Gynecomastia: Enlarged Breasts in Men

Medically Reviewed by Jabeen Begum, MD on March 14, 2024
Written by Stephanie Booth
8 min read

Gynecomastia is enlarged breast tissue in people assigned male at birth (AMAB). It usually happens when the balance of hormones in your body is thrown off.

Although breasts don't develop in people who are AMAB in the same way as they do in people who are assigned female at birth (AFAB), everyone is born with some amount of glandular breast tissue.

If you're AMAB, your body mostly makes a hormone called testosterone, which guides your body changes during puberty. Your body also naturally produces some estrogen, the hormone that steers sexual and reproductive growth in people who are AFAB. If the levels of these two hormones change and you have more estrogen than testosterone in your body, your breast tissue can swell.

You can get gynecomastia at any age, and it could come and go at different times in your life. As many as 65% of boys and men around the world are affected.

Gynecomastia vs. fat

Having enlarged breasts doesn't always mean that you need to lose weight.

Your breasts are made up of glandular breast tissue as well as a firmer, connective tissue. Fat deposits fill the spaces in between. Everyone has a slightly different ratio of these two tissues. For instance, you may have more breast tissue than fat, or it may be the other way around. Gynecomastia affects your glandular breast tissue. It doesn't have to do with the amount of fat in your body.

Gynecomastia usually isn't a sign of a serious health issue. But it could make you anxious or embarrassed if you don't like how your breasts look.

A few different terms that doctors use to describe gynecomastia include:

Unilateral gynecomastia. This means that one of your breasts is enlarged.

Bilateral gynecomastia. If your doctor uses this term, it means that both your breasts are enlarged.

Pseudogynecomastia.If you have extra weight, it's common to have enlarged breasts. This is a different condition called "pseudogynecomastia." It's caused by extra fat deposits in your breasts.

The signs of gynecomastia include:

  • A lump under your nipple (often the first sign people notice)
  • Tenderness
  • Soreness
  • Swelling

Changes in one or both of your breasts might make you worry that you have breast cancer, which does occur in a small number of men. Gynecomastia is not necessarily a sign of cancer, but your doctor may run some tests to rule it out.

Gynecomastia can range from mild to severe. Your doctor can "stage," or describe, the type you have in a few different ways. A new grading system proposed by a team of plastic surgeons is more detailed than older versions.

  • 1a: Puffy nipple
  • 1b: Slightly enlarged breast
  • 2a: Moderately enlarged breast
  • 2b: Moderately enlarged breast with sagging
  • 3a: Large chest enlargement with side rolls but no sagging
  • 3b: Large chest enlargement with side rolls and possible sagging
  • 4a: Severe chest enlargement without sagging
  • 4b: Severe chest enlargement with noticeable sagging

Not everybody needs or wants surgery to treat their gynecomastia. But if you do, staging can help your surgeon choose the best procedure to manage it.

A surprising number of things can trigger the hormone imbalance that causes male breast growth.

Natural changes in hormones

These happen during:

  • Infancy: Over half of male babies have swollen breasts for the first few weeks after they're born.
  • Puberty: This can last a few months or a few years. 
  • Older age: After you reach 50, gynecomastia becomes more common.

Conditions related to gynecomastia

Some other causes of gynecomastia include:

  • Low testosterone (in conditions such as hypogonadism)
  • Thyroid issues because hormones from that gland control growth and sexual development
  • Cancer, including tumors of the lungs, pituitary gland, or adrenal glands
  • Obesity,which can result in more estrogen
  • Alcohol use disorder
  • Chronic stress, which can trigger your body to make more estrogen and put a damper on testosterone
  • Kidney disease or failure (when they can no longer clean and filter your blood)
  • Liver disease
  • Type 1 diabetes
  • Being severely underweight

Medications and drugs

As many as 25% of all cases of gynecomastia may be side effects of medicines. The list of drugs includes:

  • Anti-androgens: You're given this type of drug to treat an enlarged prostate or prostate cancer.
  • HIV drugs: Gynecomastia can sometimes be a side effect of an HIV treatment called "highly active antiretroviral therapy."
  • Anti-anxiety drugs: Medicines such as diazepam (Valium) can sometimes cause gynecomastia.
  • Heart medications: Some types of ACE inhibitors and calcium channel blockers, among others, have been linked to gynecomastia.
  • Opioids: From methadone to morphine, these drugs have hormonal side effects.
  • Ulcer drugs: Some ulcer drugs that you buy at the store can lead to gynecomastia, such as cimetidine (Tagamet HB).
  • Recreational drugs: These include heroin and weed.
  • ADHD medications: Some types contain amphetamine, which can cause changes to your breasts.
  • Antibiotics: Some kinds of antibiotics can cause gynecomastia.
  • Antidepressants: Tricyclic antidepressants, an older class of antidepressants, can cause breast swelling.
  • Cancer treatments:For instance, drugs that you get during chemotherapy may also cause gynecomastia.
  • Plant oils: Some essential oils, such as lavender and tea tree oil, may also cause gynecomastia. They can have this side effect if you swallow supplements that contain them. But you could also be affected by shampoos, soaps, and other skin products.

Gynecomastia and steroids

Anabolic steroidsare a type of hormone that's able to quickly build muscle and improve how well you perform at a sport. Taking them has many side effects and health risks that are far more serious than gynecomastia. They're illegal in many countries. If you use this type of steroid, you may have heard that you can take other types of drugs to prevent, or shrink, enlarged breasts. But it's unclear how well these strategies work, or how safe they are to take.

If your doctor suspects you have gynecomastia, they'll ask you about your health and any other symptoms you may be having. They'll also likely ask questions about your medical history that might include:

  • Have you had illnesses such as mumps, kidney issues, or liver disease?
  • What drugs (legal or illegal) have you taken?

It's important to be honest with your doctor about any drug use. This gives them a clearer idea of what's going on in your body. Your doctor is not required by law to report drug use to the police unless you're about to hurt yourself or someone else. Their main concern is to help you improve your health.

Your doctor might also order some tests to rule out any medical conditions that could be causing your breast tissue to swell. They could include:

  • Blood or urine (pee) tests 
  • Mammogram
  • Biopsy
  • CT scan
  • MRI scan
  • Ultrasound of your testicles

Gynecomastia pinch test

To confirm that you have gynecomastia, your doctor will check your breasts. You'll probably be asked to lay back on an exam table with your hands over your head. Your doctor will place their thumb and index finger on each side of your breast and slowly bring them together. If you have gynecomastia, they'll be able to feel a firm disk-like shape under your skin. If your breast swelling is because of fat deposits (pseudogynecomastia), they won't feel anything until your nipple area.

Most of the time, gynecomastia slowly goes away on its own. For instance, if it happens during puberty, it usually goes away sometime between 6 months to 3 years.

But in some instances, your doctor might refer you to a specialist known as an endocrinologist . This type of doctor has special training in hormones and how they affect your body.

Gynecomastia treatment without surgery

Your doctor could suggest:

  • Treating an underlying health issue. If a health condition is found to be causing your gynecomastia, managing it will be important.
  • Changes to your drug use. Your doctor could suggest you stop using a recreational drug or supplement. Or, they may switch up a prescription medication you take. Don't stop taking any medications without first speaking to your doctor.

Gynecomastia treatment pills

Among the drugs your doctor may prescribe:

  • Anastrozole (Arimidex)
  • Raloxifene (Evista)
  • Tamoxifen (Soltamox)

These are FDA-approved medications for breast cancer. But if a hormone imbalance is causing your breast growth, your doctor may prescribe one to address your issue.

Male breast reduction surgery is usually not suggested unless your enlarged breasts are causing you severe pain or a lot of emotional stress. Your doctor could also suggest it if they suspect your breast changes are due to cancer.

The techniques your doctor could use are:

  • Liposuction: Extra fat is removed from your breasts through a thin, hollow tube.
  • Excision: Removing your breast gland tissue is the most common surgery for gynecomastia. Also called a mastectomy, this could happen with or without liposuction.

You'll be given anesthesia before any procedure, so you aren't awake during it.

These types of surgery are usually outpatient procedures. You'll be able to go home the same day. Most people are back to their usual routine in about 2 weeks. Your breasts will take longer than that to fully heal. You might not notice the full results from the surgery for a few months.

Gynecomastia surgery cost

According to the American Society of Plastic Surgeons, the average surgeon's fee for male breast reduction surgery is $4,822. That doesn't include extra costs such as those of anesthesia.

Your cost could be higher or lower based on where you live and the surgeon who does your procedure. Most health plans don't cover gynecomastia surgery, but your surgeon might offer a payment plan.

There are steps you can take to lower your chances of having gynecomastia. For instance, you can:

  • Avoid recreational drugs, such as anabolic steroids, androgens, weed, or heroin.
  • Limit the amount of alcohol you drink. Less is healthier.
  • Go over your medications with your doctor. If any of them can cause gynecomastia, ask if there are alternatives.

Everyone's body is different. But if you feel embarrassed, anxious or depressed about how your breasts look, there are steps you can take:

  • Visit your doctor. They can rule out more serious reasons for your breast changes, which may help lower your stress level.
  • Talk to a counselor. A mental health provider can give you tips on managing the feelings you're having.
  • Find a friend or trusted family member you can trust. Help them understand what you're going through. That way, they can give you the emotional support you need.
  • Check out a support group. You'll get a chance to talk to others who understand what you're going through. Ask your doctor for help in finding groups that you can connect with.

Gynecomastia exercise

Getting to a healthy weight can't get rid of gynecomastia, but it can help decrease the amount of fat in your breasts. Find a physical activity you enjoy and try to do it regularly. Joining a gym allows you to try out different classes and get help using free weights and machines. But you can also go outside and take a walk. Every bit of movement counts and may improve your outlook in general.

Gynecomastia is often caused by a hormone imbalance, not cancer. Your doctor can help you confirm the cause and decide next steps. If it's uncomfortable or affects how you feel about yourself, surgery such as liposuction can make a difference.

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