Is Gynaecomastia Genetic? Exploring the Causes and Risks

Causes of Gynaecomastia

Primarily, Gynaecomastia results from a hormonal imbalance between oestrogen and testosterone. While testosterone is responsible for male characteristics like muscle mass and body hair, oestrogen regulates fat distribution and the growth of breast tissue. When oestrogen rises or testosterone levels drop drastically, abnormal development of breast tissue takes place.

Now, let us go through some causes of Gynaecomastia:

1. Hormonal Imbalances

• Puberty: The temporary rise in oestrogen levels at puberty may cause some breast tissue enlargement in the breasts of teenage boys. This generally disappears within a couple of years since the hormone levels will have stabilised then.

• Ageing: As men advance in age, testosterone levels may decline, body fat rises and this can subsequently cause higher levels of oestrogen. These changes thus trigger the incidence of Gynaecomastia.

2. Medications

Several drugs have been associated with Gynaecomastia because they affect hormone levels:

• Anti-androgens: Drugs used to treat conditions of the prostate, e.g., finasteride, flutamide, and bicalutamide, block testosterone and can cause Gynaecomastia.

• Anabolic Steroids: Bodybuilders and athletes who use anabolic steroids commonly experience Gynaecomastia because when there is too much testosterone in the body, the excess is converted to oestrogen.

• Antidepressants and Anti-Anxiety Drugs: Some SSRIs and benzodiazepines disrupt hormone levels.

• Heart Medications: Medications such as digoxin and calcium channel blockers can lead to Gynaecomastia.

• Medications for Ulcer and Acid Reflux: Proton pump inhibitors, H2 blockers, ranitidine, and omeprazole can alter hormones and cause breast enlargement.

• Anti-fungal medications: Certain anti-fungal drugs can treat changes in testosterone production. For example, ketoconazole.

• Chemotherapy and Cancer Treatment: Certain kinds of treatment for cancer, even some prostate cancer treatments, decrease levels of testosterone but increase oestrogen.

3. Health Conditions

Certain health conditions disturb the production of hormones, thus increasing the chance of developing Gynaecomastia. These include:

• Liver Disease and Cirrhosis: Since the liver clears hormones, its damage causes the level of oestrogen to increase.

• Kidney Failure: Chronic renal failure may cause an imbalance in the production of testosterone, resulting in Gynaecomastia.

• Hyperthyroidism: Since the thyroid controls metabolism, an overactive thyroid may lead to a higher level of oestrogen.

• Tumours: Tumours in either the testicles, adrenal glands, or pituitary gland can lead to an increase in oestrogen.

• Obesity: More body fat can mean more oestrogen being produced, and therefore, the development of Gynaecomastia.

4. Substance Use and Lifestyle Factors

• Alcohol: Heavy drinking will damage the liver, which will disrupt hormone metabolism.

• Recreational Drugs: Marijuana, heroin, and amphetamines have been implicated in causing Gynaecomastia.

• Soy Products: Some evidence has linked excessive soy product intake with Gynaecomastia because of the phytooestrogens found in soy. However, this is controversial.

• Malnutrition and Starvation: During malnutrition or starvation, testosterone levels fall while oestrogen levels generally remain relatively stable thereby resulting in the development of Gynaecomastia.

Risk Factors for Gynaecomastia

While Gynaecomastia can appear in males of any age, there are several factors that make you more likely to have Gynaecomastia. This allows men to take preventive measures and get treatment at earlier stages when needed.

1. Age and Life Stages

• Babies: Many baby boys are born with a mild case of Gynaecomastia because of their mother's oestrogen in their systems. This typically clears up by itself in a couple of weeks.

• Adolescents: Puberty is the time when Gynaecomastia is most likely to form. This temporary swelling of breast tissue is caused by changes in hormone levels and usually disappears a few months to two years later.

• Older Adults: There is an increased likelihood of developing Gynaecomastia in men over 50 years because of a natural decline in testosterone levels, along with weight gain, which can cause an increase in oestrogen levels.

2. Hormonal Imbalances

Any condition or imbalance that disturbs the harmony of testosterone and oestrogen can also raise the likelihood of Gynaecomastia. These can include:

• Low level of testosterone(hypogonadism): A congenital disorder in birth, ageing and trauma to one or both of the testicles.

• High level of oestrogen production: Obesity or cancers and liver disease can cause such a scenario.

3. Fat and Weight Gain

• Fat encourages oestrogen production, which in turn, leads to the stimulation of breast tissue.

• Obesity also decreases the body's power to regulate hormones thereby increasing the risk of developing Gynaecomastia.

4. Use of Some Drugs

Gynaecomastia is a known side effect in most prescription and some over-the-counter medications, especially:

• Anti-androgen drugs given for prostate disease

• Anabolic steroids that are taken mostly by athletes and bodybuilders

• Digoxin and spironolactone used to treat heart disorders

• Anti-anxiety drugs, and antidepressants

• Chemotherapy agents

• Medicines in treating ulcers and acid reflux disease

5. Chronic Disease Conditions

The presence of chronic disease or health conditions that could increase your chance of suffering from Gynaecomastia are:

• Liver disease – A diseased liver cannot metabolise hormones properly, thus giving rise to the levels of oestrogen.

• Kidney disease – Long-term dialysis patients are more prone to get affected.

• Hyperthyroidism- An overactive thyroid gland can increase the production of oestrogen.

• Tumours – Testicular, adrenal or pituitary gland tumours result in an imbalance of hormones.

6. Substance abuse

Recreational drugs and alcohol may affect the hormones drastically:

• Alcohol abuse – Affects the liver, thus raising oestrogen.

• Marijuana – Some research works have shown that it can lower testosterone levels

• Heroin and opioids – Its chronic use has been linked to lowered testosterone production.

• Amphetamines and steroids – Can disrupt hormones leading to Gynaecomastia.

7. Malnutrition and Starvation

• Hormone levels are altered by these conditions; therefore, when normal feeding is resumed, Gynaecomastia occurs.

8. Genetic and Family History

• If your close male relatives, such as the father, uncles, or brothers, had Gynaecomastia, one natural cause could have been inherited from them.