Your specialist for gynecomastia in Vienna

Gynecomastia is more or less clearly visible on the bare torso, depending on its severity. If it is only mild, it is more noticeable in a side view or in a semi-profile, i.e., with the torso turned at a 45° angle. In this view, the protruding nipple stands out, while the torso forms the body’s silhouette. If it is more pronounced, the protrusion is also visible under close-fitting clothing (T-shirt), and in extreme cases (B/C cup size in men!), it can hardly be concealed. As already mentioned, gynecomastia is almost always not a disease; however, in rare cases, it can be the result of a pathological hormonal imbalance.

Since men with breast tissue can develop breast cancer, in Austria, the costs for the removal of breast tissue in cases of true gynecomastia are covered by social insurance; thus, the presence of breast tissue in men is recognized as a medical condition, even if the cause is not pathological.

One in two men has breast tissue behind the areola. If these cells have a positive hormone receptor for estrogen (one of the female sex hormones, which is also produced in the adrenal glands of men), these cells would grow and enlarge when estrogen levels in the blood rise. This is precisely what happens during puberty: in young men, testosterone levels rise. The body perceives this as a hormonal imbalance, so the adrenal glands produce more estrogen to compensate; therefore, the breast tissue grows significantly during puberty, provided, of course, that the hormone receptor is positive. After puberty, testosterone levels drop again, and with them, estrogen levels. The breast tissue regresses—but not always: in about one in every 100 men, this regression does not occur, and a ‘true’ gynecomastia remains. This is generally neither dangerous nor pathological.

A similar process occurs in newborns (effect of placental hormones on the breast) – after a few weeks it recedes.

Due to the natural decline in testosterone levels with age, the level of LH (luteinizing hormone) rises as a compensatory mechanism. This leads to increased estrogen production in the adrenal glands.

Up to 1% of adult men are affected (i.e., one in every hundred), with approximately 95% of cases presenting as mixed forms (breast glandular tissue and increased fat), as previously mentioned. Around 60% of adolescents during puberty, particularly around the age of 14, experience temporarily enlarged breasts.

The causes can be varied, but are fundamentally similar: any pathological changes in the male hormonal balance can lead to true gynecomastia if they are associated with reduced testosterone production or an excess of the female hormone estrogen.

Since breast tissue is very sensitive to fluctuations in the male hormonal balance, disturbances in this balance can promote the growth of the male breast. Therefore, all factors that can interfere with the hormonal balance are risk factors for true gynecomastia.
… This hormonal imbalance can have various underlying causes:

● Pituitary tumors
● Adrenal tumors
● Lack of testosterone effect despite normal hormone production (androgen resistance)
● Klinefelter syndrome (congenital absence or malformation of the testes, 47-XXY)
Since the liver breaks down hormones such as estrogen, a chronic liver disease like cirrhosis can lead to an excess of female hormones.

Chronic kidney dysfunction, such as renal insufficiency, can also affect the hormonal balance by altering the kidney’s filtering function.

The loss of one or both testicles can also lead to true gynecomastia, as the estrogen-to-testosterone ratio can change to such an extent that breast tissue proliferates.

Since the loss of one or both testicles, true gynecomastia can occur because the estrogen-to-testosterone ratio can change so drastically that breast tissue develops. Similarly, an overactive thyroid (hyperthyroidism) can lead to an altered hormonal balance that promotes gynecomastia.

Enlarged male breasts often occur in cases of obesity. The likely cause here is increased fat storage, which stores estrogen. Increased fat means increased estrogen, so obesity can also induce breast growth. In this case, of course, increased fat is also a contributing factor.

Anorexia nervosa can also lead to the development of gynecomastia due to the drop in testosterone levels.

Another cause of gynecomastia can be medications, drugs, and personal care products. Antidepressants, antibiotics, and heart medications can also affect hormone metabolism. Furthermore, long-term use of heroin, marijuana, and alcohol can be a possible cause of hormonal changes leading to true gynecomastia. A common cause of drug-induced gynecomastia is the use of anabolic steroids, which is unfortunately often the case among bodybuilders.

There are hair and skin care products that contain small amounts of synthetic female hormones. These can be absorbed into the bloodstream through the scalp and skin. Chemical substances in tea tree and lavender oil (which are not 100% natural) are also suspected of acting like estrogens. All of these can also lead to true gynecomastia.

In young adult men, the normal estrogen level is approximately 20 to 40 picograms per milliliter of blood, while the normal testosterone level is approximately 6 nanograms per milliliter of blood.

The testosterone/estrogen ratio is therefore approximately 200 to 300. If pseudogynecomastia develops due to age-related obesity, the fat tends to accumulate in the male breast. However, lipomas can also be the cause of the condition.

If a man experiences breast growth or feels a lump behind the areola, he should consult a doctor. The most important diagnostic steps include:

● Mammography
● Breast ultrasound
● Hormone levels
If the hormone levels are abnormal, the cause must be investigated and, of course, treated before any surgery.

To help the doctor distinguish between pseudogynecomastia and true gynecomastia, it is helpful to palpate the breasts. This allows for a quick differentiation between glandular tissue and fat. The diagnosis can also be reliably confirmed with ultrasound and mammography (X-ray). Hormone levels are measured to rule out any underlying medical condition.

If the male breasts have been present since birth or the doctor cannot determine a cause, a chromosome analysis can help rule out a genetic disorder. Often, such an examination is only performed for cost reasons if there are further indications of a genetic condition.

If the diameter of the areola in a man exceeds 3 cm, gynecomastia is often present.

Breast growth can be classified into the five Tanner stages based on the size and shape of the nipple:

● B1: The mammary gland is palpable.

● B2: The mammary glands protrude and the areola is enlarged.

● B3: The mammary gland is larger than the areola.

● B4: The areola is raised and the mammary gland appears solid.

● B5: At this stage, the male breast corresponds to the mature female breast.

Gynecomastia means the growth of breast glandular tissue.

Lipomastia describes a pure accumulation of fat without glandular tissue.

In 95% of cases, a mixed form is present.

No. Removed breast tissue does not usually grow back.

However, significant weight gain or hormonal changes can affect its appearance.

The incision is usually made at the edge of the areola.

The resulting scars are generally very inconspicuous.

In Austria, if glandular tissue is confirmed, social insurance covers its removal.

Liposuction or skin tightening procedures are usually privately funded.

Light social activities are usually possible after 10–14 days.

Sports should be avoided for several weeks.