Gynaecomastia

Overview

Gynaecomastia (say 'guy-nuh-ko-MAS-tee-uh') is the medical word for enlarged breast tissue in men and boys. Everyone's body has both oestrogen (a hormone that encourages breast tissue to grow) and testosterone (the main 'male' hormone). When the balance tips slightly towards oestrogen, a small amount of real gland tissue can grow behind the nipple. It usually feels like a firm, rubbery disc or button under the nipple, and it can be tender. It is not the same as extra fat on the chest, although the two can look alike and sometimes happen together. Gynaecomastia itself is not cancer, and in most people it is harmless and settles on its own.

Yes, it is very common. It is estimated that up to half of teenage boys and a large number of adult men develop some breast enlargement at some point in their lives. Many cases are mild and never need any treatment at all.

It can affect anyone assigned male at birth, at any age. It is most often seen in newborn babies (from the mother's hormones), in boys going through puberty, and in men over 50. It is also more likely in people who are overweight, who drink a lot of alcohol, or who take certain prescription medicines.

Symptoms

Common symptoms

• Swelling or fullness of the breast area, often behind the nipple
• A firm, rubbery disc or button of tissue that you can feel under the nipple
• Tenderness, aching or sensitivity when the area is touched or pressed
• One or both sides affected — it is common to have it on both sides, but one side can be larger
• The nipple or surrounding skin may look slightly more prominent or puffy

Symptoms in children

• Newborn babies of either sex can have small, sometimes tender breast buds for a few weeks after birth — this comes from the mother's hormones and usually fades by itself
• In boys going through puberty (often around ages 12 to 14), tender breast swelling is very common and usually appears on both sides
• Puberty-related swelling most often shrinks within 6 months to 2 years as hormone levels settle

Symptoms in older adults

• Breast enlargement becomes more common with age, partly because testosterone levels slowly fall
• It is often linked to long-term medicines, weight gain, alcohol use, or conditions affecting the liver, kidneys or thyroid
• Older men may notice a softer, less tender enlargement that has built up gradually over months or years

Causes

Main causes

• Normal hormone changes — this is the most common cause, especially in puberty and with ageing
• Medicines — several common prescription medicines can cause it, including some used for heart problems, stomach acid, prostate problems, mental health conditions and infections
• Alcohol — heavy or long-term drinking affects how the liver handles hormones
• Being overweight — extra body fat changes hormone balance and also adds chest fat, which can look similar
• Liver or kidney disease — these organs help clear hormones from the body
• Low testosterone or an overactive thyroid gland
• Use of anabolic steroids or bodybuilding supplements, which can upset hormone balance
• Herbal products, and products containing lavender or tea tree oil applied to the skin (a rare but reported link)
• Very rarely, a tumour of the testicle, adrenal gland or another part of the body that makes hormones

Risk factors

• Being a teenager or being over 50
• Being overweight or obese
• Drinking a lot of alcohol
• Taking certain long-term prescription medicines
• Having liver, kidney or thyroid disease
• Using anabolic steroids or unregulated supplements

When to see a doctor

See a doctor urgently if:

• You notice a hard, fixed or irregular lump in the breast or chest
• There is discharge from the nipple, or the nipple has turned inwards
• The skin over the area is dimpled, puckered, scaly or has an open sore
• The swelling is on one side only and has come on quickly
• You also have a lump or pain in a testicle, or you have lost weight without trying

Book a routine appointment if:

• The swelling is tender or bothering you
• It has been there for more than a few months and is not settling
• You are taking a medicine you think might be linked, and want to talk it through
• You feel self-conscious about how it looks
• Your child or teenager is bothered by breast swelling during puberty

Diagnosis

A doctor can usually get a good idea of what is going on by talking to you and examining your chest. They will feel the area gently, check both sides, look at the skin and nipples, and check your testicles. They will also ask about your medicines, alcohol intake, weight changes, and any other symptoms. In many cases no tests are needed at all beyond this.

Tests that may be done

• Blood tests to check hormone levels, liver and kidney function, and thyroid function
• An ultrasound scan of the breast or chest area, which is painless and uses sound waves
• A mammogram (a low-dose X-ray of the breast), sometimes used in men to look more closely
• A small sample of tissue (biopsy) if the doctor sees anything that needs to be looked at under a microscope
• A scan of the testicles if a hormone-producing problem is suspected

What to expect at your appointment

The appointment is usually quick and private. The doctor will explain what they are doing before they examine you, and you can ask for a chaperone (a staff member to be present) if you would prefer. You may be referred to a breast clinic for a scan, which usually happens within a couple of weeks. Most people leave with reassurance or a simple plan rather than a serious diagnosis.

Treatment

Treatment depends on what is causing the swelling, how long it has been there, and how much it bothers you. Many people need nothing more than watching and waiting, because the tissue often shrinks by itself. If a medicine or another health condition is behind it, treating that is the first step. Options range from simple lifestyle changes, to medicines prescribed by a specialist, to surgery for swelling that has been there a long time and does not settle.

Self-care at home

• Keep to a healthy weight — losing extra body fat can reduce both hormone changes and chest fullness
• Cut down on alcohol, or stop drinking if your doctor advises it
• Avoid anabolic steroids and unregulated bodybuilding or 'testosterone booster' supplements
• Wear a close-fitting vest or supportive top if tenderness is uncomfortable
• Choose looser shirts or layered clothing if you feel self-conscious
• Give it time — puberty-related swelling often settles over 6 months to 2 years

Medical treatments

If the swelling is recent, tender and not settling, a specialist may suggest a course of medicine that adjusts hormone balance — for example, a medicine that blocks the effect of oestrogen, or one that lowers oestrogen levels. These are only used in selected cases and are prescribed and monitored by a specialist, not bought over the counter. If a medicine you already take seems to be the cause, your doctor may be able to switch you to a different one — never stop a prescribed medicine on your own without talking to your doctor or pharmacist first. Any underlying condition, such as a thyroid or liver problem, will be treated in its own right.

When is surgery considered?

Surgery is an option when the enlargement has been present for a long time (usually more than a year or two), has not responded to other approaches, and is causing you distress. It is done by a specialist surgeon and can involve removing the gland tissue, sometimes with liposuction to remove surrounding fat. Most people are happy with the result, but as with any operation there are risks such as scarring, changes in nipple sensation, or the tissue growing back. Your surgeon will talk these through with you beforehand.

Living with this condition

For most people gynaecomastia is a cosmetic and emotional issue rather than a physical health problem. It can affect how you feel about your body, what you wear, and whether you feel comfortable swimming or changing in front of others. Knowing that it is common, harmless, and often temporary can make it much easier to live with while you wait to see whether it settles.

Lifestyle tips

• Stay active — regular movement helps with weight and mood
• Limit alcohol to within recommended guidelines, or less if your doctor advises
• Check any supplements you take with a pharmacist, especially bodybuilding products
• Keep a simple note of when the swelling started and whether it changes, to share with your doctor
• Talk to someone you trust about how it is affecting you — keeping it to yourself often makes it feel worse

Diet and exercise

There is no special diet that cures gynaecomastia, but eating a balanced diet and staying active can help you reach and keep a healthy weight. That in turn can improve hormone balance and reduce chest fat, which may make the swelling less noticeable. Aim for a mix of everyday activity and some strength and aerobic exercise you enjoy. Avoid very restrictive diets or unregulated 'fat burner' or hormone-boosting products.

Mental health and emotional wellbeing

It is really common to feel embarrassed, anxious or low about breast enlargement, especially as a teenager. These feelings are valid and worth talking about. If it is affecting your mood, sleep, confidence or relationships, please tell your doctor — support such as counselling can help a great deal. If you ever have thoughts of harming yourself, please reach out for help straight away: contact your local emergency number or a crisis line in your country, or speak to someone you trust.

Prevention

You cannot prevent the normal hormone changes of puberty or ageing, and those are the most common causes. But you can lower your chances of some other causes by keeping to a healthy weight, limiting alcohol, avoiding anabolic steroids and unregulated supplements, and reviewing long-term medicines with your doctor. If a medicine is thought to be the cause, your doctor may be able to prescribe an alternative.

Screening programmes

There is no routine screening programme for gynaecomastia. The key thing is to check your chest now and then, and to see your doctor if you notice a new, hard or one-sided lump, nipple changes, or discharge. If you have a condition or take a medicine known to cause breast enlargement, your doctor may keep an eye on it during your regular reviews.

Complications

If left untreated

• The swelling may stay the same or slowly shrink, depending on the cause
• Long-standing enlargement can become firmer and less likely to go away by itself
• Ongoing tenderness or discomfort
• Embarrassment, low mood, anxiety or avoidance of swimming, sports and intimacy
• In rare cases, an underlying cause such as a liver, thyroid or hormone problem may be missed if it is not checked

Long-term outlook

The outlook is good for most people. Gynaecomastia is not cancer, and in teenagers it usually settles within a couple of years without any treatment. For adults, treating the underlying cause — or simply adjusting a medicine or lifestyle factor — often helps. Even when it does not go away completely, it is harmless, and surgery is available for those who want it. Most people find that with the right information and support, it stops being something that holds them back.

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