How To Address Gynecomastia In Patients With Liver Cirrhosis

Patients with liver cirrhosis often experience hepatic decompensation, which requires treatment aimed at improving liver function based on the underlying cause. For instance, if a patient has active hepatitis B virus replication, antiviral therapy should be initiated. If liver enzymes such as ALT and AST are elevated, anti-inflammatory and hepatoprotective medications may be necessary to support liver health. Additionally, in managing complications of cirrhosis, it is important to use medications that reduce portal pressure, helping to prevent the formation of portosystemic shunts and thereby lowering circulating estrogen levels.

This elevated estrogen state can lead to gynecomastia — or breast enlargement — in men. Here are the primary reasons this occurs:

In male patients, gynecomastia typically results from impaired liver function, which reduces the body's ability to metabolize estrogen, leading to higher blood estrogen levels. This hormonal imbalance promotes breast tissue growth.

Another contributing factor may be portal hypertension. When collateral circulation develops due to high portal pressure, some estrogen bypasses the liver and remains in systemic circulation, further increasing estrogen effects on breast tissue.

Moreover, long-term use of spironolactone — a medication commonly prescribed for ascites and edema in cirrhotic patients — can also cause gynecomastia as a side effect. This drug acts as an aldosterone antagonist but has anti-androgenic properties that can promote breast development.

Managing gynecomastia in cirrhosis involves addressing both the hormonal imbalances and the underlying liver disease. Treatment strategies may include adjusting medications, controlling viral hepatitis, reducing portal pressure, and supporting liver function through medical therapy and lifestyle modifications.