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There are many different causes of gynecomastia, from medications to endocrine disorders. One common cause that affects males at different ages is physiologic gynecomastia. This refers to natural imbalances in testosterone:estrogen that can lead to excess estrogen activity and feminization of the male breast. Physiologic gynecomastia may occur during the following ties:
Newborn: More than half of male infants are born with enlarged breasts due to the effects of their mother’s estrogen. In a large majority the swollen breast tissue goes away within two to three weeks after birth.
Puberty: Gynecomastia caused by hormone changes during puberty can occur in up to 65% of boys. In most cases, the swollen breast tissue will go away without treatment within two years.
Middle age: The prevalence of gynecomastia peaks again between the ages of 50 and 80. At least 1 in 2 men in this age group are affected.
As a man reaches middle age the amount of circulating testosterone decreases. This is usually in conjunction with an increased amount of subcutaneous fat. This increased fatty tissue leads to an increased conversion of androgens (e.g. testosterone) to estrogens by a hormone called aromatase. The combination of decreased testosterone levels and increased conversion of testosterone to estrogen plays a large role in the increased prevalence of gynecomastia in this age group.
Of course there are other causes of gynecomastia in men aged fifty to eighty. Medical issues such as liver disease, hyperthyroidism, and certain medications, can cause gynecomastia as well and need to be ruled out during the consultation.
The treatment of older men with gynecomastia still follows basic surgical guidelines and principles. First, the patient must be in generally good health. There is no defined upper age limit for gynecomastia surgery. However, medical issues, such as hypertension, diabetes, etc. must be under control prior to surgery. In older men the main difference in the surgery compared with younger men has to do with their skin tone and nipple position. As we get older, we lose elastin in our skin which leads to decreased tone. Therefore, in certain cases, the gynecomastia surgery in older men will also need to address the loosened skin and possibly repositioning of the nipple and areola. This will allow for the most ideal contour and a patient who is happy with their results.