Enlarged Breasts in Men (Gynecomastia)

Gynecomastia is the enlargement of the glandular tissue in one or both of a young or older male's breasts. The condition is usually benign (noncancerous) and very common: Anywhere from 30% to 65% of males, depending on age, have experienced this. Though it is typically not life-threatening, it can be uncomfortable and may impact self-esteem.

While hormonal imbalances account for many gynecomastia diagnoses, it can be caused by medication. It also can be a symptom of liver disease, thyroid dysfunction, lung cancer, and other serious conditions.

This article will review the causes of gynecomastia, the symptoms someone may experience, and how it is treated.

Gynecomastia Symptoms

The main symptom of gynecomastia is enlarged breasts. It often begins as a slight bump or lump behind the nipple. This enlargement is usually painless, but some males experience tenderness. While it usually occurs in both breasts, it can occur in only one.

What Causes Gynecomastia?

There are many reasons why gynecomastia develops, but the most common cause is a hormonal imbalance. In breast tissue, there are receptors that can cause breast tissue to grow (estrogen receptors) or to not grow (androgen receptors). If a male has higher levels of estrogen than normal in their body, their breast tissue grows.

The American Society of Plastic Surgeons uses a scale to assess Grade I through Grade IV gynecomastia.

There are some periods in a male's life when they do have higher estrogen levels, including:

• Birth: Newborn males may have enlarged breasts as a result of the estrogen that's transferred during pregnancy. Typically, newborn gynecomastia goes away by itself after about a month.
• Puberty: Half of adolescent males will experience gynecomastia, usually at around age 13 or 14. It often goes away on its own within six months to two years, but the condition can persist into adulthood.
• Older adults: Decreasing levels of the hormone testosterone may contribute to the peak in gynecomastia incidence in males older than 50.

Other Causes

Gynecomastia may be caused by chronic conditions such as:

• Cirrhosis of the liver (chronic liver damage causing scarring and liver failure)
• Hypogonadism (sex glands produce little if any hormones)
• Hyperthyroidism (overactive thyroid)
• Poor kidney function
• Testicular or adrenal tumors (rare)
• Klinefelter's syndrome (genetic condition resulting from an extra copy of the X chromosome)

It's common for obesity to contribute to the development of gynecomastia.

The use of certain drugs may also lead to enlarged breasts in men. For example:

• CaroSpir (spironolactone), a heart medication
• Nizoral (ketoconazole), an antifungal medication
• Dehydroepiandrosterone (DHEA) used to treat erectile dysfunction (ED)
• Heartburn and ulcer medications
• Certain supplements
• Recreational drug use, including cannabis, heroin, and amphetamines

Anabolic steroid use often causes irreversible gynecomastia as well. The injection of external testosterone inhibits the natural production of testosterone, which cannot recover quickly enough between steroid-injecting cycles to prevent estrogen predominance.

Gynecomastia can also result from treatments for prostate cancer, as the typical treatment given blocks the production of testosterone.

Lifestyle factors of gynecomastia may include heavy alcohol use or unintentional exposure to estrogen, such as having intercourse with a female who is using vaginal estrogen replacement therapy. Some studies find endocrine disruptor chemicals in the environment, such as bisphenol A (BPA), mimic the effects of estrogen.

Diagnosing Gynecomastia

To diagnose gynecomastia, a healthcare provider will perform a physical exam of the breasts as well as the entire body to assess for any areas of concern.

It's important to be sure that a male's large breasts are due to excess growth of glandular tissue, which has a network of ducts that can be felt, and not excess fat tissue. Known as pseudo gynecomastia, this occurs when the breasts of overweight males enlarge due to increased fat and not true breast tissue.

Blood tests to check hormone levels may also be performed. Sometimes imaging tests like a mammogram or ultrasound may also be needed to confirm the diagnosis.

How Do You Fix Gynecomastia?

If pseudo gynecomastia is determined to be the cause, breast size will not decrease on its own. A combination of diet and exercise can help reduce total body fat percentage and, likely, the breast size.

In contrast, there are several possible treatment options for gynecomastia, and what is best for you depends on a few factors.

Watching and Waiting

Gynecomastia may resolve on its own and no treatment may be needed at all. In a wait-and-watch approach, no specific treatment will be prescribed. If the breast tissue continues to enlarge or if other symptoms develop, further treatment may be recommended at a later date.

Disease Management

When gynecomastia is the result of an underlying health problem or use of a medication that may cause breast growth, treating that problem or discontinuing the medication usually improves the condition. Of course, this should be done under the advice of your healthcare provider.

Medication

In cases in which the condition is persistent or causing discomfort, a healthcare provider may prescribe a brief (three to six months) course of an estrogen-blocking drug called tamoxifen or Evista (raloxifene). This is most often tried during puberty.

Adult males may also be prescribed a short course of one of these drugs. However, this treatment is only effective in males whose breast tissue is tender and who have had the condition for less than a year.

Breast-Reduction Surgery 

Surgery is a common treatment for gynecomastia. Surgery is generally not recommended for adolescents until puberty is completed to be sure the breast tissue has stopped growing.

There are a number of surgical techniques used to reduce breast tissue, including removal of the glandular tissue and excess skin. The areola may also be reduced or repositioned. Liposuction (a surgical technique using suction) can remove excess fat.

Coping With Gynecomastia

Having gynecomastia can be difficult for some males to deal with. They may be embarrassed or insecure about their bodies. Younger males going through puberty have an especially hard time.

If you experience symptoms of depression, embarrassment, or any other negative feelings, it is important to remember that you're not alone. Gynecomastia is fairly common, and it can get better over time.

Talking about your feelings with supportive family members or friends can be very helpful. If needed, talking with a counselor or therapist may be needed as part of overall treatment, to learn how to deal with feelings about body image.

Summary

Although gynecomastia, the enlargement of breast tissue in males, is not life-threatening, it can potentially cause discomfort or insecurity to the male who has it. There are many possible causes of gynecomastia, and it is important to seek medical attention to determine the cause and the best course of treatment, if any.

Gynecomastia is a common problem among males, and it's important to see your healthcare provider to rule out any medical cause for the condition. Though it may resolve on its own without treatment, gynecomastia can lead to feelings of anxiety, embarrassment, and even depression. If your condition persists and causes you discomfort, there are treatments—lifestyle changes, medication, and surgical procedures—that can help reduce the size of your breasts.