Gynecomastia is a common medical condition in males, characterized by the enlargement of glandular breast tissue. It typically results from a hormonal imbalance and should be distinguished from fat accumulation in the chest area, which occurs in overweight individuals. (1)

Common Causes of Gynecomastia: (2)

Hormonal imbalances, specifically an increase in estrogen or a decrease in testosterone, are the primary causes. Some of the most notable reasons include:

• Puberty-related gynecomastia (25% of cases): This is common among teenagers due to hormonal fluctuations during puberty. However, it usually resolves on its own within 6 months to 2 years.
• Side effects of certain medications (10-25%): Some drugs can contribute to gynecomastia, including spironolactone (used for blood pressure and heart conditions), anabolic steroids for muscle growth, and others.
• Unknown causes (25%): In some cases, the exact cause remains unidentified.

In most instances, gynecomastia resolves with no treatment over time. However, if the condition is persistent or causes discomfort, treatment options include medication or surgery, as determined by a healthcare professional. Below, we explore the available medical and surgical treatments for gynecomastia in men. (1)

Medical Evaluation Before Treatment

If you're experiencing breast enlargement, your doctor will first examine you to determine whether it's simply due to fat accumulation from obesity (known as pseudogynecomastia) or true gynecomastia caused by glandular tissue growth. This distinction is crucial in deciding the appropriate treatment.

Your doctor may also request hormone blood tests, including testosterone, LH, and FSH levels, and, if necessary, imaging tests to get a clearer diagnosis. (2)

How to Treat Gynecomastia

Gynecomastia is usually harmless and often resolves on its own without treatment. However, in some cases, medical intervention may be necessary depending on factors such as the underlying cause, the severity and duration of the condition, and its physical or psychological impact on the individual.

Options include: (1)(2)

For Teenagers

In most cases, doctors recommend monitoring the condition, as it typically resolves naturally within two years.

For Adults 

• If gynecomastia is caused by an underlying health condition or medication, treating the root cause or discontinuing the drug can often lead to improvement.
• If excess weight is a contributing factor, weight loss and exercise may help reduce chest size.
• In cases where the cause is unknown or when the condition persists despite addressing the underlying issue, a short-term course of medication (such as Tamoxifen or Raloxifene) for 3-6 months may be considered.

Surgical Treatment

When recommended?

If gynecomastia has persisted for more than a year or has not responded to other treatments, a doctor may suggest surgery to remove excess tissue.

Types of Surgery?

Depends on the severity of the condition and the type of excess tissue:

• Liposuction: Used when the enlargement is primarily due to fat accumulation.
• Mastectomy: when there is excessive growth of breast gland tissue rather than just fat.
• Combination of both procedures: In some cases, a surgeon may perform both liposuction and glandular tissue removal to achieve the best results.

*If gynecomastia is severe or has led to sagging skin, a chest lift may also be needed to remove excess skin and improve chest contour.

What to expect?

• The surgery typically takes 1 to 2 hours, though more severe cases may require additional time.
• Most patients can go home the same day or the following day, depending on their condition.
• Scars are minimal and tend to fade over time.
• Many patients experience a boost in confidence and psychological well-being after the procedure.
• The results are usually permanent, provided a healthy weight is maintained and there are no ongoing medical conditions or medications affecting hormone levels.
• Surgery is not recommended for teenagers until puberty is fully completed, as gynecomastia may recur afterward. (3)

Final Thoughts

While gynecomastia is not usually a serious health issue, it can sometimes cause discomfort and is often a source of social embarrassment. If it’s affecting your confidence or causing distress, don’t ignore it—consult a doctor for evaluation and treatment.

The diagnosis and initial treatment typically start with an endocrinologist, and if necessary you can then be referred to a plastic surgeon.

References

1. Medscape - Gynecomastia
2. UpToDate - Patient education: Gynecomastia (breast enlargement in males) (Beyond the Basics)
3. American Board of Cosmetic Surgery - Gynecomastia Surgery Guide