Risk factors for gyencomastia in a patient with cirrhosis:
(1) high body mass index (obesity, which may induce an estrogenic state)
(2) increasing age (which may be related to male andropause)
(3) hypoadrogenic state, with small testes and reduced serum free testosterone
(4) feminization with elevated serum free estradiol
Other biochemical findings not directly implicated in the development of gynecomastia include:
(1) elevated serum progesterone
(2) elevated serum prolactin
Problems confounding the analysis:
(1) elevation in the serum sex hormone binding globulin (SHBG), which makes interpretation of total serum hormone levels difficult.
(2) variation in sensitivity of the male breast tissue to hormones
