4 medical questions about gyno

[J23]

1) Why is gynecomastia tissue mildly painful/sensitive to touch? (and does this indicate a hormonal imbalance?)
I have heard that the sensitivity is due to nerve endings, but I'm am not sure if that is the reason.

2) Do all adult males have some breast tissue? (and if so, why do some instances indicate hormonal imbalance, and others don't?)


3) Is there any identifiable medical reason for why gynecomastia would only be on one side?

4) Why would breast tissue persist in males with normal hormone levels?


Gynecomastia is a very difficult condition to understand... any clarification would be great.

[Dr. Elliot Jacobs]

1) Why is gynecomastia tissue mildly painful/sensitive to touch? (and does this indicate a hormonal imbalance?  I have heard that the sensitivity is due to nerve endings, but I'm am not sure if that is the reason.
2) Do all adult males have some breast tissue? (and if so, why do some instances indicate hormonal imbalance, and others don't?)
3) Is there any identifiable medical reason for why gynecomastia would only be on one side?
4) Why would breast tissue persist in males with normal hormone levels?

1. Most often, if tenderness is present, then gyne is in the active stage of growth.  Long established breast tissue is usually not tender.
2. Yes, all adult males have some breast tissue -- concentrated directly under the areola.  It is this tissue that grows when gyne develops.
3. No identifiable reason for one sided gyne.  I am sure there is a reason -- we just don't know.
4. Most often, gyne develops during puberty.  We hypothesize that it is due to hormonal imbalances between testosterone and estrogen.  However, there is most likely a hereditary component -- ie some men's breast tissue is much more sensitive to the circulating estrogen that exists in all men.  Once gyne is established during puberty, it does not regress spontaneously, despite the fact that most guys have normal hormonal levels.

Dr Jacobs

[J23]

thank you Dr. Jacobs.

just one follow-up question, is there a difference between "low testosterone", and "fluctuating hormone levels"?

[Dr. Elliot Jacobs]

Any blood test is just a "snapshot" of your blood at any one time.  All men and women have variations in their hormones during the day.  That is the "daily fluctuation."  The fluctuations usually stay within a narrow range.

If you have a blood test which shows very low testosterone, then even with a daily fluctuation, it may not be sufficient to provide for your needs.

Best to discuss this with an endocrinologist.

Dr Jacobs