Does Gynecomastia Cause Infertility: Causes, Symptoms, Diagnosis, Treatment

Can Gynecomastia Cause Infertility? Causes, Symptoms, Diagnosis, Treatment

Overview

Gynecomastia, or enlargement of breast tissue, is mistakenly assumed to be a direct cause of infertility in men. In reality, it may be caused by hormonal imbalances, genetic factors, or other health conditions, making it crucial to identify the main cause. 

So, how exactly is gynecomastia linked to male fertility? Are there treatment options available? 

This space aims to clarify and reassure our dear men who may have doubts or fears regarding gynecomastia. The possible ways to manage and treat breast enlargement are also discussed. 

What is Gynecomastia? (man boobs or male breasts)

Gynecomastia is the medical term that refers to the enlargement of breasts in males. To answer the highly anticipated question ‘Does gynecomastia cause infertility?’ No, gynecomastia does not directly cause male infertility. 

Feeling uneasy when social media appreciates well-built or flat chests is a common feeling among men with gynecomastia. Having enlarged breasts is often not a serious condition to be worried about. However, it is better to be safe than sorry. There are some medical considerations to take into account if you have enlarged breasts. 

How Common is Gynecomastia?

Gynecomastia is commonly seen during birth or the newborn period, puberty, and older age.

In an article published in the Indian Journal of Endocrinology and Metabolism, at least 30% of men would have experienced enlargement of breast in their lifetime. 

In a tertiary care centre, the relation between the type of  gynecomastia and age was analysed among 100 Indian men. The researchers stated that  among adolescents (13-20 years) who constituted the largest group (52%) showed a significant association with physiological gynecomastia. This proved the prevalence of breast enlargement to be common during puberty. 

According to the NIH (National Institutes of Health), about 50% of boys develop gynecomastia during puberty, and it resolves within two years in 90% of cases. 

Another literature review study found prevalence of gynecomastia across different age groups as shown in the table below. 

How does Age Play a Role in Gynecomastia?

Gynecomastia is more likely to occur during the age of hormonal changes. When natural hormonal change is the cause, it may resolve on its own over time. Let’s understand the link between age and gynecomastia. 

During birth

Most of the male newborns may have enlarged breasts or breast buds due to the impact of estrogen during pregnancy. This is temporary and usually goes away within 2-3 weeks after birth.

Pubertal Gynecomastia

As we already discussed, around the period of puberty (ages 12-16), the fluctuations in hormones can cause gynecomastia (either one or both breasts). In most cases, even without treatment, it may go away within 6 months to 2 years.

Gynecomastia in adults

Onset of gynecomastia in middle-aged adults requires immediate medical assistance. It may occur due to a decline in testosterone levels signalling fertility concerns, or due to lifestyle, medical conditions, and their treatment. So, it is crucial to seek advice from a male fertility specialist when you feel enlargement in your breasts or any other symptoms that concern you.

Mature men

Natural decline in testosterone levels occurs with aging (above 50 years). Other common causes are medications and health conditions.

What are the Possible Causes of Gynecomastia?

The most common root cause of gynecomastia is hormonal imbalance. When the hormone estrogen overshadows testosterone production, it may result in enlarged breasts. The hormone estrogen is responsible for the growth of glandular breast tissue. This hormonal shift can occur in infants, pubertal boys, and mature men over 50 years. 

Medications also play a role. The following medications may trigger gynecomastia.

• Anti-androgens
• Anabolic steroids
• ADHD medicines
• Anti-anxiety medicines
• Chemotherapy 

Some health complications may also lead to enlargement of the breasts, like

• Tumors
• Thyroid dysfunctions
• Kidney issues
• Liver diseases

The use of recreational drugs, alcohol abuse, and illegal drugs may also be a potential cause of breast enlargement in men. 

 Does Gynecomastia Cause Infertility? Myth vs Science

Several myths about gynecomastia stop a person from seeking proper medical guidance. The treatment for any condition begins with awareness. Separating myths from facts with the guidance of a male fertility specialist is important. 

Common Signs and Symptoms of Gynecomastia

The common symptoms, along with gynecomastia, that may raise a concern about your fertility are

• Swelling, pain, or tenderness in the breast
• Nipple discharge
• Presence of a lump
• Lack of sexual interest or reduced libido
• Lack of body or facial hair
• Small or underdeveloped testes
• Low sperm count 
• Low sperm motility
• Abnormal hormonal levels
• Erectile dysfunction

Although gynecomastia does not directly cause male infertility, when it is associated with any of the above-discussed symptoms, it is an alarming signal to talk to a male fertility specialist. The experts may help uncover the root cause and suggest preventive or treatment measures. 

How Is Gynecomastia Related to Male Fertility?

Gynecomastia is most often signalling hormonal imbalance, particularly in the estrogen-to-testosterone ratio.This imbalance can lead to fertility issues. Identifying the root cause is crucial and can reveal a possible link between male fertility and gynecomastia.

The role of hormones  

The two primary hormones that drive the change in male breasts are estrogen and testosterone. The chief male sex hormone is testosterone, which regulates the overall physical, sexual, and musculoskeletal development. Any change in the hormonal balance, changing the androgen (male hormones) and estrogen ratio, may result in physical symptoms such as enlarged male breasts. The reasons for low testosterone could be,

• LH and FSH dysregulation. Luteinizing hormone (LH) and the follicular-stimulating hormone (FSH) are responsible for the release of testosterone in the body. An imbalance in these hormones results in low testosterone production. 
• Increased estrogen levels. Estrogen is the primary hormone responsible for breast development. 
• Enhanced aromatase activity. The enzyme aromatase converts testosterone to estrogen, resulting in a hormonal imbalance. 

Hormonal imbalance and male fertility

The hormone testosterone and male fertility are directly linked to each other. Low testosterone levels can lead to male infertility symptoms such as 

• Erectile dysfunction
• Delayed ejaculation
• Lack of sexual desire
• Reduced volume of ejaculate

Medical conditions linked to gynecomastia and male infertility

A few medical conditions may be a triggering factor for male breast enlargement and male infertility. Speaking to a male fertility specialist in Chennai can help you identify the root cause linked to gynecomastia and male infertility.

• Klinefelter syndrome: An inherited, genetic condition where males have an extra X chromosome. Symptoms may include breast growth and other male infertility symptoms like small testes and low testosterone levels.  
• Testicular dysfunction: Tumors in the testes can alter the estrogen-to-testosterone ratio, resulting in enlargement of the breasts. It may also lead to infertility by affecting the sperm count.  
• Hypogonadism: Low testosterone can be caused by the malfunctioning of the testes, hypothalamus, or pituitary gland. Sperm count, motility, and erectile dysfunction may cause infertility due to hypogonadism. 
• Pituitary disorders: The pituitary gland is responsible for producing several hormones in the body. High prolactin and low testosterone levels are the major pituitary disorders causing hormonal imbalance and poor semen quality.
• Hyperthyroidism: Abnormally high levels of thyroid hormones can change the levels of sex hormones as well. This is usually caused due to high estrogen and low testosterone levels.
• Hyperprolactinaemia: A rise in the hormone prolactin may in turn suppress testosterone production. This could result in reduced libido and low sperm count. Sometimes, it may also lead to nipple discharge.

Other health conditions that may cause gynecomastia and male infertility are

• Obesity
• Liver disorders
• Adrenal tumors
• Kidney disease
• Aromatase excess syndrome

How Do Doctors Evaluate Fertility in Men With Gynecomastia?

When consulting a male fertility specialist or an andrologist, you will be asked to perform a few tests to identify the underlying condition and evaluate fertility.  

• The individual’s complete medical history is first collected. This may include the health history of the individual and of their family, medication history, lifestyle, and symptoms experienced. 
• Physical examination of the breasts and testes. The andrologist may check the breasts for firm or distinct glandular tissue beneath the nipple as well as for changes in the skin or nipple discharge. The testicles are also examined for lumps.
• Blood samples will be used to assess hormonal levels. Testosterone, estrogen (estradiol), FSH, LH, prolactin, TSH, and DHEA are some of the hormones that may be tested.
• Semen analysis will help examine the sperm count, motility, and morphology. 
• Additional tests such as ultrasound, CT, MRI, and mammograms may be suggested by your andrologist. Genetic tests will be performed to identify syndromes like Klinefelter syndrome. 

Treatment Options for Gynecomastia and Their Impact on Fertility

Identifying the root cause and managing it is the primary focus of treatment. Although gynecomastia is not directly linked to infertility in men. Getting it treated can help prevent several complications. 

• Bringing back hormonal balance: When the hormones are off board, medications may be advised by your male fertility specialist. Replacing hormonal balance can improve symptoms. 
• Modifying medications: Certain medications can inhibit testosterone levels, causing gynecomastia. In this case, you will be advised to stop using it or change to a different medication. 
• Underlying condition: Treating the main cause of gynecomastia is crucial. Managing thyroid, kidney, and liver disorders, if present, is important to restore hormonal balance. 
• Surgery: Extra breast tissue can be removed through cosmetic surgery. The two surgical options available are liposuction and mastectomy. However, surgery does not address fertility-related issues. 

Understanding when fertility treatment is needed

Assisted reproductive technologies (ART) may be suggested when

• Semen analysis shows abnormal results
• Hormone treatments do not cause a significant improvement
• Testicular failure
• Genetic reasons affecting sperm delivery

When getting pregnant naturally becomes difficult, assisted reproductive techniques like IVF, ICSI, IUI, and TESE may be advised.

• IVF & ICSI: In Vitro Fertilization (IVF) involves retrieving a mature egg from the uterus and fertilizing it with sperm in a laboratory setting. Intracytoplasmic Sperm Injection (ICSI) is a specialised IVF process. It will be performed when male-factor infertility hinders natural conception. A healthy sperm is selected and injected into the egg for fertilization. 
• IUI: In cases of reduced sperm count, Intrauterine Insemination (IUI) can be performed. In this method, concentrated sperm are placed into the uterus to maximise the success rate. 
• TESE: For men with ejaculatory issues such as blockages, Testicular Sperm Extraction (TESE) will be advised. It is a surgical procedure to retrieve sperm. 

When Should You Consult a Fertility Specialist?

The social stigma around enlarged breasts often prevents men from seeking the right treatment. If you are experiencing gynecomastia along with male infertility symptoms, consulting a male fertility specialist in Chennai can make a crucial difference. When natural conception does not occur within a year, and infertility signs appear alongside gynecomastia, early treatment becomes essential for better outcomes.