In a groundbreaking study published on January 16 in BMJ Open, researchers found a concerning correlation between gynecomastia – defined as the abnormal enlargement of male breast tissue not attributable to excess weight – and a heightened risk of premature mortality before the age of 75.
In addition, patients with preexisting risk factors, such as cancer or circulatory, lung and gut diseases before being diagnosed with this condition were at highest risk.
Led by Anders Juul, MD, PhD, a professor of growth and reproduction and an endocrinologist at Rigshospitaletin Denmark, the study underscores the urgency for medical attention to be directed towards individuals presenting with gynecomastia.
“Clearly, newly developed gynecomastia should be considered by the evaluating doctor as the ‘canary in the coal mine,’” says Dr. Juul. Physicians should look for the underlying cause, follow these patients more closely, or both, he adds.
Due to its prevalence among older men, physicians frequently attribute gynecomastia to obesity without thoroughly investigating its underlying causes, explains Dr. Joseph Aloi, a professor specializing in endocrinology and metabolism at Wake Forest University School of Medicine and practicing endocrinologist at Atrium Health-Wake Forest Baptist in Winston Salem, North Carolina.
Dr. Aloi, who was not involved in the study, says, “These findings suggest that when men present with gynecomastia, that their doctor should take a deeper look at potential underlying conditions that could be causing it.”
Over 3 in 10 Men Will Be Diagnosed with Gynecomastia At Some Point in Their Lifetime
Gynecomastia, characterized by the non-cancerous enlargement of male breast tissue due to hormonal imbalances, affects a significant portion of the male population, with research suggesting that it will afflict at least 3 in 10 males during their lifetime, making it the predominant breast condition in men.
It’s important to distinguish gynecomastia from what is colloquially referred to as “man boobs” or pseudogynecomastia, typically linked to excess weight or obesity.
Possible Causes of Gynecomastia
According to Dr. Detlev Erdmann, MD, PhD, a plastic surgeon at Duke Health in Durham, North Carolina, who specializes in gynecomastia surgery, the onset of gynecomastia can manifest at any age but is typically instigated by fluctuations in sex hormone levels during infancy, puberty, and later stages of life.
Dr. Erdmann, not involved in the study, emphasizes that gynecomastia predominantly afflicts older men due to declining testosterone levels, often coinciding with weight gain, exacerbating the condition.
Dr. Aloi further highlights that while hormonal imbalances serve as the primary catalyst for gynecomastia, it can also arise from various medications and medical conditions, including adrenal tumors, alcoholism, kidney disease, liver disease, and thyroid disorders.
Study Participants Had Follow Ups for Up to 25 Years
Previously regarded as primarily a cosmetic concern affecting elderly obese men, gynecomastia has often been overlooked in medical circles, noted Dr. Juul.
While earlier research has hinted at a correlation between gynecomastia and comprised health outcomes, the authors assert that the association with premature mortality remains uncertain.
To delve into this matter, researchers utilized Danish national health registries, identifying over 23,000 men diagnosed with gynecomastia between January 1995 and June 2021. Of these individuals, approximately 40 percent fell within the 19 to 40 age bracket at the time of diagnosis.
Each of these men was then meticulously matched with five counterparts without the condition, totaling roughly 140,000 participants.
Subsequently, the cohort of men with gynecomastia was divided into two distinct groups for further analysis.
- Those with idiopathic gynecomastia, meaning the cause of the condition is unknown, and it isn’t caused by a known underlying health issue)
- Those with a known preexisting condition or taking medication associated with gynecomastia
Men with a Preexisting Condition Leading to Gynecomastia Were Primarily at Greater Risk of Death
Throughout the study period, participants were observed until their date of death or the conclusion of June 2021, whichever came first. Analysis revealed a 37 percent elevated likelihood of premature mortality among men diagnosed with gynecomastia compared to their counterparts without the condition.
Upon closer examination of each subgroup, the heightened risk of mortality was predominantly observed among individuals with a documented preexisting condition or those undergoing medication associated with gynecomastia, rather than those with idiopathic gynecomastia.
“So what this study shows is that gynecomastia itself doesn’t cause an increased risk of death, but gynecomastia can be caused by an underlying medical problem that does increase the risk of death,” says Dr. Erdmann.
The following conditions linked to the greatest risks were:
- preexisting cancers, with a 74 percent heightened risk
- circulatory diseases, which include things like stroke and heart disease, with a 61 percent heightened risk
- lung diseases, with double the risk
- gut diseases, with a fivefold heightened risk
Remarkably, neurological disease was linked to a 29 percent reduced likelihood of premature mortality.
Among different types of cancer, malignancies affecting the digestive tract were associated with a 39 percent elevated risk, while those impacting the genitalia demonstrated a threefold greater risk, and lymphatic system cancers posed double the risk.
Specifically regarding gut diseases, liver disorders were associated with a twelvefold heightened risk, whereas ailments affecting the gallbladder, biliary tract, and pancreas were linked to a fourteenfold heightened risk.
Men with idiopathic gynecomastia generally did not exhibit a higher risk of early mortality compared to those in the control group, except for a twofold increased risk of death from liver disease.
As the study was observational in nature, it cannot ascertain the causative factors behind the heightened risk of premature death or elucidate the reasons for the elevated mortality rates associated with particular diseases.
“For example, why do men diagnosed with gynecomastia have a fivefold increased risk of dying from liver disease? I do not know. More research is needed to unravel these associations,” says Dr. Juul.
Researchers also acknowledged their inability to account for potentially influential factors such as obesity, exposure to endocrine-disrupting chemicals, and steroid use.
Given the Elevated Risk of Premature Mortality, a Thorough Examination of the Underlying Causes of Gynecomastia is Recommended
As per Dr. Erdmann, “The increased risk of death found here suggests that if a patient comes in with gynecomastia, it could be a sign of an underlying medical problem that we should look into.” He also adds that this should be done before the condition is treated or surgically addressed.
The authors agree, concluding, “These results should therefore prompt thorough clinical examination to identify the underlying risk factors.”
However, there is no one-size-fits-all solution, says Dr. Juul. He says, “There are many reasons behind the adult development of breast tissue in men, and each case should be carefully evaluated, and options individualized.”
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