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Gynecomastia - what causes male breast growth, and how to treat it

Gynecomastia, or enlarged male breasts, is a condition that affects between 40 and 50 per cent of men at some point in their lives.

Despite male breast growth being common, particularly during puberty, many men find the condition embarrassing, causing stress and anxiety.

Whatever your age, there are various ways you can try and get rid of gynecomastia.

What are the symptoms of gynecomastia?

For many, the first sign of gynecomastia an initial lump of tissue around the nipple that feels firm or rubbery. Other significant symptoms include:

  • Puffy nipples or swelling in one, or both, breasts.
  • Tenderness or pain the breast area.
  • Discharge from one or both nipples.

Gynecomastia vs pseudogynecomastia

Gynecomastia affects the breast tissue, while pseudogynecomastia is the result of excess fat tissue.

With gynecomastia, you will feel a firm mound of glandular tissue around your areola, and it may be painful to touch. If you have pseudogynecomastia, the entire breast area is evenly enlarged.

It’s important to differentiate between the two, as the causes and therefore treatments options will vary.

The only way to properly diagnose is through a physical examination by a health professional. Other tests can include an X-ray, mammogram, or core biopsy.

What causes male breast growth?

Hormones

The most common cause of gynecomastia is an imbalance between your testosterone and oestrogen hormones.

All men produce a low level of oestrogen - the main hormone which causes breasts to grow – but usually their high levels of testosterone stop them developing breast tissue.

An imbalance might occur during puberty when hormones are more unstable, or it may happen with age when testosterone production wanes.

Diet and lifestyle

Obesity can make the male body create more oestrogen, causing breast tissue to swell and leading to gynecomastia.

Weight gain can also cause pseudogynecomastia, where fat deposits increase the size of your breasts.

Genetics

Although extremely rare, there is a genetic disorder known as Klinefelter syndrome that has been known to trigger gynecomastia. A male baby is born with an extra X chromosome which interferes with the development of the testicles, meaning they produce less testosterone. It’s thought to affect around one in every 500 newborn males.

Medications

An even less common cause of gynecomastia is medication side-effects. However, some antibiotics and cancer treatments can lead to breast growth, as can anabolic steroid use. As always, a doctor will know best if your medication is to blame so speak to them first and foremost.

Gynecomastia - surgery and alternatives

Getting rid of gynecomastia isn’t as impossible as it may feel. Many cases naturally improve and don’t require treatment at all – particularly after puberty when hormone levels eventually settle. But if symptoms persist, there are several treatment options to consider.

Gynecomastia surgery

The two most common types of surgery for treating gynecomastia are:

  • Liposuction – removes any extra fat from the breast.
  • Mastectomy – removes the breast glandular tissue.

Surgery is done under general anaesthetic and usually involves moving the nipple, removing excess fat or breast tissue (often with liposuction) and skin and reshaping your chest.

A professional, experienced clinician will help you decide which route suits your needs best. For more information and guidance, check out our guide to male breast reduction surgery.

Surgery offers a permanent solution to your gynecomastia, or your pseudogynecomastia, but it’s wise to confront the cause or your condition in the first place so it is less likely to return.

Lifestyle changes

Exercise and a healthy diet are helpful if you have pseudogynecomastia, as it targets the fat build up in your breasts. Think targeted movements like push ups and bench presses to build up chest muscles, alongside cardio.

However, exercise cannot reduce the glandular tissue of gynecomastia, so you will most likely need an additional treatment to remove this.

Testosterone replacement therapy (TRT)

Review any medications you’re currently using in case they are causing a hormone imbalance. Find out if there are any alternatives with your doctor.

If the cause of your gynecomastia is low testosterone levels, then testosterone replacement therapy might resolve the underlying issue.

TRT treatments include gels, patches, or injections. As with any sort of medication or treatment, there are potential side-effects to TRT, such as rashes and itching, plus an increased risk of certain health conditions – including sleep apnoea, prostate enlargement and cardiovascular issues – though the research on this is still in its early stages.

Gynecomastia facts

  • Gynecomastia was first used to describe an abnormal increase in fat within the male breast during the second century AD, by the infamous Roman physician Galen.
  • The word gynecomastia derives from the Greek terms gynec (which means feminine or woman) and mastos (breast).

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