Male Breasts (Gynecomastia) and Low Testosterone: Causes & Treatment

Explore the causes, symptoms, and treatments for gynecomastia (male breast enlargement) linked to low testosterone and hormone imbalance.

By Medha deb

Created on Sep 26, 2025

Explore the causes, symptoms, and treatments for gynecomastia (male breast enlargement) linked to low testosterone and hormone imbalance.

Male Breasts (Gynecomastia) and Low Testosterone

Gynecomastia is a common and often distressing condition where males develop enlarged breast tissue due to hormonal imbalances, especially relating to low testosterone levels. Understanding the underlying causes, recognizing the symptoms, and knowing your treatment options are crucial for managing this health concern effectively.

What Is Gynecomastia?

Gynecomastia is the medical term for the enlargement of breast gland tissue in males. While some people refer to this as ‘man boobs’, it is distinct from fat accumulation (pseudogynecomastia) and involves true glandular growth. The swelling can occur in one or both breasts, sometimes unevenly, and often raises concerns around physical appearance, self-esteem, and underlying health.

Hormonal Causes: The Testosterone and Estrogen Balance

The male body primarily produces testosterone—a hormone responsible for masculine traits such as muscle growth, facial hair, and a deep voice. It also produces small amounts of estrogen, a hormone mainly responsible for female sexual characteristics. In most cases, the balance heavily favors testosterone. When this balance shifts, often due to reduced testosterone or increased estrogen, gynecomastia can develop.

Low Testosterone (Low T): Conditions that decrease testosterone production or block its effects allow estrogen levels to become relatively high—even if estrogen itself is not elevated.
High Estrogen: Conditions that raise estrogen levels directly can tip the balance and promote male breast tissue growth.

How Hormonal Imbalance Causes Gynecomastia

When estrogen binds to receptors in male breast tissue, it overrides testosterone’s actions, leading to cell division and the growth of breast glands. Estrogen also prevents the programmed death (apoptosis) of these cells, allowing for persistent enlargement of the tissue. As a result, gynecomastia may be both a sign of hormone imbalance and a cause of emotional and physical discomfort.

Main Causes and Risk Factors

Several factors can disturb the delicate hormonal equilibrium in males, leading to gynecomastia. These include:

Natural Hormonal Changes:
- Infancy: More than half of male newborns develop gynecomastia due to maternal estrogen, but this typically resolves within weeks.
- Puberty: Hormone surges and drops during puberty can temporarily cause breast tissue growth, usually resolving within two years.
- Older Age: Testosterone naturally declines with age, while the effects of estrogen may become more pronounced, increasing risk.
Related: Mastalgia (Breast Pain): Understanding Causes, Symptoms, and Treatment
Medications: Drugs such as anabolic steroids, anti-androgens (used in prostate cancer), certain antidepressants, heart medications, anti-ulcer drugs, and some cancer treatments can disrupt hormonal balance.
Underlying Health Conditions: Diseases that affect the liver, kidneys, testes (like hypogonadism), thyroid, or pituitary gland can alter hormone production and metabolism, leading to gynecomastia.
Obesity: Excess body fat promotes the conversion (aromatization) of testosterone to estrogen, fueling further imbalance.
Substance Use: Alcohol, anabolic steroids, marijuana, heroin, and some herbal supplements have been implicated in hormonal disruption.

Symptoms of Gynecomastia

Recognizing symptoms early can help prompt timely evaluation and treatment. Typical symptoms include:

Breast swelling: Noticeable enlargement of one or both breasts, often starting as a tender lump under or around the nipple.
Tenderness or sensitivity: The area may feel painful, especially when touched.
Rubbery or firm tissue: Unlike fatty tissue, gynecomastia presents as firmer, often disc-shaped swelling directly under the nipple area.
Emotional distress: Many affected men experience embarrassment, lowered self-esteem, or social withdrawal.

Gynecomastia vs. Pseudogynecomastia

Characteristic	Gynecomastia	Pseudogynecomastia
Nature	Glandular tissue growth	Fat tissue buildup
Texture	Firm or rubbery under nipple	Softer, more diffuse
Cause	Hormonal imbalance	Obesity or weight gain
Tenderness	Often present	Rare
Treatment	Depends on hormones	Diet and exercise

Diagnosis: How Is Gynecomastia Evaluated?

If you notice breast enlargement or tenderness, a healthcare provider will take a thorough medical history and conduct a physical examination. Diagnostic steps often include:

Physical Exam: Checking for firmness, lumps, or swelling under the nipple and assessing for signs of systemic disease.
Medical History: Reviewing past health conditions, medications, substance use, and family history.
Blood Tests: Assessing liver, kidney, thyroid functions, and hormone levels (testosterone, estrogen, luteinizing hormone, follicle-stimulating hormone, and prolactin).
Imaging: Ultrasound or mammography may be used if there’s suspicion of a tumor or to distinguish gynecomastia from breast cancer.
Further Specialist Referral: If needed, referral to endocrinologists, urologists, or surgeons.

Mental and Emotional Impact

Gynecomastia can be a source of significant distress, leading to social anxiety, avoidance of situations like swimming or gym activities, depression, and body image issues. Addressing the psychological component is a vital part of holistic treatment.

Treatment Options for Gynecomastia

Therapy aims to correct underlying hormonal imbalance, alleviate physical symptoms, and improve psychological well-being. The approach depends on age, cause, duration, and severity.

Observation: For pubertal gynecomastia or mild cases, watchful waiting may suffice, as many cases resolve spontaneously within months or a couple of years.
Medical Treatment:
- Testosterone Replacement Therapy (TRT): For adult men with symptomatic low T, replacing testosterone may restore hormonal balance and regress breast tissue in some cases.
- Medications: Selective estrogen receptor modulators (SERMs) such as tamoxifen or aromatase inhibitors may be used in severe or chronic cases, but are typically reserved for persistent symptoms.
- Addressing Underlying Causes: Treating liver, kidney, thyroid, or pituitary disease can resolve or improve breast tissue growth. Stopping or substituting the causative medication is also important.
Surgical Options:
- Liposuction: Removes excess fat from the breast area, helpful if there’s significant fatty tissue.
- Excision Surgery (Mastectomy): Removes glandular breast tissue, often through small incisions. Surgery offers immediate and often permanent results and is considered for cases resistant to medical therapy or causing significant distress.
Lifestyle Changes: Maintaining a healthy body weight, regular exercise, limiting alcohol, and avoiding drugs or supplements known to cause hormonal disruption can help in prevention and management.

Complications and When to Seek Help

Gynecomastia itself generally poses few medical risks, but it could be a sign of a more serious underlying condition, such as testicular tumors, thyroid disorders, or certain cancers. Seek medical attention if you experience:

Persistent or rapidly enlarging breast lumps
Significant pain or tenderness
Nipple discharge, particularly bloody or clear fluid
Other systemic symptoms such as unexplained weight loss or fever

Prognosis: What to Expect

The outlook for gynecomastia is generally positive. Many cases—especially those related to puberty or an obvious trigger—resolve without intervention. Where persistent or distressing symptoms exist, appropriate therapy can be highly effective. Testicular or underlying systemic disease, while rare, must be excluded in persistent cases.

Preventing Gynecomastia

While not all causes of gynecomastia are within your control, certain lifestyle choices can reduce your risk:

Maintain a healthy weight to avoid excess fat-driven estrogen production
Avoid anabolic steroids and substances known to disrupt hormones
Limit alcohol intake, particularly heavy drinking
Review your medications with your doctor; ask about alternatives if your prescription lists gynecomastia as a side effect
Monitor for symptoms, and seek early medical advice if breast changes occur

Frequently Asked Questions (FAQs)

Q: Does gynecomastia always mean low testosterone?

A: Not always. Gynecomastia commonly results from an imbalance between testosterone and estrogen, but not all men with enlarged breast tissue have low testosterone. Other causes—such as certain medications, obesity, health conditions, or normal aging—can also contribute.

Q: Can losing weight reduce gynecomastia?

A: If breast enlargement is primarily due to excessive fat (pseudogynecomastia), weight loss and exercise can help. True gynecomastia involving glandular tissue may persist despite weight reduction, though it can become less prominent.

Q: Is gynecomastia dangerous?

A: Gynecomastia is rarely dangerous but can be a source of emotional distress. In very rare cases, breast cancer can occur in men, so it’s important to get any new breast lump evaluated by a healthcare professional.

Q: How is gynecomastia treated?

A: Treatment depends on the cause, severity, and patient preference. Strategies include addressing underlying conditions, adjusting medications, hormone therapy, certain medications to block estrogen effects, or surgery.

Q: What role does testosterone therapy play?

A: In men with proven testosterone deficiency, testosterone replacement therapy may help restore hormone balance and minimize gynecomastia. Close monitoring is required, as improper therapy may sometimes exacerbate breast tissue growth if estrogen also rises.

Key Takeaways

Gynecomastia refers to male breast glandular tissue growth, usually caused by hormonal imbalance.
Low testosterone, higher estrogen, certain medications, health conditions, or obesity can trigger gynecomastia.
Diagnosis requires medical evaluation to rule out other causes and guide treatment.
Treatment includes observation, medication, testosterone therapy (where indicated), surgery, and lifestyle changes.
Emotional impact matters—don’t hesitate to talk to healthcare providers about both physical and psychological support options.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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