Male breast enlargement, often resembling female breasts, falls into two clinical categories: true gynecomastia or pseudogynecomastia. True gynecomastia involves the non-cancerous growth of glandular breast tissue, typically resulting from an altered balance of sex hormones. Pseudogynecomastia, in contrast, is the result of excess fatty tissue accumulation in the chest area. Understanding which condition is present is the first step, as the causes, evaluations, and management strategies differ significantly.
Separating Fat Deposits from Glandular Growth
The fundamental difference between the two conditions lies in the type of tissue causing the enlargement. Pseudogynecomastia, sometimes called lipomastia, is characterized purely by the buildup of soft, fatty (adipose) tissue on the chest. This condition is strongly associated with overall weight gain and a higher body fat percentage.
When felt, the tissue in pseudogynecomastia is generally soft and uniform, spreading across the chest, and does not typically cause pain or tenderness. True gynecomastia, however, involves the development of firm, dense, or rubbery glandular tissue concentrated directly beneath the nipple and areola. A physical examination often reveals a palpable, disc-like mass, which can sometimes be accompanied by tenderness or discomfort.
Hormonal Imbalances and Other Triggers
True gynecomastia is caused by a disruption in the ratio of estrogen to testosterone, favoring the effects of estrogen on breast tissue. An increase in estrogen levels or a decrease in testosterone levels shifts this delicate balance, stimulating glandular growth.
This hormonal shift frequently occurs during natural life stages, such as the fluctuations of puberty, where up to 65% of adolescent boys experience temporary gynecomastia. It is also common in older men, affecting up to 70% of those aged 50 to 80, due to a natural decline in testosterone and an increase in body fat that converts androgens into estrogen.
Certain prescription medications are also well-known triggers for this condition. Examples of contributing medications include anti-androgens used for prostate conditions, certain cardiovascular drugs like spironolactone, and some psychiatric medications. Furthermore, underlying health issues can alter hormone metabolism and production, including chronic kidney failure, liver cirrhosis, hyperthyroidism, and certain tumors. Substance use, such as anabolic steroids, alcohol, and marijuana, is also known to disrupt the estrogen-to-androgen balance.
Signs That Require Medical Evaluation
While most cases of male breast enlargement are benign, certain physical signs warrant prompt medical evaluation to rule out a more serious underlying condition, such as male breast cancer.
Any enlargement that is unilateral, meaning it affects only one side, should be assessed by a physician. The presence of a lump that feels unusually hard, fixed to the chest wall, or irregular in shape is a significant concern. Other urgent symptoms include skin changes over the area, such as dimpling or puckering. Tenderness or pain that persists, or any discharge or bleeding from the nipple, requires an immediate consultation.
Pathways to Resolution and Management
The appropriate management strategy depends entirely on whether the cause is glandular (gynecomastia) or fatty (pseudogynecomastia). For pseudogynecomastia, the primary focus is on lifestyle modifications to reduce overall body fat. A consistent program of diet and exercise aimed at weight loss is often effective in decreasing the fat deposits in the chest.
In cases of true gynecomastia, the approach is medical, beginning with addressing the underlying cause. If a specific medication is identified as the trigger, a doctor may recommend adjusting the dosage or switching to an alternative drug. If the condition is long-standing or severe, the most definitive treatment is surgery, typically involving liposuction combined with an excision procedure to remove the firm glandular tissue underneath the nipple.