Gynecomastia cannot be corrected with chest exercises.

Grade of Gynecomastia

There are several possible causes of gynecomastia for adult men. It may be simply a remnant of adolescence. For adult onset of gynecomastia, some of the major causes are the following:

• Persistent gynecomastia for the adolescent: 25 %
• Drug induced: 10–25 %
• No detectable cause: 25 %
• Malnutrition and Liver disease: 8 %
• Primary hypogonadism (deficient testes): 8 %
• Tumors of the testes: 3 %
• Secondary hypogonadism (low sperm count): 2 %
• Hypothyroidism: 1.5 %

As you can see above, 25 % of the cases are unresolved from adolescence. The rest are unknown causes, hormone or drug induced. As men get older, testosterone gradually decreases and estrogen levels gradually increase. This accounts for hormone induced gynecomastia in many cases for some adult men.

“Low T” or low testosterone is a term that we hear commonly. The low T brings on a syndrome called “andropause”; this is similar to menopause for females. Testosterone is a male hormone that is produced in the testes and is responsible for stimulating sperm production and sex drive. This hormone is also responsible for muscle mass and bone density. As men age, the production of testosterone reduces. When this occurs, a range of symptoms can occur. Signs of low T are often subtle and are mistaken as a natural part of aging.

• Gynecomastia-As low T occurs the estrogen levels can increase causing breast development.
• Low sex drive- Testosterone plays a significant role in men’s libido. As men age, many of them experience a reduction in sex drive.
• Low semen volume- The male hormone Testosterone plays a major role in the production of semen, the liquid that helps in sperm motility. It’s simple: the more male hormone a man has the greater semen production.
• Hair loss- Men with reduced testosterone may experience a loss of body and facial hair.
• Fatigue and lack of Energy- Males with low T have reported fatigue and a decrease in energy levels.
• Loss of muscle- With low T one may note loss of muscle strength and mass especially in their arms, legs, or chest.
• Increases in body fat-Men with low T also experience an increase in body fat. The reasons are unclear.
• Decrease in bone mass- Osteoporosis
• Mood Change- Testosterone is thought of as “fuel” for men. It drives many bodily processes, in addition to mood and mental health. Men with low T are more likely to have depression, low focus and irritability
• Pseudo-gynecomastia is fat deposits causing development of the male breast, rather than enlargement by glandular tissue, as it is with gynecomastia. Pseudo-gynecomastia is usually attributed to aging and/or gaining weight. The average patient states that his male breasts were not present in his teens, but developed at a later time in life as he gained weight. For the pseudo-gynecomastia patient many times it is possible to get a pleasing result with just liposuction.
• A variety of medical condition may cause male breast enlargement
• Malnutrition and liver disease
• Men with disorders of the sex organs may have reduced production of testosterone and high levels of estrogen, which can lead to gynecomastia. Some genetic disorders, for example Klinefelter’s syndrome, trauma, reduction of blood flow, infection, or aging.
• Hyperthyroidism and chronic renal disease. Cancer rarely occurs except testicular tumors which can produce hormones which may cause gynecomastia.

Many drugs are known to have gynecomastia as a result. The following are drugs associated with male breast enlargement.

• Calcium channel blockers which are used for controlling high blood pressure.
• Spironolactone (Aldactone) which is a diuretic and having anti-androgen activity.
• ACE inhibitor medications for high blood pressure such as; captopril (Capoten) and enalapril (Vasotec).
• Various antibiotics such as; isoniazid, metronidazole (Flagyl), and ketoconazole (Nizoral, Kuric, Xolegel, Extina).
• Anti-ulcer drugs like; cimetidine (Tagamet), ranitidine (Zantac), and omeprazole (Prilosec).
• Antiandrogen therapy for cancer of the prostate.
• Methyldopa [Aldomet]
• Highly active antiretroviral therapy [HAART] which is for treatment of HIV disease that can lead to fat accumulation which may lead to pseudo-gynecomastia or true gynecomastia.
• Diazepam (Valium).
• Digitoxin, heart medication.
• Drugs used for abuse (such as, marijuana, alcohol, and heroin).
• Skin care products containing tea tree and lavender oils.
• There are many reasons for adult onset gynecomastia. It is important to determine the source before surgery. Once we establish a source we can comfortably proceed with surgery.
• The treatment for adult onset gynecomastia is the same as the others, i.e., breast gland excision and liposuction