What type of imbalance causes true gynecomastia?

True gynecomastia is primarily caused by a hormonal imbalance, specifically an increase in estrogen levels relative to testosterone levels in males. This condition involves the proliferation of glandular breast tissue, which is typically encouraged by elevated estrogen concentrations or decreased testosterone levels. Such hormonal changes can occur due to various factors, including puberty, aging, certain medications, liver disease, hyperthyroidism, and tumors affecting the hormonal axis.

While fluid imbalances, electrolyte imbalances, and muscle imbalances can have various physiological impacts, they do not directly lead to the development of gynecomastia. The condition is specifically related to the levels and effects of hormones on breast tissue, underpinning why hormonal imbalance is the root cause of true gynecomastia.