Liver health has a surprising role to play in breast enlargement in some men. Gynecomastia or enlarged breasts in men is medically attributed to hormonal imbalance, especially of estrogen, due to the poor functioning of the liver. Experts point out that men diagnosed with any liver condition which could lead to cirrhosis are at risk of gynecomastia if they don’t seek timely medical intervention.
“The liver regulates hormone levels in your body, and the production of hormones is affected when someone has a liver complication,” says Prof. Dr Tom Cherian, senior liver specialist & transplant surgeon, Manipal Hospital, Vijayawada, and founder of the South Asian Liver institute. He also adds that it is a common misconception that only women suffer from hormonal imbalances, as men are also susceptible to hormonal issues.
Liver and sex hormones
One of the major endocrine functions of the liver is to regulate the levels of sex hormones, like estrogen and androgen. Though these hormones are initially secreted from the testes (androgen) and ovaries (estrogen), their levels are maintained by the liver, which metabolises these excess hormones by inactivating and facilitating their excretion through bodily waste.
“Estrogen levels will be slightly higher in women, which is the reason for their feminine traits, whereas androgen levels will be higher in men, resulting in their masculine traits. The liver plays a role in regulating these hormones,” adds Dr Cherian.
The regulatory role played by the liver in maintaining sex hormone levels is one of the main factors for sexual dimorphism or gender-distinguishing traits in humans. Ideally, men should have more androgen and women will have more estrogen.
“When there is a liver condition like cirrhosis in men, the liver will not be able to metabolise the excess estrogen, and there will be an imbalance in the body, leading to conditions like enlarged breasts,” says Dr Rahul Rai, consultant, hepatology and liver disease transplant physician, Narayana Multispeciality Hospital, Jaipur. He also adds that men diagnosed with these conditions will also suffer from sudden shrinkage of testicles along with an overall negative impact on their testicular functions.
Dr Rohan Badave, consultant, medical gastroenterology, Manipal Hospitals, Goa, points out that estrogen levels in your body are also determined by factors like peripheral conversion of some levels of androgen into estrogen within the body.
“The peripheral conversion of androgen to estrogen increases in a person with cirrhosis,” he adds.
Dr Badave also points out that another risk factor for gynecomastia in men with liver conditions is the high level of sex hormone binding globulin (SHBG), which leads to low levels of free testosterone in your body for physiological functions. These globulins are proteins produced in the liver which bind with the sex hormones. The ‘free’ sex hormones circulating in the blood are the ones that are used for various bodily functions by the tissues.
Liver cirrhosis and gynecomastia
Dr Rai explains that cirrhosis is an end-stage liver condition (common to multiple liver complications) in which the liver tissues become permanently scarred and lose their regenerative abilities.
“Every liver condition that can permanently damage liver tissue and lead to cirrhosis could be a cause for gynecomastia,” he adds.
The main liver complications which could lead to cirrhosis are:
- Alcoholic Liver Disease
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Fatty Liver Disease
- Non-Alcoholic Fatty Liver Disease
Dr Badave adds that one of the most common causes of cirrhosis is alcoholic liver disease. “Gynecomastia is seen in alcoholic people more frequently compared to others,” he adds.
Liver function tests are vital
Dr Cherian adds that although gynecomastia is not always caused due to liver complications, it is always better to get your liver checked since the condition has a strong connection with liver health.
“So, if you have it [gynecomastia], it’s better to get the tests done. I would recommend a simple ultrasound and a set of liver function tests,” he says.
Dr Rai suggests that conditions like breast cancer (rare in men) and excess fat deposition in the upper body and chest region could be reasons for breast enlargement in men. He adds that some diuretic drugs prescribed to reduce fluid retention in the abdomen could also cause gynecomastia.
“If a person develops gynecomastia because of cirrhosis, it is permanent most of the time. But if it is drug-induced, it can be reversed by stopping or replacing the drug,” says Dr Badave.
Takeaways
- Liver complications can lead to gynecomastia in men.
- The condition can result from liver cirrhosis, hormonal imbalance or certain medications.
- It is important to get the necessary tests done to rule out anything serious.
