Causes of gynaecomastia in young adult males and factors associated with idiopathic gynaecomastia

Abstract

Gynaecomastia is a common clinical condition. Persistent pubertal or late onset idiopathic gynaecomastia is the leading cause of gynaecomastia in different series. The aim of this study was the assessment of the prevalence and characteristics of different causes of gynaecomastia in young adult males, and evaluation of the factors associated with idiopathic gynaecomastia. Fifty-three male patients (mean age 22.04 +/- 2.22, range 19-29), who had been admitted to our outpatient clinics with gynaecomastia as the main presenting symptom were enrolled in the study. Patients were evaluated with breast palpation, breast ultrasonography, anthropometric measurements and sex steroid levels. Secondary causes of gynaecomastia were ruled out. Thirty age-matched healthy individuals were also studied as healthy control group. Idiopathic gynaecomastia was diagnosed in 31 of 53 patients (58%), with 17 (32%) persistent pubertal and 14 (24%) late onset course. Other causes of gynaecomastia were hypogonadism in 13 cases (25%), hyperprolactinaemia in five (9%), chronic liver disease in two (4%), and drug induced (prolonged use of H2 antagonists) in two (4%). Patients with idiopathic gynaecomastia, either pubertal or late onset, were compared with the healthy control group in order to find out associated factors. Anthropometric measurements revealed a significant increase in body weight and body mass index (BMI) in the patient group compared with healthy controls (72.4 +/- 13.3 vs. 63.6 +/- 7.9 kg, p = 0.0086 and 25.2 +/- 4.0 vs. 21.5 +/- 2.7 kg/m2, p = 0.0001). Total skin fold thickness (SFT) of four different regions were also higher in the patient group (50.9 +/- 22.1 vs. 32.6 +/- 10.2 mm, p = 0.0006) indicating a higher body fat percentage. Total serum testosterone (4.76 +/- 1.31 vs. 5.70 +/- 1.06 microg/mL, p = 0.0038) and luteinizing hormone (LH) (4.80 +/- 1.92 vs. 7.32 +/- 1.90 mIU/mL, p < 0.0001) levels were significantly lower in the patient group while oestradiol levels were similar. There was a significant correlation between total testosterone and LH levels (r = 0.27, p = 0.0445). Total testosterone and LH levels were negatively correlated with BMI and total SFT. As a result most common form of gynaecomastia is idiopathic gynaecomastia either as persistent pubertal or late onset forms in young adult males. Idiopathic gynaecomastia is closely correlated with generalized obesity, reduced LH and testosterone levels which may be the result of increased conversion of testosterone to oestradiol in increased adipose tissue mass.

Unilateral Painful Gynecomastia as the Initial Manifestation of Graves' Disease: Case Report

“…5 Although the real prevalence is below 10% in one study, gynecomastia in men who were hyperthyroid due to Graves' disease was reported in 25-40% of the patients in other investigations. 2,6,7 This difference may be related to ethnic variations and the criteria that were used to identify the presence of gynecomastia.…”

Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review

“…8 Gynecomastia is not limited to boys with obesity but increases with increasing body weight. 6 Gynecomastia is typically bilateral (but can be unilateral), is correlated with increasing amount of body hair, and is associated with early sexual maturation.…”

“…7 Less common causes of gynecomastia include hypogonadism, hyperprolactinemia, chronic liver disease, and medications, particularly H2 antagonists. 8 Breast cancer is rare among male children and adolescents. Klinefelter syndrome 47, XXY is the most common genetic cause of gynecomastia.…”

A retrospective study of gynecomastia in male patients referred to Hatyai Hospital with breast lesions

“…Causes of gynecomastia are largely idiopathic. Identified causes of gynecomastia are hypogonadism (25%), hyperprolactinemia (9%), chronic liver disease (4%), and drug induced (4%) [2]. Gynecomastia is thought to result from several mechanisms including increased androgen and leptin levels, human chorionic gonadotropin, and luteinizing hormone [3,4].…”