When male breasts are more than just a cosmetic problem
Gynecomastia describes the excessive growth of breast glandular tissue in men. What many initially mistake for fat accumulation is, in many cases, a hormonally driven process: an enlargement of the breast tissue due to an imbalance between testosterone and estrogen .
For many men, the topic is fraught with shame, yet gynecomastia is medically well-explained and often treatable. It's important to understand the cause: Is there a genuine hormonal imbalance? Is the breast growth triggered by medication or lifestyle factors? Or is it simply a case of pseudogynecomastia, meaning fatty tissue in the chest area?
What exactly is gynecomastia?
Unlike lipomastia, which can cause "male breast enlargement" due to excess weight, true gynecomastia involves an increase in glandular tissue , often palpable as a soft or firm swelling behind the nipple. Gynecomastia can occur on one or both sides and is usually benign, but frequently distressing for both the individual and their physical well-being. A malignant cause (e.g., breast cancer in men) should always be ruled out by a doctor in cases of gynecomastia.
In most cases, it arises from a disruption of the hormonal balance , in which either:
- There is too little testosterone
- too much estrogen is produced
- The conversion (aromatization) of testosterone to estrogen is increased.
Sometimes a combination of these factors is the cause, often exacerbated by medication, alcohol, or latent liver dysfunction.
Symptoms and forms
Typical for gynecomastia is a visible and palpable enlargement of the male breast - often accompanied by:
- sensitive or painful nipples
- feeling of tension
- palpable lump or tissue proliferation
- asymmetrical form (one-sided)
- accompanying insecurity in the social environment (e.g. swimming pool, sports)
Pseudogynecomastia , in which primarily fat accumulates under the skin without enlarged glandular tissue, should be distinguished from true mastocytosis. This form is particularly common in overweight men or those with a high percentage of body fat.
Common causes
Gynecomastia is not a disease in itself, but usually a symptom of a hormonal or metabolic change . These include:
- Puberty: Temporary, hormonally driven, usually reversible
- Elevated estrogen: e.g., due to excessive aromatase activity in overweight individuals, or due to impaired estrogen breakdown in liver diseases.
- Medications: e.g., anabolic steroids, antiandrogens, antidepressants, blood pressure medication
- Chronic alcohol or cannabis use
- Hyperthyroidism or kidney disease
- Tumors of the testicles, adrenal gland or pituitary gland (rare)
An undetected fatty liver or chronic inflammatory processes can also disrupt the hormonal balance, especially in men over 40.
Hormonal connections
The central problem in gynecomastia is almost always an imbalance between androgens (testosterone) and estrogens (especially estradiol) .
Especially in overweight men, increased amounts of aromatase are produced in fatty tissue —an enzyme that converts testosterone into estrogen. As a result, despite normal testosterone levels, estrogen levels can rise disproportionately, which can promote breast growth.
Another problem: High estrogen levels reduce the body's own testosterone production via feedback mechanisms, which can further exacerbate gynecomastia. This creates a hormonal cycle that can only be broken through targeted diagnosis and treatment of the underlying cause.
How is gynecomastia diagnosed?
The diagnostic process begins with a clinical examination by the doctor, during which it is determined whether the tissue is glandular or fatty.
This is often supplemented by a blood test focusing on hormonal balance :
- Total testosterone & free testosterone
- SHBG (Sex Hormone-Binding Globulin)
- Estradiol (E2)
- LH, FSH (for classifying hormone regulation)
- Prolactin (if a pituitary disorder is suspected)
- Liver and kidney function tests, if necessary
In some cases, an ultrasound examination of the breast or testicles may be necessary - especially if there are palpable lumps or suspicion of hormone-producing tumors.
What can be done about gynecomastia?
The treatment always depends on the cause:
- Pubertal gynecomastia : Usually resolves spontaneously.
- Hormonal gynecomastia : Optimization of testosterone and reduction of estrogen, possibly via TRT in combination with aromatase inhibitors (e.g., anastrozole) under medical supervision.
- Pseudogynecomastia : targeted reduction of body fat percentage (diet, strength training, HIIT)
- Drug-induced form : Discontinuation or change of the triggering medications
- Surgical intervention only when necessary: Surgical removal in cases of stable, hormonally balanced breast enlargement.
Key factors here are lifestyle, diet, hormone diagnostics and, if necessary, targeted hormone therapy .
Conclusion
Gynecomastia is often a reflection of hormonal or metabolic imbalances and should not be dismissed as a purely cosmetic issue. In men, enlarged breasts can be a sign of testosterone deficiency, estrogen dominance, inflammation, or medication side effects .
By specifically investigating the causes and restoring hormonal balance, it is possible to slow down or even stop the development.
Tip: If you suspect that your hormone levels are out of balance, a targeted hormone check can help - e.g. with the Premium Hormone Analysis .
