Concern

Treatment for Gynecomastia

Gynecomastia is a benign enlargement of glandular breast tissue in males caused by an imbalance between estrogen and testosterone. It may affect one or both breasts and can cause tenderness or discomfort. The condition occurs across the lifespan, including in newborns, adolescent boys during puberty, and older men as hormone levels change. Many cases resolve on their own, while persistent gynecomastia may cause psychological distress and can be addressed with medical or surgical treatment. The tissue behind the nipple determines how surgery is planned: firm glandular tissue has to be excised, while surrounding fat can be removed with suction. A mostly fatty chest and a mostly glandular chest therefore require different operations, even when they look alike beneath a shirt. We establish that ratio during examination and build the operation around it.

Medically reviewed by Dr. Kamakshi R. Zeidler, MD, FACS · Updated April 2026

At a Glance

Gynecomastia affects over 50% of males at some point in their lives, with prevalence peaks in newborns, adolescents, and men over 50^[4]

In adolescents, more than 90% of gynecomastia cases resolve spontaneously within one to two years without treatment^[1]

The condition results from an imbalance between estrogen and testosterone, and can be caused by medications, medical conditions, or normal hormonal changes^[5]

Gynecomastia is the most common benign disorder of male breast tissue and is not associated with increased risk of breast cancer in otherwise healthy men^[2]

Signs & symptoms

Enlargement of breast tissue, often described as a firm or rubbery mass beneath the nipple
Breast tenderness or sensitivity, particularly in early stages
Swelling in one or both breasts, which may be asymmetric
A palpable, moveable lump under the nipple area
Nipple discharge in some cases
Psychological distress or self-consciousness related to breast appearance

What causes Gynecomastia

Imbalance between estrogen and testosterone hormone levels
Normal hormonal fluctuations during puberty, with estradiol rising faster than testosterone
Age-related decline in testosterone production, particularly in men over 50
Medications including spironolactone, finasteride, digoxin, cimetidine, and certain antipsychotics
Medical conditions such as hypogonadism, hyperthyroidism, liver cirrhosis, and kidney failure
Substance use including anabolic steroids, marijuana, and alcohol
Obesity, which can increase estrogen production through aromatization of androgens in fat tissue

Risk factors

Adolescence (puberty-related hormonal changes)
Age over 50 years
Obesity or excess body fat
Use of anabolic steroids or testosterone supplements
Medications that affect hormone levels (e.g., prostate cancer treatments, anti-ulcer drugs)
Chronic liver disease or cirrhosis
Kidney failure or dialysis
Klinefelter syndrome or other conditions affecting testosterone production
Alcohol use
Exposure to estrogen-containing products or endocrine-disrupting chemicals

How it's assessed

Physical examination to assess breast tissue, distinguish from pseudogynecomastia (fat-only enlargement), and check for masses
Medical history review including medication use, substance use, and family history
Blood tests for hormone levels including testosterone, estradiol, LH, and DHEAS
Thyroid function tests to rule out hyperthyroidism
Liver and kidney function tests
Mammography or breast ultrasound to evaluate tissue composition and rule out breast cancer
Testicular ultrasound if a testicular abnormality is suspected

How is Gynecomastia treated

Several approaches can address gynecomastia:

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Recovery & outlook

In newborns, gynecomastia typically resolves within a few months as maternal estrogen clears
In adolescents, more than 90% of cases resolve spontaneously within one to two years
Persistent gynecomastia lasting longer than 12 months may become fibrotic and less likely to resolve without intervention
Surgical treatment generally produces lasting results with high patient satisfaction
Gynecomastia is not life-threatening but can cause significant psychological impact

Frequently Asked Questions

Gynecomastia is a benign enlargement of glandular breast tissue in males caused by an imbalance between estrogen and testosterone. It can affect one or both breasts and is common in newborns, during puberty, and in men over 50. It is distinct from pseudogynecomastia, which is enlargement caused by fat accumulation without glandular tissue growth.
Common signs include a firm or rubbery mass beneath the nipple, breast tenderness or sensitivity, and visible swelling in one or both breasts. The enlargement may be asymmetric. Nipple discharge can also occur, but it is less common.
Gynecomastia results from an imbalance between estrogen and testosterone. Causes include normal hormonal changes during puberty or aging, medications such as spironolactone or finasteride, medical conditions including liver disease and thyroid disorders, and substances such as anabolic steroids and marijuana.
Seek medical evaluation for new or rapidly growing breast tissue, persistent breast pain or tenderness, nipple discharge, especially if it is bloody or dark, a hard or fixed lump, or gynecomastia that causes significant distress. Prompt evaluation can help rule out rare conditions such as male breast cancer.
Treatment depends on the cause and severity. Many cases, particularly in adolescents, resolve on their own. Options include addressing an underlying condition, adjusting contributing medications, using hormone-blocking medications in persistent cases, and male breast reduction surgery when cosmetically significant gynecomastia has not responded to other approaches.
In many cases, yes. Gynecomastia in newborns typically clears within a few months, and most adolescent cases resolve within one to two years. Gynecomastia that persists for longer than 12 months may become fibrotic and less likely to resolve without intervention. Persistent cases in adults often benefit from medical evaluation.
Gynecomastia surgery most often combines two techniques in one outpatient procedure. Liposuction through small incisions removes the fatty component and feathers the edges into the chest wall so that no shelf is left behind. Direct excision through a periareolar incision removes the firm glandular disc that suction cannot take. Which technique dominates depends on the ratio of fat to glandular tissue found during examination. Severe cases with substantial skin excess may also require skin removal and nipple repositioning. We publish gynecomastia surgery as a separate procedure, where the technique and recovery are covered in greater detail; this page focuses on the condition itself.
The distinction comes down to the tissue. Fat is soft and distributed across the chest wall. True gynecomastia feels like a firm, sometimes tender disc centered beneath the nipple and areola, and it does not shrink with weight loss because it is glandular rather than adipose tissue. Many men have both fat and glandular tissue. The chest may improve with weight loss and then reach a point where it stops changing; that plateau is usually the glandular component becoming more visible after the surrounding fat has diminished. An examination distinguishes the two, and a thorough assessment may also include medication history, hormonal testing, or imaging because several other conditions can enlarge male breast tissue and are worth excluding first.