Will Gynecomastia Go Away Naturally?

In order to understand if gynecomastia will go away naturally, we first must understand what gynecomastia is and how it occurs. Understanding how gynecomastia occurs and what is the main causative origin, will better help us understand if gynecomastia will go away naturally. 

What exactly is gynecomastia? 

Gynecomastia is the enlargement of breasts in male patients. Specifically, it is growth of breast glandular tissues that are specifically found in the breasts. This occurs because there is an imbalance of testosterone to estrogen ratio. Typically, in a male, the hormone testosterone is dominant over the hormone estrogen. Yet, due to some disorders or medication use, either testosterone is depleted, or estrogen is increased, leading to estrogen being the dominant hormone. We know that estrogen is the key component in females that help with breast growth and the menstruation cycle therefore, leading to breast growth in males. 

Now how does this occur? First it is important to understand that there are typically 3 different age groups where we see gynecomastia in males. They are infancy, puberty/adolescent aged, and males between the ages 50-80 years old. Literature shows that in infancy the causative agent is during pregnancy. Specifically, the placenta is known to produce estrogen and other hormones to help regulate the pregnancy. Estrogen is transmitted through the fetal vessels and can lead to the fetus. Therefore, male patients are actually born with gynecomastia. We know that the source is from the placenta, so when the child is born, this source is officially cut off. That is why it is typically seen that the gynecomastia will go away on its own naturally. 

This is known as a physiological cause, meaning that our own body is reacting in a different way that is altering the production of some sort of meets end, in this case it is hormones. Another way to picture this is Type 1 Diabetics; for some reason they are born without a specific cell called a beta cell. This beta cell is responsible for producing insulin and allowing sugars to enter our cells. In essence, insulin acts like a gateway for our sugars to enter the cell. If we do not have insulin our sugars stay in our blood stream and increase, leading to diabetes. We are not sure what really causes the lack of beta cells, but as you know we have a vast knowledge on how to help type 1 diabetic patients. 

We also see physiological causes for gynecomastia in both the adolescent and elderly stages in male patients. To better understand this process let’s look at how testosterone is produced. Testosterone actually starts off as cholesterol! In order for cholesterol to transform into testosterone it must first get transferred from its location in the body, to the inner membrane of a steroid producing cell called Leydig cell. In order to get to that location, in essence it takes a bus, which is a certain protein. While cholesterol is in that cell it gets transformed or catalyzed into pregnenolone and this occurs in the mitochondria. A specific unique enzyme must be present for it to get converted to pregnenolone. Then pregnenolone is converted eventually to dehydroepiandrosterone which is then converted to androenediol which is finally converted to testosterone. Testosterone in turn, also gets converted to estradiol by a specific enzyme called aromatase or it is converted to dihydrotestosterone by a specific enzyme called 5-alpha-reductase. As you can see there are multiple steps that lead to the formation of either estradiol or dihydrotestosterone. This is the NORMAL physiological sequence of how testosterone is produced and broken down. Now, somewhere along this assembly line, there is a distribution. It could be that our body is producing too much aromatase, the enzyme that helps to convert testosterone to estradiol therefore we have an increase in estrogen. It could be that our body does not produce enough 5-alpha-reductase, therefore a decrease in dihydrotestosterone, which is the most dominant form of a male’s testosterone. Why could this occur? 

 There are a number of reasons why this can occur, and that is why it is always important to get a thorough check up from your doctor. It could be primary hypogonadism which is seen in adolescent patients. Which means that our body does not produce enough hormones. It could be that the hypothalamus is not responding correctly, or that there is an underlying autoimmune disease process to our pituitary gland. These glands are responsible for sending messages all over your body to help regulate your hormones. For example, if your body realizes that your testosterone is low, it sends a signal to your hypothalamus that sends a hormone to your pituitary, which then sends another hormone to your testes to produce more testosterone. You could potentially have testicular cancer that does not recognize the responses from your pituitary gland. 

As you can see, there are a lot of root causes why one thing happens over the other, again stressing the importance of medical attention if you are having symptoms of gynecomastia. 

Typically, most males experience bilateral breast enlargement with mild tenderness. They seek medical attention usually because of the embarrassment of the breast enlargement. Usually, even when all of this is going on, and a thorough examination and proper tests are ordered, we allow the body 3 months to try to autocorrect itself. Literature has shown that gynecomastia can go away on its own if caused by a physiological process. Yet, if it does not resolve in 3 months, then medical treatment is warranted. 

Finally, the most common way gynecomastia would go away naturally is if it is caused by a known agent. Typically, these are either prescription drugs, or drugs that are abused. For example, there are a lot of medications that can cause gynecomastia. Such as acne treatment known as spironolactone, or hair loss treatment known as finasteride. Some antibiotics also cause gynecomastia. Male pattern baldness is caused by an increase in dihydrotestosterone. Finasteride is a 5-alpha-reductase enzyme blocker; therefore, it directly blocks the conversion of testosterone to dihydrotestosterone. Yet, as you know from our assembly line, that allows for an uneven balance ratio and more estradiol floating around, leading to gynecomastia. To help solve this is simple, just stop taking the causative agent and gynecomastia will go away. 

In sum, gynecomastia is caused by a number of ways. Understanding how it is cause will help us understand if it will go away naturally. In theory, gynecomastia goes away naturally in many physiological processes but can linger after 3 months, and if it does then that is when medical treatment is needed. The most common way to treat gynecomastia is observation and stopping the causative agent or correcting the causative agent, leading to gynecomastia going away naturally. 

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