Physiologic Gynecomastia

Table of Contents

Gynecomastia is the enlargement of a man’s breasts. There are two types of gynecomastia: physiologic and pathologic. Physiologic gynecomastia is completely natural and will go away on its own, but pathologic gynecomastia should be identified and treated as soon as possible. Gynecomastia, whether physiologic or pathologic, does not cause any complications, although it can be embarrassing.

The incidence of physiologic gynecomastia peaks in infants, teenagers, and males over 50 years old. 

Also Read: Gynecomastia Patient Reviews

  1. Gynecomastia in New-Born

Due to the transplacental transfer of maternal estrogens to the baby, up to 65-90 percent of new-born babies (male, female) have palpable breast tissue. Although parents are concerned, new-born gynecomastia generally heals on its own within four weeks after birth. Children with symptoms that last longer than a year should be evaluated further because they may have persistent neonatal gynecomastia.

Why Gynecomastia in neonates happen

It results from the transfer of maternal and placental oestrogen and progesterone; it may persist up to several months

points to be noted:

  • 1. Neonatal breast enlargement is a common reaction to maternal oestrogen levels falling near the end of pregnancy. These cause the pituitary gland in the infant to produce prolactin
  • 2. New-born breast growth is common and can happen both in new-born girls and boys
  • 3. It is usually bilateral, though it may not be symmetrical; if it is unilateral, consider a breast abscess. Also, investigate infective mastitis in a new-born, especially if the infant is ill and the breast enlargement exhibits infection-like characteristics like heat, and erythema 
  • 4. It normally starts in the first week of life and goes away after a few weeks, although it can last for months.
  • 5. An enlarged breast may discharge fluids; this generally goes away on its own within a few weeks. Squeezing the breast to promote discharge can cause pain, additional enlargement, hypertrophied tissue persistence, and, in rare cases, infection (mastitis or abscess)

When to Worry About Swollen Breasts in neonatals

If the breasts appear infected (swollen, red, painful, or discharge) and the infant has a fever, contact your pediatrician to see if an infection has developed.

  1. Gynecomastia in Adolescent

The second peak of physiologic gynecomastia is experienced during puberty. Which is totally normal and you don’t need to be worried.

However, there are chances of pathologic gynecomastia in boys as the result of supplement, substance, or medication use, or from the unmasking of genetic abnormalities with delay of expected pubertal development. 

Although teenage physiologic gynecomastia usually disappears on its own, intervention may be needed to mitigate emotional distress.

Why breast enlargement happens in a boy at puberty

Several processes contribute to the development of gynecomastia during puberty:

  • A. A surge of gonadotropins induces testicular activity
  • B. Oestrogen production by the Leydig cells of the testicle reaches adult levels before that of testosterone
  • C. Also, the peripheral aromatization of weak testicular and adrenal androgens to oestrone and oestradiol, this leads to a relatively low androgen to oestrogen ratio, and development of gynecomastia

Pubertal Gynecomastia Occurrence Rate in Boys:

  • A. Seen in 38 % of boys aged 10-16 years
  • B. Reaching a peak of 65% in 14-year-olds 
  • C. Pubertal gynecomastia resolves in 73% of boys after 2 years and 92% after 3 years 
  •  25% or more of pubertal gynecomastia is unilateral, and when bilateral, the degrees vary

Types of pubertal gynecomastia: 

  • 1. Benign adolescent hypertrophy. This kind of pubertal gynecomastia is distinguished by firm, slightly sensitive breast tissue just under the areola; this is the most frequent type of pubertal gynecomastia.
  • 2. Gynecomastia resembling normal female breast growth – if there is ongoing physical suffering, surgical intervention may be required.
  • 3. Gynecomastia is linked with another disease, such as hyperthyroidism, Klinefelter’s syndrome, or drug consumption. This kind of puberty-related gynecomastia is rare.

There is no need for further examination if the gynecomastia is obviously neonatal or pubertal. But if it is pathological, it should be diagnosed and the causes must be treated.

When to Worry About Swollen Breasts or Lumps in puberty

If gynecomastia in puberty persists more than two years, then you should consult your doctor.

There are also chances of pathologic gynecomastia in rare cases (less than 5%), and may arise from a broad array of uncommon pathological conditions. These may include conditions such as: congenital anorchia, Klinefelter’s syndrome, testicular feminization, hermaphroditism, adrenal carcinoma, chronic liver disease, primary hypogonadism, secondary hypogonadism, testicular tumors, hyperthyroidism, renal disease and malnutrition. On the other hand, several drugs may induce proliferation of male breast tissue.

In case of pathologic gynecomastia, the cause should be eliminated and for cosmetic reasons the surgery can be done. The best surgery option is liposuction combined with glandular excision.

  1. Gynecomastia in men older than 50 years

Gynecomastia is more common in elderly people between the ages of 50 and 80. At least one in every two males in this age range is affected.

As a man ages, the quantity of testosterone in his blood drops. This is frequently accompanied by an increase in subcutaneous fat. This increased fatty tissue causes an increase in the conversion of androgens, such as testosterone, to oestrogen. It is done by Aromatase hormone. The combination of reduced testosterone levels and increased testosterone-to-estrogen conversion has a significant impact in the increasing incidence of gynecomastia in this age group.

There are, of course, additional reasons for gynecomastia in males aged 50 to 80. Gynecomastia can also be caused by medical conditions such as liver disease, hyperthyroidism, and certain medicines. During the consultation, these probable reasons must be checked out.

Physiologic gynecomastia in elderly men can be a cosmetic issue that can be addressed surgically. In the event of pathologic gynecomastia, the cause should also be treated.

If an older guy chooses surgery to address gynecomastia, he must be in generally good condition. Prior to surgery, medical concerns such as hypertension, diabetes, and other comparable diseases must be under control. 


Some of the possible risks and short-term side effects of gynecomastia surgery for older men include: Possible adverse reaction to anesthesia, breast asymmetry, discomfort and numbness during the procedure, visible scarring

To sum up…

Physiologic gynecomastia is completely normal, it doesn’t require treatment, it will be cured itself. But if it persists then you should consult your doctor.

Don’t press or touch your baby’s chest unnecessarily when it is enlarged, it can infect the breast. 

It is totally normal to have slightly enlarged breasts during puberty, there is nothing to be concerned about, it is temporary.

If you are an elder experiencing an enlarged breast and you want to remove it, please make sure that you are a good candidate for surgery. Since having surgery when you are old can have some complications.

Also Read: Can Gynecomastia be Reduced by Going to the Gym

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