Gynecomastia is the benign, non-cancerous enlargement of the male breast due to an increase in glandular tissue. This condition is caused by an imbalance where the ratio of estrogen to androgen hormones is elevated, stimulating breast tissue growth. While it affects men across the lifespan, it is most common during the hormonal fluctuations of adolescence. The question for many is whether this physical change, often experienced in youth, will spontaneously disappear once adulthood is reached.
The Typical Timeline: When Gynecomastia Usually Resolves
The majority of gynecomastia cases that arise during puberty are considered physiological, a temporary response to hormonal shifts. During adolescence, the body experiences a transient rise in estrogen relative to testosterone, which temporarily stimulates the growth of breast tissue. This hormonal shift is usually self-correcting as the body matures and the production of testosterone stabilizes into adult male norms.
This pubertal form of the condition is highly common, affecting up to 65% of adolescent males, with a peak incidence around ages 13 and 14. For the vast majority, the breast enlargement is transient and resolves without any intervention. Resolution typically occurs within six months to two years from the onset of the condition. If the condition is going to resolve naturally, it will almost always do so entirely before the male reaches 20 years of age.
Why Gynecomastia May Persist After Age 20
If gynecomastia persists past the late teenage years and into the 20s, it is significantly less likely to resolve on its own. Persistence past this age is usually due to two main factors: either an ongoing external or internal cause maintaining the hormonal imbalance, or a permanent change in the breast tissue structure itself. Addressing the underlying cause is the initial step for any adult-onset or persistent case.
Underlying Causes
In adulthood, persistent or new-onset gynecomastia often points to an active driver disrupting the normal hormone balance. Many prescription medications are known to cause gynecomastia as a side effect, including certain heart medications, anti-androgens, and some psychiatric drugs. The use of illicit substances, such as marijuana and alcohol, along with anabolic steroids, can also alter the estrogen-to-androgen ratio.
Several internal medical conditions can lead to persistent hormonal imbalance. Chronic diseases like liver cirrhosis or kidney failure can impair the body’s ability to metabolize and excrete estrogen, allowing it to accumulate. Endocrine disorders, such as hypogonadism (low testosterone production) or hyperthyroidism, directly alter the balance of sex hormones and can cause or maintain gynecomastia in the adult male.
Tissue Structure Change
The reason pubertal gynecomastia that lasts for more than a year or two often becomes permanent is due to a change in the structure of the breast tissue. Early-stage gynecomastia, known as the florid phase, consists of actively proliferating glandular ducts and loose, cellular stroma, which is still responsive to hormone changes. This is the stage where natural regression can occur if the hormonal trigger is removed.
As the condition becomes long-standing, the tissue enters the fibrous phase. During this phase, the initial glandular tissue is replaced by dense, non-hormonally responsive fibrous tissue, similar to scar tissue. This fibrotic tissue cannot be reabsorbed or shrink naturally, even if the hormonal levels return to normal. This structural transformation prevents any chance of spontaneous resolution once adulthood is reached.
Interventions for Permanent Gynecomastia
When gynecomastia persists past the typical resolution age and does not resolve after addressing any underlying medical issues, intervention is an option. Medical management may be an option, particularly for cases of recent onset in adults or for older men where surgery is contraindicated. Selective Estrogen Receptor Modulators (SERMs) like Tamoxifen, work by blocking estrogen receptors on the breast tissue.
These medications are most effective in the early, glandular stage of gynecomastia and can sometimes help reduce tenderness and size. They are significantly less effective, however, once the tissue has entered the long-standing, fibrotic phase. For men with confirmed hypogonadism, testosterone replacement therapy can also help by restoring the hormone balance, but this approach is not a direct treatment for the established fibrous mass.
Surgical intervention remains the definitive treatment for long-standing, permanent gynecomastia. The choice of surgical technique depends on the composition of the enlarged breast. If the enlargement is primarily due to excess fatty tissue, a condition known as pseudogynecomastia, liposuction alone may be sufficient.
For true gynecomastia, which involves the dense, fibrotic glandular tissue, direct surgical excision is required. This procedure involves physically cutting out the firm glandular mass. Often, a combination of liposuction to contour the surrounding area and direct excision to remove the central glandular disk is performed to achieve the best cosmetic result.