Men cannot get uterine fibroids, because uterine fibroids grow exclusively in the muscular wall of the uterus. But the cell type responsible for fibroids, smooth muscle, exists throughout the body in both sexes, and the same kind of benign tumor can show up in male organs. These growths are called leiomyomas, the same pathological name that fibroids carry, and they have been documented in the prostate, the epididymis, the skin, and other soft tissues. They are far rarer in men than uterine fibroids are in women, and the reasons for that gap involve hormones, anatomy, and a surprisingly underexplored corner of medicine.
What Uterine Fibroids Actually Are
Fibroids, known medically as leiomyomas, are benign tumors that grow from smooth muscle cells. In women, the vast majority originate in the myometrium, the thick muscular layer of the uterus. They are strikingly common: roughly a quarter of women of reproductive age develop symptoms such as heavy menstrual bleeding, pelvic discomfort, anemia, and pregnancy complications, though many more carry fibroids without symptoms.1PubMed Central. Uterine Fibroids By age 50, the cumulative exposure is even higher, with estimates suggesting the majority of women will have developed at least one fibroid by that point.2PubMed Central. Regulatory role for tumor suppressor REST on estrogen receptor (ESR1) expression and leiomyoma pathophysiology
Their growth is tightly linked to the hormonal environment of the menstrual cycle. Each month, the uterine muscle responds to estradiol and progesterone by ramping up cell division to prepare for a potential pregnancy. During that burst of proliferation, a mutation can arise in a smooth muscle cell that sets a fibroid in motion.1PubMed Central. Uterine Fibroids Progesterone signaling in particular drives fibroid cell proliferation through multiple pathways.3PubMed Central. Progesterone Signaling and Uterine Fibroid Pathogenesis; Molecular Mechanisms and Potential Therapeutics This monthly hormonal push is a big part of why fibroids are so overwhelmingly a condition of the female reproductive tract, and why they tend to shrink after menopause when those hormonal cycles stop.
Smooth Muscle Tumors in Male Anatomy
Smooth muscle is not unique to the uterus. It lines blood vessels, the gastrointestinal tract, the bladder, the prostate, and many other structures in both sexes. Because leiomyomas are fundamentally smooth muscle tumors, they can theoretically arise anywhere that smooth muscle exists.4PubMed Central. Benign Calcified Axillary Leiomyoma in a Young Male: A Case Report In men, the documented sites include several organs in and around the reproductive tract.
The prostate is one of the best-known locations. Prostatic leiomyomas are uncommon benign tumors that can mimic the much more familiar condition of benign prostatic hyperplasia (BPH), the age-related prostate enlargement that millions of men experience. In one reported case, a 67-year-old man underwent emergency surgery for what appeared to be severe BPH with urinary obstruction; pathology revealed a well-defined leiomyoma within the prostate tissue, not garden-variety enlargement.5PubMed Central. Prostatic Leiomyoma: An Uncommon Diagnosis Found in Clinically Suspected Cases of Severe Benign Prostatic Hyperplasia Without Elevated Serum Total Prostate-Specific Antigen Levels The medical literature contains fewer than 30 documented cases of prostatic leiomyoma, which gives a sense of how rare this finding is.6Clinical Genitourinary Cancer. Clinical Genitourinary Cancer
The epididymis, a coiled tube at the back of each testicle, is another site. Epididymal leiomyomas originate from the smooth muscle surrounding that tube and tend to present as painless, slowly growing scrotal swellings that can persist for years before a man seeks medical attention. A reported case involved a 50-year-old man whose right-sided scrotal mass had been gradually enlarging for three years before surgical removal and biopsy confirmed a leiomyoma.7PubMed Central. A rare case of epididymal leiomyoma presenting as a chronic hemiscrotal swelling In an even more unusual case, a 56-year-old man presented with painless masses on both sides of the scrotum, and bilateral paratesticular leiomyomas were confirmed after surgical excision.8PubMed Central. Bilateral Synchronous Paratesticular Leiomyoma – A Rare Entity
Why These Tumors Are So Much Rarer in Men
The sheer difference in prevalence between uterine fibroids and male leiomyomas comes down to the hormonal environment. The uterus is uniquely exposed to cyclical surges of estrogen and progesterone every month for decades. That repeated stimulation drives smooth muscle cell division, creating more opportunities for the mutations that seed a fibroid. Men do not have an organ that undergoes anything comparable. Male smooth muscle tissues are relatively quiescent by comparison: they grow, they maintain themselves, but they are not being hormonally pushed into rapid proliferation on a monthly schedule.
This does not mean male hormones are irrelevant to smooth muscle growth. The prostate, for instance, is exquisitely sensitive to androgens, and the conversion of testosterone into its more potent form (dihydrotestosterone) is central to BPH.9PubMed Central. Androgens and estrogens in benign prostatic hyperplasia: past, present and future But BPH is not a leiomyoma. It involves a diffuse overgrowth of glandular and stromal tissue across the prostate, not a discrete smooth muscle tumor the way a fibroid is. The distinction matters clinically, even if the urinary symptoms can overlap.
Interestingly, estrogen signaling may also play a role in prostate overgrowth. Research has shown that estradiol can ramp up the expression of fibrosis-related genes in prostatic stromal cells, promoting the accumulation of myofibroblasts, cells that produce excess connective tissue.10Cell Death & Disease. Estrogen and G protein-coupled estrogen receptor accelerate the progression of benign prostatic hyperplasia by inducing prostatic fibrosis This finding is a reminder that both sexes have both androgens and estrogens circulating, and the interplay between them shapes how smooth muscle and surrounding tissue behaves throughout life.
BPH as the Closest Functional Parallel
If you are a man wondering whether there is a male equivalent to fibroids in terms of real-world impact, BPH is the closest thing. Both conditions involve overgrowth of tissue in a reproductive organ, both are driven in part by sex hormones, and both produce symptoms related to pressure on surrounding structures. For fibroids, the classic complaints are heavy periods, pelvic pain, and bladder pressure. Large fibroids can compress the bladder enough to cause urinary urgency, frequency, and sometimes retention. Surgical removal of a large pelvic mass in women has been shown to reduce daytime urinary frequency and increase voided volumes, with overall symptom and quality-of-life scores improving substantially.11SpringerLink (Int Urogynecol J). A prospective observational study of lower urinary tract symptoms before and after surgical removal of a large pelvic mass
For BPH, the core complaints are a weak urinary stream, difficulty starting urination, getting up multiple times at night, and a feeling that the bladder is not emptying fully. Like fibroids, BPH responds to medications that alter the hormonal environment. Drugs that block the conversion of testosterone into dihydrotestosterone can shrink the prostate over time, analogous to how hormonal therapies for fibroids aim to lower estrogen and progesterone exposure.9PubMed Central. Androgens and estrogens in benign prostatic hyperplasia: past, present and future Both conditions also share procedural treatment options. High-intensity focused ultrasound (HIFU), for example, has been applied to both uterine fibroids and prostate tissue as a way to destroy tissue without open surgery.12PubMed Central. High intensity focused ultrasound in clinical tumor ablation
The parallel is not perfect. BPH is a diffuse process, not a discrete tumor, and it does not carry the same risk of heavy bleeding or pregnancy complications. But from the standpoint of a hormone-driven tissue overgrowth that compresses the urinary tract and worsens with age, BPH is the condition most men can relate to when trying to understand what fibroids feel like.
Leiomyomas Outside the Reproductive Tract
Smooth muscle tumors can also appear in locations that have nothing to do with reproductive organs. The skin is one such site. Cutaneous leiomyomas arise from the arrector pili muscles, the tiny smooth muscles attached to hair follicles that produce goosebumps. These tumors tend to present as small, firm nodules, sometimes painful, that can appear on the arms, chest, face, or elsewhere. A case report describes a 34-year-old man who developed a nodule on his left arm that was initially thought to be a fibroma or neuroma until pathology confirmed it as a cutaneous pilar leiomyoma.13Clinical Cancer Investigation Journal. Solitary cutaneous pilar leiomyoma: A rare entity with review of literature Another reported case involved a 60-year-old man with a painless chest nodule that turned out to be a pilar leiomyoma with unusual cellular features.14PubMed. Cutaneous leiomyosarcoma originating in a symplastic pilar leiomyoma: a rare occurrence and potential diagnostic pitfall These tumors are rare enough that they often get misdiagnosed initially.15PubMed Central. Solitary pilar leiomyoma of the nasal dorsum: case report and literature review
Soft tissue leiomyomas have also been reported in unusual locations like the axilla (armpit). One case involved a 30-year-old man with a longstanding lump in his right armpit that turned out to be a calcified leiomyoma, a finding so uncommon that it required imaging and pathology to rule out other diagnoses.4PubMed Central. Benign Calcified Axillary Leiomyoma in a Young Male: A Case Report These extrauterine leiomyomas reinforce the point: the smooth muscle tumor itself is not sex-specific, even though its most famous manifestation (uterine fibroids) overwhelmingly is.
When Skin Lumps Signal Something More Serious
Multiple cutaneous leiomyomas in a man should raise a red flag for a genetic condition called hereditary leiomyomatosis and renal cell cancer syndrome, or HLRCC. This inherited condition is caused by a mutation in the fumarate hydratase (FH) gene, which encodes an enzyme involved in cellular energy metabolism.16PubMed Central. Hereditary leiomyomatosis and renal cell cancer (HLRCC): renal cancer risk, surveillance and treatment People who carry this mutation are predisposed to developing cutaneous leiomyomas, uterine fibroids (in women), and an aggressive form of kidney cancer.
HLRCC affects both sexes. In women, the uterine fibroids tend to appear earlier and be more numerous than typical sporadic fibroids. In men, the syndrome often reveals itself through skin nodules, since there is no uterus to produce the more obvious signal. A case report describes a 27-year-old man who presented with a painful nodule on his left upper arm that had been there for five years, followed by additional painless nodules elsewhere on his body. A family history of kidney cancer prompted genetic testing, which confirmed a pathogenic FH variant and a diagnosis of HLRCC.17PubMed Central. Identifying Hereditary Leiomyomatosis and Renal Cell Cancer through Unobtrusive Cutaneous Nodules: A Clinical Report In another case, a 15-year-old boy with HLRCC was found to have bilateral renal cell carcinoma in polycystic kidneys, an unusually early and severe presentation.18PubMed Central. Bilateral, multicystic fumarate hydratase-deficient renal cell carcinoma in patient with hereditary leiomyomatosis & renal cell carcinoma syndrome
The kidney cancers associated with HLRCC tend to be aggressive, which is why early identification matters so much. For men, the skin leiomyomas may be the only visible clue before kidney surveillance detects something more dangerous. If you have multiple firm skin nodules and any family history of kidney cancer or early-onset fibroids in female relatives, genetic counseling and FH gene testing are worth discussing with a doctor.
The Diagnostic Challenge in Men
One recurring theme across the medical literature on male leiomyomas is how often they get misdiagnosed or discovered incidentally. Because these tumors are so rare in men, they simply are not on most clinicians’ radar. A lump near the testicle is far more likely to prompt concern about testicular cancer than about a benign smooth muscle tumor. A prostate that is causing urinary obstruction will be evaluated for BPH or prostate cancer long before anyone considers a prostatic leiomyoma.
Imaging adds another layer of difficulty. When a pelvic leiomyoma grows large enough, it can appear on MRI as a sizable mass whose origin is unclear. One case report describes a man undergoing prostate cancer workup whose MRI revealed a 9-centimeter pelvic mass alongside a suspicious prostate lesion. The mass turned out to be a leiomyoma, but its size and location created significant diagnostic confusion.19PubMed Central. Pelvic leiomyoma associated with intermediate risk prostate cancer: A case report
The concern with any smooth muscle tumor is making sure it is truly benign. Leiomyosarcoma, the malignant counterpart, can look similar on imaging and even on initial biopsy. Prostatic leiomyosarcoma is rare and aggressive, with features that can delay diagnosis because it mimics benign conditions.20PubMed. Prostate Leiomyosarcoma: A Rare Misleading Tumor Careful pathological examination, including looking for signs of cell division, nuclear abnormalities, and tissue death within the tumor, is necessary to distinguish a harmless leiomyoma from a leiomyosarcoma that requires aggressive treatment.5PubMed Central. Prostatic Leiomyoma: An Uncommon Diagnosis Found in Clinically Suspected Cases of Severe Benign Prostatic Hyperplasia Without Elevated Serum Total Prostate-Specific Antigen Levels For scrotal leiomyomas, the same principle applies: removal and thorough pathological evaluation are the gold standard, both to confirm the diagnosis and to rule out anything malignant.8PubMed Central. Bilateral Synchronous Paratesticular Leiomyoma – A Rare Entity
Smooth Muscle Tumors Across Species
It is worth noting that smooth muscle tumors of the reproductive tract are not just a human phenomenon. In veterinary medicine, testicular smooth muscle tumors have been reported in stallions and rams, though they are exceedingly rare in those species too.21PubMed Central. First report of primary testicular leiomyosarcoma in two dogs The fact that these tumors crop up across mammalian species in tissues with smooth muscle reinforces the idea that this is a fundamental property of the cell type rather than something tied exclusively to human female biology. The uterus just happens to be the organ that creates the perfect storm of hormonal exposure, repeated proliferation, and abundant smooth muscle to make fibroids spectacularly common in one sex.
For men, leiomyomas remain a medical curiosity, important mostly because they can mimic more worrisome conditions. Finding one is almost always reassuring from a cancer standpoint, provided the pathologist confirms there are no malignant features. But the rarity itself creates a practical problem: if nobody is expecting it, nobody is looking for it, and the path to a correct diagnosis can be roundabout. Awareness that these benign smooth muscle growths can occur in male tissue, whether in the prostate, the scrotum, the skin, or elsewhere, helps both patients and clinicians avoid unnecessary alarm while still getting the right workup done.