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Gynecomastia: Causes, Types, Diagnosis & Treatment Options

A resource page covering A-Z aspects of gynecomastia.

Gynecomastia: Causes, Types, Diagnosis & Treatment Options2019-03-04T06:14:12-05:00

Gynecomastia, in very simple terms, is the enlargement of male chest caused by excessive growth of breast tissue inside breast glands. The name comes from the Greek words  gynaik meaning “female” and  mastós meaning breast. So the two words gynaik and mastós joined together forms the word gynecomastia meaning female breasts.

how many men in the united states have gynecomastia

According to official statistics, 36% of adult young men and 57% of older adult men in the United States have this medical condition in one of the four grades and the numbers are only rising year after year . The Food and Drug Administration (FDA) reports that approximately 200,000 to 3 million cases are reported each year.[1]

How Many Men Have Gynecomastia ?

Young Adult Men In United States
Older Adult Men In United States

Is Gynecomastia Life Threatening ?

No for 99.9% of the cases. The medical community considers gynecomastia as benign or not harmful to the body and gynecomastia generally does not pose an immediate health risk.[2] Most cases of gynecomastia diagnosed in men happens NOT as a result of any serious underlying medical condition. Now this being said, a very very small percentage of instances of gynecomastia are caused by other underlying conditions such as a tumour.

However, the real risk is in terms of you losing self-confidence to form relationships, missed social exposure, feelings of inferiority as well as the chances of being ridiculed and bullied among peers due to this condition. In one study by Concordia University and University of Manitoba called “Men and Masculinities”, researchers found that young men do face body image anxieties and fears as those experienced by girls and women.[3] Being afflicted with Gynecomastia hinders young men from developing a positive body image.

gynecomastia can cause emotional insecurity in men

What Lies Beneath

The enlargement is actually caused by the presence of excess breast tissue under and around your nipple (areola is the medical term). You can see an illustration of the difference between gynecomastia and a normal male chest below.

Anatomy Of A Male Chest With Gynecomastia

An illustration showing the difference between gynecomastia and normal chest in men

The Hidden Dangers & Social Cost Of Gynecomastia

Boys and adult men who have gynecomastia are often hesitant to share their plight with family members due to a number of reasons. Sometimes they are ashamed thinking they are going to be laughed at. If your loved one has this medical condition, please understand the enormous pressures they are facing and afford them with all the empathy you could. This is especially, all the more important for teenagers with gynecomastia.[3]

An image that talks about the emotional and social challenges experienced by those having gynecomastia

Whatever the severity (grades of gynecomastia) of this condition is, having larger chests than men of their age or peers poses a negative psychological for men. According to the April, 2013 issue of Plastic and Reconstructive Surgery, “Merely having gynecomastia was sufficient to cause significant deficits in general health, social functioning, mental health, self-esteem, and eating behaviours and attitudes compared with controls,” [4] American Society of Plastic Surgeons (ASPS) Member Surgeon Dr. Brian I. Labow and his colleagues at Boston Children’s Hospital wrote.

Not All Breast Enlargement In Men Are Gynecomastia

Before we dive deep into other aspects of gynecomastia, let’s get some more clarity on breast enlargement in men. One of the common misconceptions is that all breast enlargement in men are as a result of gynecomastia or breast tissue growth. This is simply not true. In the case of gynecomastia, it is excess breast tissue under and around the areola (nipple) that gives the outer appearance of breast enlargement. However, not all breast enlargement need not necessarily be caused due to excessive breast tissue growth.

First, make sure that what you is in fact gynecomastia with the help of a doctor

Another common cause of breast enlargement in men is due to excessive accumulation of stubborn pectoral (chest) fat. Pectoral (chest) fat can also mimic the visual appearance of gynecomastia and this is called pseudogynecomastia or lipomastia or adipomastia and is a very different scenario.[5] There are definite ways you can find out if your breast enlargement is caused by excessive breast tissue growth or pectoral fat and that must be your next logical step if you think you have breast enlargement.

Difference Between Gynecomastia And Pseudogynecomastia

An illustration showing difference between gynecomastia and pseudogynecomastia

Difference Between Pseudogynecomastia And Normal Chest Anatomy

An illustration showing the difference between pseudogynecomastia and normal male chest

Breast Enlargement In Most Cases

The classification of breast development into gynecomastia and pseudogynecomastia is mostly for the sake of clarity. In the majority of cases of men with breast enlargement, what causes feminisation will be a mix of breast tissue and chest fat. This is because of the high levels of estrogen signalling the body to retain more fat and store in in the chest along with breast tissue.[6] We will look at as to why this happens in detail in the causes of gynecomastia below.

mixed gynecomastia

Grades Of Gynecomastia

Gynecomastia is classified into 4 grades by the American Society of Plastic Surgeons based on factors like size of breast enlargement and feminization of the breast. Grade 1 is considered mild and the highest grade of 4 is considered severe with noticeable feminization of the male chest.[7] The table below shows each grade and its description.

Grade or Type Description Severity
1 A localized button of tissue that is concentrated around the areola Very mild
2 Moderate breast enlargement exceeding areola boundaries
with edges that are indistinct from the chest
Mild to high
3 Moderate breast enlargement exceeding areola boundaries
with edges that are distinct from the chest with skin redundancy present
High and visible
4 Marked breast enlargement with skin redundancy and feminization
of the breast
Severe and visibly feminine
An illustration showing the difference between pseudogynecomastia and normal male chest

Causes Of Gynecomastia

Gynecomastia can be caused due to a number of reasons but whatever those causes are, they always lead to an excess presence of estrogen or female hormones in men. This can happen either when estrogen is produced more or when testosterone production is drastically reduced. Both scenarious results in estrogen becoming the dominant hormone in the estrogen-testosterone scale. All males do have some amount of estrogen naturally present in their body. In the case of men with gynecomastia, estrogen becomes dominant and as a result, they develop feminine features like breast enlargement. Gynecomastia is also increasingly seen as a result of drug abuse, radiation from cancer treatments as well from use of medications like risperidone.[8]

An image with the text what causes gynecomastia on it

For some, breast enlargement due to excessive breast tissue growth comes out of the blue for no apparent reason which is referred to as idiopathic in medical terms. Why there is an excess production of estrogen is sometimes unknown but one central and inseparable aspect of all cases of gynecomastia is abnormal levels of estrogen. When the female hormone estrogen becomes the dominant sex hormone in male, it signals and influences the body to develop female physiological features and the most visible of that is excessive breast tissue like that of a female.

excess estrogen is the primary cause for gynecomastia

Presence of the female hormone estrogen in higher than usual proportion in the male body is the fundamental underlying cause of gynecomastia.[9] This increased presence of estrogen leads to the development of feminine characteristics and increased breast tissue growth. Local tissue factors like increased presence of estrogen in the breast area, increased aromatase activity, conversion of testosterone (male hormones) into estrogen (female hormones) also contributes to development of breast tissue growth or gynecomastia. There have been a number of studies and there is some agreement in the scientific world that a number of the food items especially, the genetically modified ones that we in North America consumes on a daily basis are high in estrogen facilitating excess production of estrogen.[10]

One of the major causes of gynecomastia among body-builders is the use of steroids.[11][12] Steroids can influence the estrogen levels in the body and gynecomastia among body building professionals is a very common after-effect of not properly planned steroid use. When steroids are used, it changes the testosterone and estrogen balance in the body and as a result, the balance tilts towards estrogens and gynecomastia develops as a result.

One of the recurring questions about the causes of gynecomastia comes from body-builders who have developed gynecomastia as a result of unsystematic steroid use. There are products in the market specifically for bodybuilders or those taking steroids to address the threat of developing gynecomastia. If you are taking steroids, you will get gynecomastia unless you flush the excess estrogen. The process of flushing out excess estrogen and reversing its effects to prevent gynecomastia is called post cycle therapy.[13]

Another cause of gynecomastia is Klinefelter syndrome and is a chromosomal abnormality.[14] Individuals with this condition will have an extra “X” chromosome and to put things in perspective for you, X and Y chromosomes in our body determines our gender and men usually have “XY” combination whereas women have “XX” combination. However, in the case of men with Klinefelter syndrome, they will have an additional “X” chromosome leading to an abnormal “XXY” combination. According to studies on this medical condition, men with Klinefelter syndrome has a 20 fold chance of breast cancer than others [15] and gynecomastia is a common symptom among men with medical condition.

The thyroid gland is one of the hormone producing glands in our body and controls a number of crucial functions like heartbeat rate and how fast we burn calories. When the thyroid gland become over-active, it produces more thyroid hormones than required and this leads to a medical condition known as hyperthyroidism. Hyperthyroidism is predominantly found in women but men can also have this medical condition and this is considered one of the causes of gynecomastia. [16]

When men get older, the testosterone levels either become dormant or retards from their earlier levels and this can lead to a dominance of the female hormone estrogen that is already present in relatively few numbers. As mentioned above breast development occurs during three phases of life and the last one is during older adult age.[1]

According to some studies, up to 25% of all cases of gynecomastia have no apparent cause.[9] This in itself does not mean that there is no underlying reason but could be because of the lack of studies or research on this medical condition. The medical community for lack of a better word, simply does not know what is causing gynecomastia for a subset of the gynecomastia patient population.

In almost 20-25 % off all cases, the causes of gynecomastia can be traced back to the use and sometimes abuse of drugs.[17] A number of drugs can directly or indirectly increase the amount of estrogen or catalyze its production. Estrogen is a female hormone that gives women their bodily features and when this hormone is produced more and more, it leads to breast tissue growth. Take a look at this list of drugs that may cause gynecomastia for more information.

One of the recent findings about the causes of gynecomastia is the “estrogen diet” a diet comprising of food items that contributes to or speed up the production of estrogen. This is a topic that is beyond the scope of a brief mention here and for detailed information, take a look at our causes of gynecomastia page.

How Does Breast Tissue Growth Happen

Breast tissue growth happens as a result of three factors forming a negative feedback cycle or loop. These three factors are excess estrogen, low testosterone and pectoral fat with each having a domino effect on the other. The cycle begins when the male body gets an excessive amount of estrogen as a result of drug abuse, from a medication side effect or as a result of a pre-existing medical condition.

the negative feedback loop that causes gynecomastia

When there is an excess amount of estrogen, it suppresses the male hormone testosterone production and signals the body to develop feminine features such as breast tissue and to retain more fat in the chest. Another result of excessive estrogen is low metabolism this further reduces the amount of fat burned off by the body. Chest fat along with abdominal fat creates an enzyme called aromatase that converts the male hormone testosterone into the female hormone estrogen. This again increases the level of estrogen and forms a negative feedback loop. Pectoral fat binds itself to breast tissue and they both supplements each other. This is why most breast enlargement in men is a mix of breast tissue and pectoral fat. Pectoral fat in this scenario acts as a secondary gland that produces estrogen. For in-depth information about the causes of gynecomastia, we have a dedicated page about the factors, medical conditions, medications as well as food items that can cause breast tissue growth. Read the causes of gynecomastia page for more information.

How To Know If You Have Gynecomastia

An image of a doctor specializing in the treatment of gynecomastia

The diagnosis of gynecomastia can be done by your family doctor but it is best left to a doctor who specialises in the diagnosis and treatment of this medical condition. Below is one of the classic approaches that doctors use to make sure that the underlying mass is breast tissue. There are also advanced diagnostic tests like scanning if gynecomastia cannot be confirmed by physical examination alone.

Diagnosis Of Gynecomastia

Classic Approach

The patient lies flat on his back with his hands clasped beneath his head. Using the separated thumb and forefinger, the examiner slowly brings the fingers together from either side of the breast. In patients with true gynecomastia, a rubbery or firm mound of tissue that is concentric with the nipple–areolar complex is felt. In patients with pectoral or chest fat, no such disk or tissue is found.

Diagnosis of gynecomastia and pseudogynecomastia by a doctor
Gynecomastia Pseudogynecomastia
A mass under the nipple area of the breast with or without pain when touched or squeezed. Breast enlargement involves the both breasts equally and evenly, without pain during palpation.

Gynecomastia Treatment Options

Once you have confirmed that what you have is in fact gynecomastia (breast tissue) and not lipomastia (chest fat), the next logical step is to look at all available options to get rid of it. I am using the word “treatment” in a very broad sense and is including temporary and permanent solutions.

An image with the text gynecomastia treatment options written on it

We will now take a detailed look at the main pros and cons of each of these treatment options below.

Gynecomastia Shirts

Gynecomastia compression shirt
  • Compression shirts are cheap and affordable costing anywhere from $10-30 making it affordable for most individuals.

  • The effect of compression shirt is instant. You wear a compression shirt and your gynecomastia is no more visible or felt to the outside world.

  • They are only a temporary option and once you take off the compression shirt, the effect is reversed and can bring back that feeling of shame and desperation.

  • Compression shirts only work in formal settings. If you want to take your shirts off at the beach or by the pool, wearing a compression shirt will only attract eye balls.

  • There is a bit of uneasiness in the first few days of wearing it and can feel like being choked. This will go away as you start to get used with wearing them on a daily basis.

Affordable Temporary Solution

Compression shirts are a fast and affordable option to get hide a saggy chest and even though the effect is only temporary, I highly recommend that you get one just to see the effect of not having breast enlargement. You get to see the results of not having it and that will motivate you to do whatever it takes to get rid of this medical condition. have one of the best selection of compression shirts in the United States.

Read More About Gynecomastia Shirts

Gynecomastia Supplements

Some background information is necessary when it comes to gynecomastia supplements. Almost 99% of breast enlargement that we see in men is a mix of breast tissue and chest fat. Gynecomastia supplements that are available in the market are developed to burn off chest fat and thereby break the negative feedback loop of high estrogen > pectoral fat > low testosterone. That is their primary mechanism of action. Losing the chest fat results in a less saggy breast and it also helps to brings down the testosterone to estrogen conversion.

An image of a supplement to get rid of gynecomastia
  • Burns off chest fat

  • Reduces testosterone to estrogen conversion

  • Reduces breast enlargement caused by pectoral fat.

  • Will not eliminate already developed breast tissue

Non-Surgical Option

Supplements are an ideal option for those who cannot afford surgery out of the pocket. They burn off chest fat and can make a significant difference when it comes to chest shape when combined with workouts to lose chest fat.

Supplements For Chest Fat

Gynecomastia Surgery

An image of a gynecomastia surgeon
  • You are guaranteed that your breast enlargement is permanently gone for good when you wake up from sedation after surgery. Gynecomastia surgery has a 100% success rate.

  • The whole process from admission to discharge will only take 3-4 and you will leave the hospital as a completely different man with a whole new level of confidence.

  • You are also in the safe in hands of a surgeon who has at least 6-8 years of training and many more years of experience. You will also be given customised and personalised treatment and will be consulted in all aspects of surgery.

  • Is not covered by medical insurance.

Expensive But Guaranteed Option

Surgery is the expensive yet guaranteed option to get rid of gynecomastia. Surgery for gynecomastia is called reduction mammoplasty. The price you pay is definitely worth as your surgeon will perform the surgery based on your body contour and it will look natural. Surgery is also the fastest treatment option to permanently get rid of that excess unwanted breast enlargement.

A-Z Guide To Gynecomastia Surgery

Natural Management Of Gynecomastia

One question that I get asked a lot is whether gynecomastia can be eliminated naturally. By “natural”, I mean an approach that does not involve supplements or surgery. The short answer is, you cannot eat your way out of breast tissue. A great variety of food items that we eat contains estrogen and this is all the more higher in genetically modified food. But even if you completely go organic and do not eat food items high in estrogen, that will not move the needle. Breast tissue once developed will not go away without surgery or prescription pharmacological agents given for breast cancer that open up a barrel of side effects. However, it is best to avoid food items that are high in estrogen so that you are doing what is humanely possible to not worsen the estrogen levels.

diet with as much as few estrogen rich foods

A natural approach to gynecomastia comes down to controlling or limiting the intake of estrogen rich foods and increasing food items that contain testosterone or promotes testosterone production. Below is a very limited list of some common food items that is rich in estrogen. This is not a definitive guide and also do your own research and find out what other food items contain estrogen.

No: Description
1 Dried fruits
2 Flax seed
3 Peas
4 Beans
5 Peas
6 Sesame seeds
7 Chickpeas
8 Bran cereals
9 Soybean
10 Tempeh
11 Tofu
12 Alfalfa sprouts
natural treatment options to get rid of gynecomastia

Estrogen – Testosterone Balance In diet

The best way to achieve estrogen-testosterone balance is to focus on eating foods that both regulate estrogen and promote healthy testosterone production in combination with a healthy lifestyle. The way the estrogen-testosterone ratio is regulated in the body is a bit complex and we will briefly go through what the process is and how we can use it to our advantage.

diet for gynecomastia

So how exactly do men produce unwanted estrogen and what constitutes a healthy level of estrogen for men? It may seem counterintuitive, but the majority of circulating estrogen in men is actually derived from the male sex hormone we call testosterone. The mechanism from which this occurs centers around an enzyme known as aromatase. The primary form of circulating estrogen is known as estradiol. Men lack the female reproductive organs necessary to produce this hormone so its main source is from the conversion of free testosterone to estradiol through this enzyme known as aromatase. This enzyme is expressed in various tissues throughout the body naturally but this can result in fluctuations in hormone levels throughout the body. Increased activity of this aromatase enzyme in fat cells surrounding the breast tissue is an underlying contributor to gynecomastia in males.

how to manage gynecomastia naturally

How To Naturally Raise Testosterone Levels ?

There are two aspects two naturally raising your testosterone levels. The first is to decrease your estrogen levels by avoiding estrogen rich foods and the second is to increase food items that are rich in testosterone and polyphenols which act to lower estrogen.[20] Polyphenols compounds are surprisingly common and may already be a part of your diet. Common beverages that are high in polyphenols include:

No Food Item
1 Green tea
2 Black or fermented teas (jasmine, oolong, etc.)
3 Coffee
4 Red wine
5 White wine
6 Almond milk
7 Apple juice
8 Pure lemon juice
9 Pummelo juice
10 Pomegranate juice
11 Dark chocolate
12 Black and green olives
13 Artichoke
14 Strawberries
15 Peppermint
16 Blueberries
17 Red raspberries
18 Red and yellow onions
19 Whole grain rye
20 Apples
21 Spinach
22 Shallots
23 Broccoli
24 Apricots
25 Nectarines

A full list of the top 100 foods high in polyphenols is available in a database published by Nature. Incorporating a variety of these foods into a healthy diet is a great way to begin to shift the ratio between testosterone and estrogen in the right direction. In addition to polyphenol-rich foods, another set of related compounds that are known to be effective aromatase inhibitors are chrysin and propolis. Interestingly, these compounds are synthesized by honey bees, making honey another good addition (in moderation) to a diet focused on hormone balance for men.

testosterone rich foods for gynecomastia

Food Items Rich In Testosterone

No Food Item
1 Organic Beef and pork cuts with moderate amounts of fat
2 Organic Chicken (skin on is preferable)
3 Organic salmon and tuna
4 Nuts: pistachios, almonds, cashews, pecans, brazil nuts, walnuts.
5 Avocados
6 Raw coconut
7 Whole olives
8 Eggs
9 Oyesters
10 Spinach
11 Pumpkin
12 Squash
13 Crab
14 Lobster
15 Chick peas
16 Kidney beans

Other factors including body fat percentage and inflammation are known to have an effect on aromatase activity and consequently balanced hormone levels in men. White fat cells (the majority of the fat cells in humans) are known to be a major source for the production of aromatase, so maintaining a healthy diet is highly important. Inflammation from dietary sources such as excess alcohol consumption and certain fats (those with a low omega-3 to omega-6 ratio) are also known to be contributing factors to increasing aromatase activity in the body.

vitamin D for testosterone estrogen balance

Vitamin D also likely plays an important role in testosterone production. Results from contemporary studies are mixed, but there is likely a beneficial link between higher vitamin D levels and hormonal balance between testosterone and estrogen levels in men.[21] It is important to have vitamin D levels checked by a medical professional in combination with testosterone in order to determine if supplementation may be needed. It is also important to consume foods high in Vitamin D if you have lower than normal levels. Vitamin D rich foods also happen to overlap with foods known to help improve testosterone levels, including fatty fish, dairy products, egg yolks, and beef liver.

Factors that can help to increased testosterone production

Lastly, the easiest way to maintain a hormonal balance for men is to combine the listed dietary recommendations with adequate sleep, a low stress lifestyle, and a healthy body weight. Above all, studies have shown that maintaining a healthy body mass composition and getting plenty of sleep may be the be most important factors for boosting levels of testosterone and reducing unwanted estrogen production.

Not A Full Fledged Approach

Going on an anti-estrogen diet is definitely a right step but do not count on it to help you get dramatic results. It is more of a supportive practice that aids other treatment options like gynecomastia supplements and gynecomastia surgery. It has been proved beyond doubt that a number of foods that we consume on a daily basis are ticking estrogen bombs and by following a natural anti-estrogen diet, you are effectively cutting one source of excess estrogen.

  • A diet-based approach to limit estrogen in the body.

  • Will not eliminate or reverse already developed breast tissue.

Medical Review Team

Medical reviewer at Gynecoma.comThe content of this page was fact-checked and medically reviewed by Dr.Sergii Vasyliuk MD on October 22, 2018. You can read more about Dr.Sergii Vasyliuk MD and his credentials at our about us page.

The content of this page was fact-checked and medically reviewed by Dr.Marija Petkovic MD on December 19, 2018. You can read more about Dr.Marija Petkovic MD and her credentials at our about us page.



Suggested Further Reading

A-Z guide to pseudogynecomastia

causes and frequently asked questions about gynecomastia in teenagers

a-z guide to gynecomastia surgery

compression shirts for men with gynecomastia

the best workouts to lose chest fat for men

what is man boobs

a detailed guide about causes of gynecomastia

an image of a doctor explaining the different available gynecomastia treatment options

a definitive guide covering everything on gynecomastia surgery cost

a-z guide to breast reduction supplements for men

a comprehensive guide to post cycle therapy to get rid of gynecomastia

the main requirements to get insurance coverage for gynecomastia surgery