Gynaecomastia
Gynaecomastia is enlargement of the glandular breast tissue in men. It is not the same as fat accumulation from excess weight, even though they look alike…
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Medicines commonly prescribed for Gynaecomastia
For informational purposes only. Always consult a doctor before using any medicine.
DIVIGEL 0.5 mg TRANSDERMAL GEL in SACHETSIllustrative imageDosage form: GEL, 0.5 mgActive substance: estradiolManufacturer: Orion CorporationPrescription required
VAGIFEM 10 micrograms VAGINAL COATED TABLETSIllustrative imageDosage form: VAGINAL SUPPOSITORY/CAPSULE/TABLET, 0.01 mgActive substance: estradiolManufacturer: Isdin S.A.Prescription required
EVOPAD 50 micrograms/24H TRANSDERMAL PATCHESIllustrative imageDosage form: TRANSDERMAL PATCH, ESTRADIOL HEMIHYDRATE 3.2 mgActive substance: estradiolManufacturer: Theramex Ireland LimitedPrescription required
Gynaecomastia is enlargement of the glandular breast tissue in men. It is not the same as fat accumulation from excess weight, even though they look alike from the outside: the difference is felt on examination, and it completely changes the approach. In most cases it is benign and reversible, but it is worth investigating, because it sometimes reflects a hormonal problem, a medication effect or, rarely, something more serious.
How it presents
- a firm, mobile disc of tissue directly beneath the nipple, felt as a plate or button;
- it may be on one side or both, and is often asymmetrical;
- tenderness or pain on touch, particularly when the growth is recent;
- the nipple may be more sensitive or rub against clothing;
- in pseudogynaecomastia there is only soft fat, without that central firm disc.
When it is physiological
There are three points in life when it appears without indicating disease:
- newborns — from maternal hormones; it disappears within weeks;
- puberty — it affects more than half of adolescent boys, appears at around 12–14 and resolves on its own within one to two years in most cases;
- older age — from falling testosterone and a relative increase in oestrogen.
Causes worth excluding
- medicines — the most common avoidable cause. Spironolactone, some blood pressure drugs, omeprazole and similar, antidepressants, antipsychotics, finasteride, anti-androgens, some antiretrovirals and antifungals;
- anabolic steroids and testosterone — the body converts the excess into oestrogen. A very common cause among gym users and one that is often not disclosed in consultation;
- alcohol, cannabis, opioids;
- chronic liver disease;
- kidney failure;
- hyperthyroidism;
- hypogonadism — low testosterone of any origin;
- Klinefelter syndrome;
- tumours — testicular, adrenal or hCG-producing; uncommon, but the reason the testes are always examined;
- obesity, which increases the conversion of androgens to oestrogens;
- significant weight regain after undernutrition.
When to see a doctor
- the enlargement has come on quickly or is painful;
- it is on one side only and the lump is hard, irregular, fixed or not centred under the nipple;
- there is discharge from the nipple, particularly if bloodstained;
- the nipple skin is retracted, ulcerated or dimpled like orange peel;
- there are palpable nodes in the armpit;
- you have noticed a change in the size or firmness of a testicle;
- there is reduced sex drive, erectile problems or loss of body hair;
- it started after beginning a medicine;
- you take or have taken anabolic steroids;
- in an adolescent it has persisted more than two years or is very marked;
- it affects you psychologically — a perfectly valid reason to attend.
The second to fifth points require male breast cancer to be excluded. It is uncommon, but it exists, and it is diagnosed late precisely because it is not thought of.
How it is investigated
The doctor palpates the breast to distinguish glandular tissue from fat, examines the testes, assesses the liver and signs of testosterone deficiency, and reviews all medication and supplements thoroughly, asking explicitly about anabolic steroids.
Usual blood tests: total and free testosterone, LH, FSH, oestradiol, prolactin, thyroid function, liver and kidney function, and hCG and alpha-fetoprotein if a tumour is suspected. Imaging: breast ultrasound and mammography if the picture is atypical, and testicular ultrasound where relevant.
Treatment
- observation — in adolescents and in recent cases with no concerning cause; many resolve on their own;
- withdrawing or substituting the responsible medicine, always with a doctor;
- stopping anabolic steroids and alcohol;
- treating the cause — thyroid, liver, hypogonadism;
- weight loss in pseudogynaecomastia, where it is what actually works;
- tamoxifen — useful in the early, painful stage, within the first months;
- surgery — the definitive solution once the tissue is more than a year old and has become fibrous, at which point medication reverses nothing.
Timing matters: in the first 6–12 months the tissue still responds to medical treatment; after that it is replaced by fibrous tissue and only surgery resolves it.
Common questions
Will chest exercises get rid of it? No. Exercise reduces fat but not glandular tissue.
Is it cancer? Almost never. But a hard, one-sided lump away from the nipple does need investigating.
Will it resolve on its own in a teenager? In most cases, within one to two years.
Does it affect fertility? Gynaecomastia itself does not, but some of its causes — low testosterone, anabolic steroids, Klinefelter syndrome — do.
Do the "anti-oestrogen" supplements sold in gyms help? No, and some make it worse. The cause is often precisely what is being taken.
Online consultation
In an online consultation the doctor helps distinguish true gynaecomastia from fat accumulation, reviews your medication and supplements thoroughly, advises which blood tests and scans are needed, recognises the features that require cancer to be excluded, and explains within what window medical treatment can work and when only surgery will.
This material is for information only and does not replace a medical consultation.
Consult with a doctor about Gynaecomastia
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Medically reviewed by
Reviewed on Aug 9, 2026
Online doctors for Gynaecomastia
Discuss your symptoms and possible next steps for Gynaecomastia with a doctor online.
