cases.
Male breast enlargement can occur as a result of significant weight gain, in the absence of actual breast tissue excess. This is sometimes referred to as "pseudogynecomastia", which implies that the breast has enlarged because of the accumulation of fatty tissue only. While it is true that male breast enlargement in some cases is primarily due to excess body mass / obesity, in many cases patients who appear to have "pseudogynecomastia" turn out to have a significant amount of fibrous breast tissue as well. This is not that surprising, given the fact that it has been shown that the condition of being overweight can upset the balance of estrogens and androgens in favor of estrogens (sometimes called a "pro-estrogenic state"), which is a set-up for the development of true gynecomastia.
Male breast enlargement associated with excess body mass / obesity may improve with weight loss. In many men, however, the feminized appearance of the breast will persist, due to underlying true gynecomastia, incomplete regression of breast area fat, persistent skin excess after weight loss, or some combination of the three.
Increasingly patients are being seen for gynecomastia that develops after using 'prohormone' and/or anabolic steroid supplements as part of a bodybuilding regimen or to improve athletic performance. While the goal is to increase muscle mass, strength and performance, some of these agents and supplements can be converted by the body into estrogen-like compounds. Additionally, supplemental androgens may suppress the normal production of natural androgens by the testes. These factors can tip the balance of androgens and estrogens in favor of the estrogens, which then stimulates the development of breast tissue and results in visible breast enlargement. This form of breast enlargement generally persists after supplement use is stopped, requiring surgical treatment.