Key Takeaways
- Gynaecomastia (also spelt gynecomastia, and often called gyno) is an enlargement of the breast gland tissue in men.
- The main symptom is a firm or rubbery disc of tissue directly beneath the nipple, often with a puffy or raised areola, on one or both sides.
- It is caused by an imbalance between oestrogen and testosterone, linked to puberty, ageing, some medications, anabolic steroids and certain medical conditions.
- Gynaecomastia during puberty often settles within six months to two years. Gland tissue present for more than a year or two in adults is unlikely to resolve on its own.
- A one-sided, hard or fixed lump, nipple discharge or skin changes should be checked by a GP promptly.
Gynaecomastia is one of the most common chest conditions in men, yet many men are unsure whether what they have counts as gynaecomastia or is simply chest fat. The difference matters, because gland tissue and fat behave differently and respond to different treatments.
This guide explains what gynaecomastia is, the symptoms to look for, what causes it, how it is graded, whether it goes away on its own, and what the treatment options are.
What Is Gynaecomastia?
Gynaecomastia is the growth of breast gland tissue in the male chest. Every man has a small amount of breast tissue behind the nipple. In gynaecomastia, that gland tissue enlarges in response to a hormonal imbalance. The US spelling is gynecomastia, and the condition is commonly shortened to gyno.
Three presentations are seen in practice:
- True gynaecomastia: enlarged gland tissue, felt as a firm disc beneath the nipple. It does not shrink with diet or exercise.
- Pseudogynaecomastia: fat across the chest with no gland enlargement. It usually reduces, at least partly, with weight loss.
- Mixed gynaecomastia: a combination of gland and fat, and the most common presentation. Weight loss reduces the fat, but the gland remains.
Gynaecomastia Symptoms: What Gyno Looks and Feels Like
The most recognisable symptoms of gynaecomastia are:
- A firm or rubbery disc under the nipple. It is usually centred directly beneath the areola and can be felt by pressing gently on the area.
- Puffy or raised nipples. The areola may look cone-shaped or puffy, particularly through a fitted shirt. This is covered in detail in solutions for puffy nipples in men.
- Fullness of the chest. Larger amounts of gland, often with fat, create a rounded chest shape.
- Tenderness or sensitivity. Common when the gland is actively growing, and often settles over time.
- One or both sides. Gynaecomastia can affect one side, both sides, or both sides unevenly.
How to tell if you have gynaecomastia or chest fat
Gland tissue feels firm and sits directly under the nipple. Fat feels soft and spreads across the chest. Many men have both, which makes self-assessment unreliable. A physical examination by a doctor, sometimes with an ultrasound, is the reliable way to tell them apart. The comparison is explained further in pseudogynaecomastia vs true gynaecomastia.
What Causes Gynaecomastia?
The underlying mechanism is an imbalance between oestrogen and testosterone at the breast tissue. Either oestrogen activity is relatively high, testosterone is relatively low, or both. The reasons vary:
- Life-stage hormone changes. Gynaecomastia is most common in newborns (from maternal hormones), adolescent boys (from the hormone changes of puberty) and older men (from age-related falls in testosterone).
- Medications. Several classes of medication are associated with gynaecomastia, including some blood pressure, heart, antidepressant, anti-androgen and heartburn medications. If you take regular medication, a GP review is a useful first step.
- Anabolic steroids. Steroids suppress the body’s own testosterone and can be converted to oestrogen. Gland tissue that develops during steroid use often does not fully resolve after stopping.
- Medical conditions. Liver disease, kidney disease, an overactive thyroid and testicular conditions can disrupt hormone balance and need to be excluded during assessment.
- Excess body fat. Fat tissue converts androgens to oestrogen, contributing to both fatty chest enlargement and, in some men, gland growth.
- Cannabis. The evidence is mixed, as discussed in cannabis and gynaecomastia.
In many men no specific cause is found. This is called idiopathic gynaecomastia, and it is assessed and treated in the same way.
Grades of Gynaecomastia
The Simon classification is widely used to grade gynaecomastia by size and excess skin:
- Grade I: small visible enlargement, no excess skin
- Grade IIa: moderate enlargement, no excess skin
- Grade IIb: moderate enlargement with some excess skin
- Grade III: marked enlargement with significant excess skin
The grade, along with the balance of gland and fat, guides which treatment is suitable. Higher grades with excess skin are more likely to need skin removal as part of surgery.
Does Gynaecomastia Go Away on Its Own?
It depends on the cause and how long the gland has been present.
During puberty: often yes. Pubertal gynaecomastia frequently settles within six months to two years, so watchful waiting with GP review is usually the first step. More detail for parents is in teenager with gynaecomastia: when does surgery become an option?
Caused by a medication or steroids: possibly, if the cause is stopped early, before the gland becomes fibrous.
Present for more than a year or two in adults: unlikely. Over time the gland develops fibrous tissue and stops responding to hormonal change.
Mainly fat: weight loss usually reduces it, though not always completely.
When to See a Doctor
Most gynaecomastia is benign, but not every chest change in men is gynaecomastia. See your GP promptly if you notice:
- A new lump on one side only, particularly if it is growing quickly
- A hard, irregular or fixed lump, or one that is not centred under the nipple
- Nipple discharge, or nipple or skin changes such as dimpling
- Pain together with rapid growth
- Other symptoms that may suggest an underlying medical condition
Breast cancer in men is rare, but it does occur. A one-sided, hard or fast-growing lump should always be assessed rather than assumed to be gynaecomastia.
Treatment Options for Gynaecomastia
Non-surgical options
- Treating the cause. Managing a medical condition or, with your doctor, reviewing medications that may be contributing.
- Medication. In some recent-onset cases, a GP or endocrinologist may consider medication. It is less likely to help once the gland has become fibrous.
- Weight loss and exercise. These reduce the fatty component but do not shrink gland tissue. Chest training builds the muscle underneath without removing the gland. More on this is in how to get rid of man boobs.
Surgery
When gland tissue has persisted and has not settled, surgery removes it. The main techniques are gland excision through a small incision at the lower edge of the areola, liposuction for surrounding fat, a combination of both, and skin excision in higher grades. The options are explained in gyno surgery: your gynaecomastia treatment options, and procedure details are on the gynaecomastia surgery page.
Medicare items 31525 and 31526 may apply to gland removal when the enlargement is not due to obesity and photographs document the clinical need. Costs and Medicare are covered in gyno surgery cost in Australia.
Consultation
A referral from your GP is required before consultation. At consultation, Dr Scott J Turner reviews your history and possible causes, examines the chest to assess gland, fat and skin, and explains which options are suitable.
For surgery performed for cosmetic reasons, the Medical Board of Australia’s guidelines require at least two consultations before surgery, including one in person with the surgeon who will operate, screening for psychological factors such as body dysmorphic disorder, and a cooling-off period of at least seven days before you can confirm surgery. To arrange a consultation, contact the practice.
Frequently Asked Questions
What does gynaecomastia look like?
Gynaecomastia usually looks like a puffy or raised nipple, or a rounded fullness of the chest centred behind the nipple. It can affect one or both sides. The key feature is a firm or rubbery disc of tissue directly beneath the areola, which can be felt as well as seen.
Does gynaecomastia go away on its own?
Gynaecomastia during puberty often settles within six months to two years. Gynaecomastia caused by a medication or steroids may settle if the cause is stopped early. Gland tissue present for more than a year or two in adults becomes fibrous and is unlikely to resolve without surgery.
How do I know if I have gynaecomastia or chest fat?
Gynaecomastia feels like a firm disc directly under the nipple, while chest fat feels soft and spreads across the chest. Many men have both. A physical examination by a doctor, sometimes with an ultrasound, is the reliable way to confirm which is present.
Can gynaecomastia affect only one side?
Yes. Gynaecomastia can affect one side, both sides, or both sides unevenly. A new lump on one side only, particularly one that is hard, fixed or growing quickly, should be checked by a GP to rule out other causes.
Is gynaecomastia serious?
Gynaecomastia itself is benign, but it can be a sign of an underlying hormonal or medical cause, and it can cause tenderness and affect confidence. A GP review is a sensible first step, especially if the change is new, one-sided, hard or painful.
