I remember a young man, maybe 16 or 17, sitting in my office. He was a talented athlete, but he’d started making excuses to skip swim practice. He finally admitted, looking at the floor, that he was too embarrassed to take his shirt off in the locker room. He was dealing with gynecomastia, a condition that, while not physically dangerous, can feel incredibly isolating. If you’re reading this, please know you are far from alone. This is one of the most common things we see in men and boys of all ages.
Let’s talk about what’s really going on.
What Exactly Is Gynecomastia?
Simply put, gynecomastia is the enlargement of the actual glandular tissue in a man’s or boy’s chest. It’s not just fat. This is a key difference. Many people have extra fat tissue on their chest due to weight, which we call pseudogynecomastia (the “pseudo” means false). True gynecomastia is an increase in the breast gland itself.
It often feels like a small, rubbery, or firm disc of tissue right under the nipple. You might notice it in one breast or both. It can be a little tender, especially when it’s first developing.
The important thing to remember is that this is a benign (noncancerous) condition. While we always want to rule out anything serious, gynecomastia itself is not a threat to your physical health.
Still, that doesn’t make it any less distressing. Your mental and emotional health are just as important, and feeling self-conscious about your body is a very real and valid concern.
Why Does Gynecomastia Happen?
At its core, gynecomastia is almost always about a hormone imbalance. Specifically, it’s about the relationship between testosterone (the primary male hormone) and estrogen (the primary female hormone). Yes, men have estrogen, too! When estrogen levels are a bit too high relative to testosterone, it can stimulate the breast glands to grow.
This imbalance is completely normal and expected at certain life stages:
- Newborns: Many baby boys are born with small breast buds. This is from exposure to their mother’s estrogen in the womb and it fades within a few weeks.
- Puberty: This is a huge one. As a boy’s body goes through the hormonal rollercoaster of puberty, it’s very common for estrogen to rise faster than testosterone for a bit. More than half of adolescent boys experience some degree of gynecomastia. It almost always resolves on its own within six months to two years.
- Older Adulthood: As men age, testosterone production naturally declines. This can tip the hormonal scale, making gynecomastia more common in men over 50.
Sometimes, though, it can be a sign of something else going on. We always want to consider these possibilities, even if they’re less common.
| Category of Cause | What This Means & Examples |
|---|---|
| Underlying Medical Conditions | Certain health issues can throw your hormones out of whack. We’d look for things like hyperthyroidism (overactive thyroid), kidney or liver disease, low testosterone (hypogonadism), or, very rarely, tumors on the adrenal or pituitary glands. |
| Medications | A surprising number of drugs can cause this as a side effect. Some common ones include certain diuretics like spironolactone, heart medications like digoxin, heartburn drugs like cimetidine, and prostate medications like finasteride. |
| Substances | Use of alcohol, marijuana, amphetamines, or heroin can contribute. Also, the misuse of anabolic steroids is a well-known cause. |
How We Approach Treatment
First off, we talk. I want to hear your story and understand how this is affecting you. Then, a simple physical exam helps me feel the tissue to confirm if it’s glandular (gynecomastia) or fatty (pseudogynecomastia).
Depending on your age and situation, the plan can vary:
- Watchful Waiting: Especially for teens, the best approach is often patience. As hormones balance out, the tissue usually shrinks on its own.
- Addressing the Cause: If a medication is the culprit, we might be able to switch it. If it’s an underlying health issue, treating that condition is the priority.
- Medication: In some cases, we might discuss medications that can help rebalance hormones, though this is less common.
- Surgery: For gynecomastia that persists and causes significant distress, male breast reduction surgery is an option. A plastic surgeon removes the excess glandular tissue. This is a personal choice, but it can be life-changing for some men.
And what about exercise? If you have pseudogynecomastia (the fatty kind), then yes, exercise and weight loss can absolutely help. But for true gynecomastia, exercise won’t remove the glandular tissue.
Take-Home Message
- It’s Common: Gynecomastia affects over half of males at some point. You are not an anomaly.
- It’s Hormonal: The root cause is usually an imbalance between estrogen and testosterone, which is often a normal part of life stages like puberty and aging.
- It’s Not Dangerous: This is a benign condition and not a form of cancer. However, any new breast lump should always be checked by a doctor.
- Distinguish the Type: True gynecomastia is firm glandular tissue under the nipple, while pseudogynecomastia is softer, fatty tissue all over the chest.
- Talk to Your Doctor: If the appearance bothers you or if you have other symptoms like pain or nipple discharge, please come in for a chat. We can figure out the cause and discuss what, if anything, needs to be done.
It takes courage to talk about something so personal. Whether you’re a teen, a young adult, or an older man, remember that your feelings are valid. We’re here to listen and help you find a path forward that makes you feel comfortable and confident in your own skin. You don’t have to navigate this alone.