What Is Gynecomastia?
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Medically reviewed by Do-Eun Lee, MD
Disclaimer: Health recognizes that not everyone who is female was born with female reproductive organs and that not everyone who is male was born with male reproductive organs. Health also recognizes that people may not identify as any one sex or gender. The information in this article is based on how researchers present their results, and the gender- and sex-based language used most accurately reflects their research design and outcomes.
Gynecomastia is a condition involving an increase in male breast tissue due to hormonal imbalance, or changes in testosterone and estrogen levels. Occurring at birth, during adolescence, or late in adulthood, gynecomastia can include swelling, tenderness, and even a lump in the breast. This increase in breast tissue may affect one or both breasts and can be influenced by puberty, aging, medications, drug use, and health conditions that affect hormones.
Gynecomastia is common. Percentage estimates vary, with some research showing that gynecomastia will affect up to 65% of men at some point in their life.
Treating gynecomastia depends largely on the cause of the condition. In some cases, gynecomastia will go away on its own and not require treatment. Other times, an underlying condition will need to be addressed. Some people who experience chronic gynecomastia may choose to get surgery.
Types of Gynecomastia
There are three types of gynecomastia. These types—which are typically based on how long a person has had the condition—are florid, intermediate, and fibrous.
Florid gynecomastia is usually seen in early stages of the condition, usually around four months or earlier. This type is characterized by an increase in ductal tissue and vascularity, or noticeable veins.
Intermediate gynecomastia is thought to be the progression of florid gynecomastia to fibrous gynecomastia.
Once a person reaches fibrous gynecomastia, the condition is unlikely reversible, which is why early diagnosis and treatment is important. This stage usually occurs after about one year. This type of gynecomastia presents with few ducts and more stromal fibrosis—or dense breasts with very little glandular or vascular tissue.
Gynecomastia Symptoms
For many people, gynecomastia has very few symptoms other than the swelling of the breast tissue in one or both breasts. The breasts also may be tender to the touch, or the nipples may get irritated when clothing rubs up against them. But this is more common in adolescents who are going through puberty than it is in older people.
If you have rapid swelling of your breast tissue, nipple discharge, or bleeding, it is important to see a healthcare provider. These symptoms are not typical of gynecomastia and could be a sign of a more serious condition.
Even if you do not find the swelling bothersome, you should still have a healthcare provider assess your breasts since gynecomastia can sometimes be a symptom of an underlying health condition. For instance, 10% to 40% of men with hyperthyroidism have gynecomastia, and 10% of people with testicular tumors have gynecomastia.
What Causes Gynecomastia?
In some cases, gynecomastia is idiopathic, meaning it has no known cause. Other times, gynecomastia is associated with imbalances in the hormones estrogen and testosterone. The age at which the condition develops—at birth, during puberty, or as an older adult—can dictate the exact cause.
Gynecomastia occurring at birth is thought to be caused by the increased level of estrogen circulating before birth.
Meanwhile, gynecomastia that occurs in adolescence is related to fluctuating hormones in puberty. Young people who use anabolic steroids or abuse drugs like alcohol, marijuana, heroin, or amphetamines can develop gynecomastia as well.
In people older than 65 years, a decline in testosterone levels is thought to cause gynecomastia.
Risk Factors
Underlying medical conditions increase your risk of developing gynecomastia. These conditions include:
Obesity
Hypogonadism, when testes don't properly function
Adrenal disease
Cirrhosis, scarring of the liver
Kidney failure
Tumors that impact your body's hormones
Taking certain medications also increases your risk. Here are some of the medications and supplements that can lead to gynecomastia:
Medications that block testosterone, such as treatments for prostate cancer
Certain antibiotics
Anti-ulcer drugs
Some cancer treatments, such as chemotherapy
Certain medications for heart and blood vessel diseases
Some medicines used to treat anxiety, depression, and psychotic disorders
Certain over-the-counter drugs or herbal supplements with phytoestrogens
Lotions with lavender or tea tree oil
How Is Gynecomastia Diagnosed?
If you suspect you have gynecomastia, it is important to talk with a healthcare provider. Diagnosis of gynecomastia usually begins with a review of your medical history and a physical examination. Other tests are ordered when a healthcare provider suspects that there may be an underlying condition causing the increase in breast size. Here are some of the tools used to diagnose gynecomastia.
Medical history: A healthcare provider will likely ask when your first noticed the enlarged breast tissue and how long you have had it. They also will want to know if you have any symptoms like pain, bleeding, nipple discharge, and weight changes as well as any underlying conditions or risk factors like breast cancer risk. You also should share what medications you are taking and if you use any recreational drugs like marijuana or alcohol.
Physical examination: During your physical exam, a healthcare provider will carefully inspect and move your breast tissue to check for unusual firmness, asymmetry, nipple discharge, and lumps. They also will try to determine if you have true gynecomastia or pseudo gynecomastia (which is excess fat tissue behind, around, and under the nipples).
Blood tests: If an underlying condition is suspected, the healthcare provider may order bloodwork to assess your hormone levels, liver function, and thyroid function.
Mammogram: This X-ray of the breast can help healthcare providers rule out breast cancer—especially if they find a lump during the physical examination. A lump may also require an ultrasound and biopsy.
Testicular ultrasound: Sometimes a healthcare provider will order a testicular ultrasound to look for a tumor or other abnormalities that could be causing the gynecomastia.
Treatments for Gynecomastia
When gynecomastia occurs in infants or adolescents, it usually goes away on its own without treatment. However, if the condition is severe, persists, or is bothersome, it can be helpful for teens and young adults to wear a special elastic or compression tank top to keep the breasts from sagging and improve the appearance of the chest.
In extreme cases, surgery may be an option—particularly if there is more breast tissue than fat present. Most of the time, when surgery is recommended, the young person has fibrous gynecomastia and has had the condition for more than one year.
As for adults who develop gynecomastia, a healthcare provider will determine if your condition is caused by a medication that you are currently taking or by an underlying health condition that is affecting your hormone levels. If the condition persists—even after treatment of the suspected underlying condition or adjustment of your medications—there are other options for addressing the condition.
While the U.S. Food and Drug Administration has not approved the medications for this particular purpose, a healthcare provider may recommend taking medications that block the effects of estrogens, such as Soltamox (tamoxifen) or Evista (raloxifene), to treat gynecomastia.
When appropriate, a healthcare provider may recommend breast reduction surgery to remove some of the breast tissue. This approach may be recommended for people who have fibrous gynecomastia and have had the condition for a year or longer.
How to Prevent Gynecomastia
Because gynecomastia occurs naturally in the body, you cannot prevent many of the hormone changes that cause this condition. There also is no known method you can use to prevent it. That said, gynecomastia can sometimes be caused by drug use. Stopping your use of these substances or getting treatment for a substance abuse problem could prevent the condition from developing.
Likewise, if you are taking a medication that causes drug-induced gynecomastia, you can talk to your healthcare provider about switching medications to reduce the likelihood that you develop gynecomastia. Keep in mind, though, that you should not stop taking your medication without talking to a healthcare provider first. Doing so could cause harmful side effects or put your health at risk.
Related Conditions
Your healthcare provider will often look to see if there is an underlying cause responsible for your condition. For instance, medical conditions like hypogonadism, adrenal disease, thyroid disease, cirrhosis, and kidney failure can all contribute to gynecomastia.
Tumors that occur in adrenal glands, pituitary gland, lungs, and testes also can lead to the condition. For this reason, most healthcare providers will run tests to see what is causing the condition or consider altering your medications to see if your symptoms improve.
Living With Gynecomastia
Living with gynecomastia can be challenging at times, especially if you are self-conscious about your appearance. From deciding what to wear each day to avoiding social situations that you find embarrassing, gynecomastia has the potential to cause stress and anxiety as well as impact self esteem.
If you are bothered by the way gynecomastia makes you look or feel, start by talking with a healthcare provider. They may be able to alter your medications or test you for an underlying medical condition, which can help determine what the right treatment for your breast swelling is. You also can consider working with a mental health professional to work through your thoughts and feelings and develop coping strategies.
It may also be helpful to build a support network. Begin by talking to trusted family members and friends. You also can connect with others who have gynecomastia. For instance, Gynecomastia.org offers an online support forum where you can ask questions and talk to others with the condition.
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