What are the causes?
In pseudogynecomastia which involves obesity and the rapid loss of weight, this case is the one that needs no further screening and is directed for surgery.
In true gynecomastia there is an underlying hormonal imbalance that needs to be identified. In this case after this imbalance has been healed and the gynecomastia persists then a surgical solution can be sought.
This hormonal imbalance may arise:
Normally because of fluctuation in blood hormone levels
Birth, maternal estrogens circulating are transiently higher than normal but this usually resolves.
Adolescent , 66% of adolescent boys develop gynecomastia due to normal hormone increase. The gynecomastia is in most cases mild , its psychological impact negligible and in most cases is resolved on its own.
Old age, when the testosterone levels are declining and the ratio between testosterone and estrogens tilts towards the estrogens.
Intrinsic due to gland disfunction or failure. In this case a panel of examinations is needed in order to pinpoint the cause and its remedy. Any surgical approach ought to be reserved for a later time.
Drug induced. Hormones, antiandrogens , cardiovascular drugs or even abused drugs ( alcohol, heroin etc) can be the cause of gynecomastia.