Gynecomastia

What is gynecomastia?

Gynecomastia is enlarged breast (chest) tissue in people assigned male at birth (AMAB). It’s a benign (noncancerous) increase in breast volume due to an increase in glandular tissue. Obesity can also cause an increase in breast size due to excess adipose (fat) tissue. Healthcare providers call this pseudogynecomastia.

Gynecomastia can affect people AMAB of all ages. But it usually occurs during the newborn period, puberty and older adulthood. It’s very common, affecting over 50% of people AMAB at some point in their lives. Gynecomastia most often happens due to an imbalance of hormones — specifically testosterone and estrogen.

Gynecomastia isn’t harmful to your physical health, but it may make you self-conscious and affect your self-esteem. Your mental health is just as important as your physical health. Talk to your healthcare provider and/or a mental health professional if gynecomastia is causing you distress and/or it’s happening alongside other symptoms.

What does gynecomastia look and feel like?

Gynecomastia typically looks and feels like a button-sized growth underneath your nipple. You may be able to see this as a breast lump or feel it when you press on the area. The lump may move easily within the breast tissue and may be tender to touch. Breast lumps and enlargement may occur in one or both breasts.

If you have obesity, you may develop enlarged breasts due to excess adipose tissue (pseudogynecomastia). This looks like a general increase in breast size, not a lump.

It’s important to note that male breast cancer can also cause a lump in your breast tissue. Male breast cancer is much rarer than gynecomastia. But it’s essential to see your healthcare provider for a physical examination that can help distinguish between the two. Sometimes, your provider might order further imaging tests.

What causes gynecomastia?

Gynecomastia is the enlargement of glandular tissue in your breast(s). Estrogen is responsible for the growth of glandular breast tissue. Estrogen also suppresses the release of testosterone. This is because it suppresses luteinizing hormone (LH), the hormone responsible for the release of testosterone in your testicles. In other words, an increase in estrogen and a decrease in testosterone most often leads to gynecomastia.

Gynecomastia is more likely to happen during periods of hormonal fluctuations, especially at or during:

• Birth: More than half of newborns AMAB have enlarged breasts, or breast buds. It typically happens due to exposure to the birthing parent’s estrogen levels. Gynecomastia in newborns usually goes away within a few weeks.
• Puberty: More than half of adolescents AMAB have some degree of breast enlargement during puberty. It likely happens due to a faster rise in estrogen than in testosterone. But this imbalance usually regulates with time — about six months to two years.
• Late adulthood: Gynecomastia is common in people AMAB over 50. With age, your body produces less testosterone. People over 50 are also more likely to be taking medications that can cause gynecomastia.

These causes of gynecomastia are natural and to be expected — they’re not physically harmful. But gynecomastia can also be a symptom of certain medical conditions that require treatment.

Conditions that cause gynecomastia

Gynecomastia may be a symptom or result of the following health conditions:

• Adrenal tumors.
• Hyperthyroidism (overactive thyroid).
• Kidney disease or kidney failure.
• Klinefelter syndrome (an inherited condition).
• Liver disease and cirrhosis.
• Male hypogonadism (low testosterone).
• Pituitary gland tumors (pituitary adenomas), especially prolactinomas.
• Testicular tumors.

These conditions typically have other symptoms, not just gynecomastia.

Medications that may cause gynecomastia

Gynecomastia may be a side effect of certain medications, including:

• Cimetidine (for heartburn and acid reflux).
• Digoxin (for certain heart issues).
• Finasteride (for enlarged prostate or alopecia).
• Ketoconazole (for fungal or yeast infections).
• Spironolactone (for high blood pressure and heart failure).
• Thiazides (a class of diuretics).
• Phenothiazines (a class of first-generation antipsychotic medications).
• Theophylline (for asthma and COPD).
• Methotrexate (for rheumatoid arthritis and cancer).
• Imatinib (chemotherapy drug).

Substances, including amphetamines, marijuana and heroin, may also cause gynecomastia. Misusing anabolic steroids can, as well.

What is the treatment for gynecomastia?

Some people don’t want or need treatment for gynecomastia. But if you do, your healthcare provider may recommend a few different strategies depending on your situation:

• Stopping or switching a medication: If a medication or other substance is causing gynecomastia, your provider may recommend that you switch to a different one or stop using it. Make sure your provider is aware of any nonprescription medications — like dietary and herbal supplements — you’re taking. Never stop taking a prescription medication without your provider’s guidance.
• Underlying condition treatment: If an underlying condition is the cause, like a tumor or hypogonadism, treatment for the condition may also treat gynecomastia.
• Gynecomastia surgery: Some people choose to get surgery for gynecomastia (male breast reduction) to remove excess breast tissue. This is an elective cosmetic surgery.

Does gynecomastia go away?

For newborns and adolescents, gynecomastia is usually temporary — it goes away once your hormones rebalance. For people who have chronically low testosterone levels, gynecomastia may not go away without treatment.

Days may feel like weeks when you’re living with gynecomastia, especially if it’s affecting how you view yourself. If you’re concerned about how long you’ve had gynecomastia or it’s causing you distress, reach out to your healthcare provider.

Can gynecomastia go away with exercise?

If you have gynecomastia due to obesity (pseudogynecomastia), weight loss may decrease it. And exercise can contribute to weight loss.

If you have gynecomastia due to a hormonal imbalance, exercise likely won’t make a difference. This is because an imbalance of estrogen and testosterone is responsible for an increase in your breast tissue, and exercise can’t override that.

Can I prevent gynecomastia?

Unfortunately, you can’t prevent many of the hormone changes that cause gynecomastia. If needed, you may reduce your risk of gynecomastia by switching medications or seeking treatment for a substance use disorder.

When should I see my healthcare provider about gynecomastia?

If gynecomastia is causing you distress and/or you have other new symptoms, talk to your healthcare provider. They can check to see if an underlying medical condition is the cause and discuss potential treatment options.

What questions should I ask my provider?

You may want to ask your healthcare provider:

• Why did I get gynecomastia?
• Do I need to switch any of my medications?
• What is the best treatment for gynecomastia?
• How long will gynecomastia last?
• How can I prevent getting gynecomastia again?
• Should I get screened for breast cancer?
• Should I watch for signs of complications?

A note from Cleveland Clinic

If you feel uncomfortable about the look and size of your breasts (chest), reach out to your healthcare provider. Your provider is there to help you, not judge you. They can pinpoint the cause of the size increase and provide guidance on when it’ll likely go away or if treatment may help. If you’re feeling anxious or depressed about how you look, reach out to a mental health professional.