Hello titillated
I think most of your questions have already been answered, but just to throw something else into the stewing pot, I will tell you about my gynaecomastia which seems to be a bit different from most guys'.
I am 32, 6ft tall and 220lbs. I am quite muscular. I am also gay and have identified myself as being gay from a very early age (pre-puberty).
My chest area first became a concern to me from about the age of 8 when other children at school teased me about my 'boobs'. I was not overweight at the time. Like just about every other guy on here, it became a nightmare to deal with.
So I have had excess tissue in this area before the hormones kicked in at about 12 years old. My chest seems to be more fatty than glandular, so this suggests that what I have is pseudo-gynaecomastia rather than 'true' gynaecomastia. I will get an expert opinion on it next week when I go to see a PS in Birmingham.
Although I have not had any hormonal tests, I am otherwise very masculine. I have large amount of muscle tissue, a high sex drive and male pattern baldness, so this suggests that I have a good supply of testosterone.
My chest didn't suddenly get bigger in proportion to the rest of my body at any time, so I am not convinced that oestrogen played a role in it at all.
In the last three years I have lost significant weight to try and shift that fat in that area before considering surgery. I now have a set of before and after pics of my body. Despite a lot of fat loss and significant muscle gain, the best area remains the identical in size and shape. Most guys with gynaecomastia seem to have puffy nipples and the 'breast' sticking out somewhat. Whereas my 'breasts' are not puffy or pointed, the look 'normal' for a male. However, they do hang slightly with a pendular appearance.
Gynaecomastia can happen at different stages in life for a number of reasons. Most commonly it seems to be caused during puberty and is said to be oestrogen related. Adult onset gynaecomastia is often caused by use of anabolic steroids where the testosterone that is artificially put into the body aromatises or breaks down into smaller metabolites - one of which is oestrogen which then causes the gynaecomastia.
Like when the menopause was identified and began to be talked about more and more in the 70s and 80s, many health-care professionals disputed its existence. A similar debate is now going on regarding the Andropause (the male version). Gynaecomastia is increasingly being recognised as a medical condition, but in the UK (where I am from) many health authorities consider surgical intervention as cosmetic rather than corrective. However, because gynaecomastia often presents or causes severe psychological problems, it's pathology cannot be ignored and medicine has an ethical obligation to treat it which is why a sympathetic GP will refer a patient for further investigation and possibly surgical intervention at the expense of the state.
Hope my version of events helps your understanding.