The Main Causes of Gynecomastia
The causes of gynecomastia are easy to identify if you know what to look for. Hormonal fluctuations are generally the root cause of gynecomastia (gyno, man boobs, male breasts, and bitch tits), caused from puberty, medications, or a pituitary tumor.
2 Hormonal Influences for Developing Gynecomastia
1. Estrogen
Estrogen and Puberty Causes of GynecomastiaEstrogen based gynecomastia generally develops during a man’s teenage years. As a teenager this is a time when testosterone levels are its highest. Since estrogen is one of the main metabolites of testosterone, it increases on par. Some teens tend to have more of a problem than others, either due to their higher testosterone levels or they are more sensitive to estrogen’s effects. Hardness behind the nipples, soreness, and enlargement typically occurs.
Estrogen Increases Breast Size
This is also why women on the birth control pill usually go up a cup size, due to its higher estrogen content If caught early enough, estrogen lowering medications like Arimidex (Anastrozole), Aromasin (Exemestane), or Femara (Letrozole), aka aromatase inhibitors, can shrink the mammary tissue resulting in the gland returning to its former size. However, if the gynecomastia has been allowed to settle, typically for a few months or longer, the tissue growth may become permanent. The only option thereafter is gynecomastia surgery to remove the offending tissue. Most of the time teenage boy’s gynecomastia does not become permanent. It’s usually for such a brief time, alongside moderate estrogen levels, the breast tissue does not get a chance to harden.
Estrogen and Anabolic Steroids
The most common steroids that increase estrogen being testosterone and Dianabol (Methandrostenolone). The estrogen levels attained during a steroid cycle are many folds higher than puberty, resulting in a much higher probability of developing gynecomastia. This is especially true for men that are predisposed to developing gyno. A common preventative measure for developing gynecomastia during a steroid cycle is to take medications known as aromatize inhibitors (AI’s). Drugs like Arimidex, Aromasin, or Letrozole can prevent the conversion of testosterone and other anabolic steroids to estrogen.
Alcohol, Marijuana and EstrogenExcessive alcohol and marijuana consumption can lead to gynecomastia due their effects of increasing estrogen. Marijuana is a well known offender in this regard.I'm not condoning drinking or marijuana use but if it's something you enjoy often either keep it to a minimum or make sure you have something in place to reduce your increased estrogen. Prolactin and Breast Tissue Causes of GynecomastiaProlactin is the hormone primarily responsible for producing breast milk in pregnant women. In men, prolactin governs the refractory period (time before you have sex again) and decreasing sex drive/libido after ejaculation. It’s what makes you want to have a nap after sex! Prolactin levels generally rise from the consumption of certain medications, or after developing a pituitary tumor.
Drugs and Medications that Increase Prolactin- DHT (Dihydrotestosterone) lowering medications for hair loss and enlarged prostate (BPH)- Finasteride (Propecia/Proscar), Dutasteride (Avodart)
- Dopamine antagonists (antipsychotics/aeuroleptics) for mental illness/psychosis
- Zyprexa (Olanzapine), Risperdal (Risperidone), Seroquel (Quetiapine)
- Testosterone lowering medications for prostate cancer
- Bicalutamide (Casodex), Goserelin (Zoladex), Cyproterone (Androcur), Flutamide (Euflex), Megestrol (Megace), and Nilutamide (Anandron)
- Progestin based anabolic steroids and steroids with progestin metabolites
- Trenbolone (Finaplix), Nandrolone (Deca Durabolin), Oxymetholone (Anadrol)
When prolactin levels get too high it may also cause the production of breast milk in men! It’s a side effect that strikes deep in to the heart of a man’s ego. As you can well imagine men are not supposed to lactate! It’s generally a warning sign something is going wrong with your medication treatment and/or other bodily functions.
Prolactin TreatmentTwo things can be done to reduce prolactin levels. Either reduce or remove the offending medication or take a prolactin inhibitor aka the class of medications called dopamine agonists. Two dopamine agonists are generally used in this case;
- Cabergoline (Dostinex, Cabaser)
Cabergoline is generally the most effective and tolerated medication amongst the two, resulting in lowering prolactin values and side effects. Talk to your doctor about which treatment may be best for you.
Pituitary Tumors and ProlactinAlthough rare, sometimes a pituitary tumor develops resulting in increased prolactin levels. Typical treatments involve the medications Mirapex and Cabergoline as a first line treatment, or surgery to remove the offending tumor as a secondary treatment.
Prolactin levels may rise extremely high in the case of pituitary tumors, which makes it one of the causes of gynecomastia quite common. If the gynecomastia has been around for while, you most likely will need surgery to have the increased breast tissue removed.
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Estrogen is the primary reason why women have larger breasts than men. It’s promotes tissue growth of the mammary gland and surrounding areas.
Another one of the causes of gynecomastia is through increased estrogen from the use of aromatizing (converts to estrogen) 
