What is gynecomastia?

Gynecomastia is the non-cancerous enlargement of glandular breast tissue in men and boys. It occurs when there is an imbalance between oestrogen and testosterone. Oestrogen can stimulate breast tissue growth, while testosterone generally counteracts this effect. When oestrogen has a greater effect than testosterone, firm breast tissue may develop beneath the nipple.

What are the causes of gynecomastia?

Gynecomastia generally develops when the balance between oestrogen and testosterone changes. Several factors can contribute to this imbalance.

Normal hormonal changes : These are among the most common causes. Breast enlargement is common in newborn boys, occurring in approximately 60–90% of male newborns. It is usually a temporary response to maternal hormones transferred during pregnancy and typically settles on its own within the first few weeks after birth [1]. Gynecomastia can also develop during puberty as hormone levels fluctuate and often resolves within several months to two years. In older men, declining testosterone levels and increased body fat can contribute to breast enlargement.
Excess body weight: Chest enlargement caused mainly by fat is called pseudogynecomastia. True gynecomastia involves glandular breast tissue, although both can occur together. Fat tissue also converts some testosterone into oestrogen, which may contribute to glandular growth. Weight loss can reduce chest fat but may not remove established glandular tissue.
Certain medications: Some calcium channel blockers, and psychiatric medicines have been associated with gynecomastia.
Certain substances: Some substances may also affect hormone balance. These include anabolic steroids, alcohol, cannabis, amphetamines, heroin and methadone. Anabolic steroid use is a recognised cause, particularly among men using these substances to increase muscle mass.

What health conditions can cause gynecomastia?

Certain medical conditions can interfere with hormone production or metabolism and lead to breast enlargement. Identifying these conditions is important because treating the underlying problem may improve gynecomastia.

Adrenal tumours: Adrenal tumors are rare causes of gynecomastia. Some tumours produce oestrogen or other hormones that the body converts into oestrogen. This can cause breast enlargement that develops quickly or continues to increase, which should be assessed by a doctor.
Hyperthyroidism: . Hyperthyroidism, or an overactive thyroid, can affect the balance between testosterone and oestrogen, contributing to gynaecomastia. It may also increase the conversion of testosterone into oestrogen, encouraging breast tissue growth.
Liver disease : Liver disease can affect the body’s ability to process hormones. In conditions such as cirrhosis, reduced liver function can increase oestrogen activity. Alcohol-related liver disease can further affect testosterone production. Spironolactone, which may be prescribed for fluid retention in some patients with liver disease, can also contribute to gynecomastia.
Kidney disease: Kidney disease, particularly advanced chronic kidney disease and dialysis, can cause changes in testosterone and other reproductive hormones. These changes may contribute to breast enlargement.
Pituitary adenomas: Pituitary tumours are usually benign. Some produce excess prolactin, which can lower testosterone levels and occasionally contribute to gynaecomastia. This can shift the hormonal balance towards oestrogen’s effects on breast tissue.

What are the signs of gynecomastia?

Common signs include:

Firm or Rubbery Tissue Beneath the Nipple: A firm or rubbery lump may develop directly beneath the nipple or areola. This tissue may feel slightly raised or thickened compared with the surrounding breast tissue.
Tenderness or Aching in the Breast: The breast may feel tender, sore, or achy, particularly when touched or pressed. Discomfort can occur as the breast tissue develops or changes.
Increased Nipple Sensitivity: The nipples may feel more sensitive or sore than usual, even with a light touch or gentle pressure.
Puffiness or Enlargement of the Areola: The areola, the darker area surrounding the nipple, may appear swollen or puffy. Changes may occur on one or both sides.
Enlargement of One or Both Breasts: Breast tissue may increase in size on one side or both sides. The amount of enlargement can vary from person to person.
Unequal Breast Size Between the Two Sides: One breast may become more enlarged or develop more breast tissue than the other. Mild differences between the two sides can occur during the development of the condition.

Early gynecomastia may be softer and more tender, while long-standing tissue can become firmer and more fibrous. Once the tissue becomes predominantly fibrous, medicines are generally less effective.

Certain changes require prompt medical assessment. These include a hard lump that is not centred beneath the nipple, skin dimpling or ulceration, bloody nipple discharge or enlarged lymph nodes in the armpit. Male breast cancer is much less common than gynecomastia, but these features should not be ignored.

How is gynecomastia diagnosed?

Medical history: The doctor may ask when the breast enlargement began, whether it has changed over time, and whether there is any pain or tenderness.
Medication and substance history: You may be asked about prescription medicines, supplements, alcohol, and recreational substances that could contribute to breast enlargement.
Physical examination: The doctor examines the breast tissue to assess its size, consistency, tenderness, and any unusual lumps and changes.
Other areas examined: The testicles, thyroid gland, and abdomen may also be examined to look for possible underlying causes.
Blood tests: Tests may be recommended to check hormone levels, including testosterone, oestradiol, luteinising hormone (LH), follicle-stimulating hormone (FSH), prolactin, and beta-hCG.
Organ function tests: Thyroid, liver, and kidney function tests may also be performed to identify conditions that could contribute to gynecomastia.

What are the treatment options for gynecomastia?

Treatment depends on the underlying cause, how long the condition has been present, its severity and whether the enlargement consists mainly of glandular tissue, fat or both.

Watchful waiting and lifestyle changes

Pubertal gynecomastia often resolves without treatment. Doctors may therefore recommend observation, particularly when there are no concerning features. If excess weight contributes to breast enlargement, gradual weight loss may reduce both fat and oestrogen production. Reducing alcohol consumption and stopping anabolic steroid use may also help when these are contributing factors.

Medications

Medicines are generally more useful during the early stages, when the tissue is still developing and has not become predominantly fibrous.

Tamoxifen: Tamoxifen blocks oestrogen receptors in breast tissue and may help reduce breast tenderness and enlargement in selected patients.
Raloxifene: Raloxifene works through a similar hormonal pathway and may also be considered in certain cases.
Testosterone replacement therapy: Testosterone therapy may be appropriate for men with confirmed testosterone deficiency. It is not recommended for men with normal testosterone levels,as the body can convert testosterone into oestrogen, potentially worsening breast enlargement.

Radiation therapy

In selected men receiving certain anti-androgen treatments for prostate cancer, low-dose radiation therapy may occasionally be considered to help prevent or reduce breast tissue growth and tenderness.

Surgery

Surgery may be considered if gynecomastia does not improve, causes significant discomfort, emotional distress, or involves long-standing breast tissue enlargement and excess skin.

Subcutaneous mastectomy or glandular excision: This procedure involves the removal of the enlarged glandular tissue through an incision, often placed along the edge of the areola. The surgeon generally preserves an appropriate layer of tissue beneath the nipple to maintain a natural contour.

Liposuction combined with glandular excision: This can address both excess fat and firm glandular tissue. Liposuction shapes the surrounding chest area, while excision removes the gland beneath the nipple.

Why choose Narayana Health?

Breast enlargement can cause discomfort and affect your confidence. At Narayana Health, your doctor can assess the changes and review your medicines and medical history. An endocrinologist can investigate possible hormonal causes, recommend tests where needed, and advise on treating any underlying condition.

If surgery is being considered, our plastic surgery specialists can assess your suitability and explain the procedure, risks and recovery, helping you make an informed decision.

Conclusion

Gynecomastia is common and, in most cases, is not harmful to physical health. However, persistent breast enlargement, tenderness or a noticeable lump can cause significant concern and affect confidence and quality of life.

Early evaluation can help identify reversible causes and determine whether observation, lifestyle changes or medical treatment may help. Long-standing glandular tissue may require surgery when other approaches are not suitable or effective.

References

1. Ukaonu CE, Clay GM Jr, Curtis SA. Severe male breast enlargement. Am Fam Physician. 2017 May 1;95(9):583-584. Accessed September 17, 2026. https://www.aafp.org/afp/2017/0501/p583.pdf

FAQs

1. Can gynecomastia occur after weight loss?
A. Yes. Weight loss can reduce fat-related chest enlargement, but firm glandular tissue may remain if true gynecomastia is present. A doctor can determine whether the remaining enlargement is mainly glandular tissue or fat.

2. Does exercise reduce gynecomastia?
A. Exercise can help reduce overall body fat and improve the appearance of the chest when excess fat contributes to enlargement. However, exercise cannot directly remove established glandular breast tissue.

3. Can gynecomastia come back after surgery?
A. Recurrence is uncommon when the underlying cause has been addressed, but breast enlargement can develop again if contributing factors such as hormonal disorders, certain medicines, or anabolic steroid use continue.

4. Does gynecomastia affect fertility?
A. Gynecomastia itself does not usually cause infertility. However, if breast enlargement is associated with an underlying hormonal or testicular condition, further evaluation may be needed.