Liver dysfunction
The liver is the prime site for metabolism of various endogenous and exogenous substances. This function makes liver an important regulator of concentration of various hormones, including estrogen and testosterone. An injury to the liver may disturb this balance of activated and inactivated hormones, which may favor estrogen-like effect on breast tissue.
A comprehensive study takes into account prevalence of gynecomastia in cirrhotic patients, disregarding the common association of enlarged breasts with obesity. About 44% of cirrhotic patients had gynecomastia, which establishes the role of liver disease in the etiology of gynecomastia. These patients also had low levels of free serum testosterone. [6]