Adult Gynecomastia

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Medical Author: Miguel Delgado, M.D.


Dr. Delgado is a highly skilled surgeon specializing in gynecomastia surgery. Dr. Delgado has committed a significant amount of his practice to the care and education of men and boys with gynecomastia. Dr. Delgado’s practice philosophy is to provide the highest quality of patient care to the people who seek out his professional services. Dr. Delgado and his staff are committed to understanding their patients concerns, educating them on their options, and executing the best surgical outcome for each patient. Dr. Delgado is the new owner of since 2010. He has dedicated a significant part of his life and practice to improving the community.



What Causes Adult Gynecomastia?

Gynecomastia in adults is often a result of an imbalance of the hormones testosterone and estrogen. There are numerous potential causes of adult gynecomastia and large male breasts. The most common cause is untreated or unrecognized adolescent gynecomastia. Below are some of the major causes of male gynecomastia and their prevalence:

  • Persistent adolescent gynecomastia: 25%
  • Drug-induced: 10 – 25 %
  • No detectable cause: 25 %
  • Malnutrition and liver disease: 8 %
  • Primary hypogonadism (deficient testes): 8%
  • Tumors of the testes: 3 %
  • Secondary hypogonadism (low sperm count): 2
  • Hypothyroidism: 1.5 %.

As you can see, 25% of gynecomastia cases are persistent from adolescent gynecomastia. The other causes of male gynecomastia symptoms are hormonal, drug-induced, or unknown.


Gynecomastia Diagnosis

Receiving a gynecomastia diagnosis to determine the type and cause of gynecomastia symptoms is an essential part of deciding the most appropriate treatment or gynecomastia surgery.


Medical History Evaluation of Gynecomastia Symptoms

During a consultation for gynecomastia treatment, a medical evaluation should include:

  • Age of onset and duration of gynecomastia symptoms
  • Any recent changes in nipple size and any pain or discharge from the nipples
  • History of mumps, testicular trauma, alcohol use, or drug use
  • Family history of gynecomastia
  • History of sexual dysfunction, infertility, or hypogonadism (a condition in which the production of sex hormones and germ cells are inadequate).


Physical Examination of Gynecomastia Symptoms

  • A thorough examination of the breasts, with attention to size and feel of tissue
  • Assessment for any nipple discharge or axillary lymphadenopathy (obvious enlargement of lymph nodes in the area of the arm and breast)
  • Testing to differentiate between true gynecomastia and pseudogynecomastia (enlarged breast tissue caused by fat accumulation)
  • Assessment of glandular tissue
  • Examination of the testicles, with attention to size and consistency, as well as nodules or asymmetry
  • Observation of any signs of feminization.


Evaluating Adult Gynecomastia

In order to diagnose gynecomastia in adults, during a physical examination, the doctor has the patient lie flat on his back, with his hands clasped beneath his head. The doctor then presses his separated thumb and forefinger, either side of the breast. In patients with true gynecomastia, the doctor will feel a rubbery or firm mound of tissue surrounding the nipple and areola, whereas, in patients with pseudogynecomastia, no such disk of tissue is found.
The physical evaluation can usually determine the etiology (biology) of gynecomastia symptoms. Once determined, male gynecomastia surgery is the most reliable way to permanently get rid of male breasts. When the cause of male gynecomastia symptoms can not be determined by a physical evaluation, additional gynecomastia diagnostic tests include:

  • Blood tests for hormone or endocrine levels
  • Blood tests for liver and kidney function
  • Urine test
  • Ultrasound
  • Mammogram.

If there are no other causes of gynecomastia found after additional diagnostic tests, gynecomastia symptoms are then of “unknown etiology” or gynecomastia with idiopathic causes.


Examples of Adult Gynecomastia


Before Treatment Adult GynecomastiaAfter Treatment Adult Gynecomastia
You can see more examples of Grade 1, 2, 3, and 4 gynecomastia here.


Adult Gynecomastia and Pseudogynecomastia

True gynecomastia is when the male breast is enlarged due to glandular tissue, which can cause small to large male breasts, defined by four grades of gynecomastia. Pseudogynecomastia is due to an increase in fat deposits, which can be due to age, weight gain, or both. The condition is usually attributed to weight gain and/or aging. The average pseudogynecomastia man states that as a teenager, his chest was normal, but the condition developed later in life, often made more pronounced due to weight gain. Unlike with true gynecomastia, liposuction will often give a man with pseudogynecomastia a good result.



Male Menopause

The term “male menopause” is sometimes used to describe decreasing testosterone levels related to aging. Many physicians also use the term “andropause” to describe male age-related hormone changes. Other medical terms include testosterone deficiency syndrome, androgen deficiency, and late-onset male hypogonadism. Regardless of the term, it refers to decreasing testosterone levels due to aging, which can cause gynecomastia in adults. The chart below illustrates the slow decline in testosterone levels in the bloodstream as men age.


Low Testosterone Levels (Low-T) and Gynecomastia

Testosterone is a powerful male hormone produced in the testicles, responsible for stimulating sperm production and sex drive. Low testosterone levels are linked to reduced bone density and muscle mass. “Low T” is a common and popular term for low testosterone levels. Reduced testosterone triggers a syndrome known as male menopause or “andropause.” Signs of low testosterone often go undetected and are mistaken as a natural part of aging. As men age, testosterone production naturally declines, which can cause a variety of symptoms, including large male breasts.


The Difference Between the Female and Male Menopause

When women go into menopause, ovulation stops, and hormone production rapidly decreases in a relatively short time span. In men, testosterone production declines over a longer period of many years. The symptoms arise gradually and are often unrecognized as being caused by a decrease in testosterone levels. A serum testosterone blood test is the best way to determine a low or reduced testosterone level.


Eight Signs and Symptoms of the Male Menopause

It is not uncommon for men who have a lower-than-normal testosterone level to show minimal or no signs or symptoms of low testosterone levels. In these cases, no treatment is necessary. When symptoms of gynecomastia in adults occur, the following are the eight most common signs that it could be due to male menopause:

  • Reduced libido: Testosterone plays a major role in the male sex drive. As men age and testosterone levels decrease, so does their sex drive.
  • Reduced semen volume: Testosterone is vital to semen production, the fluid that assists in sperm motility. The more testosterone a man has, the greater his semen production.
  • Loss or reduction of facial and body hair.
  • Lack of overall energy or fatigue.
  • Loss of muscle mass and strength, especially in the arms, legs, or chest.
  • Increase in total body fat — the cause is unclear.
  • Reduced bone mass (osteoporosis).
  • Mood changes: Testosterone is considered a “fuel” for men. It is a hormone that controls multiple body systems, as well as mental health and mood. Men with low testosterone are more likely to experience depression, short attention span, and irritability.

For a closer look at the controversy surrounding the pros and cons of testosterone replacement, I recommend reading the Time Magazine article: “Are You Man Enough? The Truth About Low Testosterone.”



Drugs Associated with Adult Gynecomastia

There are many medications that can cause male gynecomastia symptoms as a side effect when used for essential medical treatment, including:

  • Calcium channel blockers used for controlling high blood pressure
  • Spironolactone (Aldactone), a diuretic that also has anti-androgen capabilities
  • ACE inhibitor medications for high blood pressure such as captopril (Capoten) and enalapril (Vasotec)
  • Various antibiotics such as isoniazid, metronidazole (Flagyl), and ketoconazole (Nizoral, Kuric, Xolegel, Extina)
  • Anti-ulcer drugs including cimetidine (Tagamet), ranitidine (Zantac), and omeprazole (Prilosec)
  • Anti-androgen therapy for cancer of the prostate
  • Methyldopa (Aldomet) used to treat hypertension
  • Highly active antiretroviral therapy (HAART) for the treatment of HIV. The drug can lead to fat accumulation, which may, in turn, lead to pseudogynecomastia or true gynecomastia
  • Diazepam (Valium), an antidepressant
  • Digitoxin, a heart medication
  • Drugs such as marijuana, alcohol, and heroin
  • Skincare products containing tea tree and lavender oils.


Treatment for Adult Gynecomastia

Adult gynecomastia is a very common condition that causes the appearance of male breasts or man boobs and is usually a result of hormone imbalance. The causes of hormonal imbalance are complex and multifactorial. One accepted explanation is testosterone decline due to aging. This is supported by 25% of gynecomastia symptoms occurring in men over 60 years of age.

Various medications to reduce gynecomastia symptoms have limited and unpredictable results and are associated with a wide range of side effects. Male breast reduction surgery is, without a doubt, the most effective way to get rid of adult gynecomastia symptoms. However, male gynecomastia surgery is not “one size fits all,” and there are different types of gynecomastia surgery, depending on the grade of gynecomastia.


For personalized information about gynecomastia plastic surgery procedures, please complete Dr. Delgado’s inquiry form.


Miguel Delgado, M.D., F.A.C.S. is a world-renowned Board-Certified Plastic Surgeon granted by the American Board of Plastic and Reconstructive Surgery and a member of the American Society of Plastic Surgery and Aesthetic Society. Dr. Delgado has a surgical practice solely dedicated to cosmetic plastic surgery. He specializes in gynecomastia surgery and is the medical director of, the oldest and largest gynecomastia forum dedicated to supporting, educating, and providing solutions for men with breast enlargement. Dr. Delgado celebrates 30 years of practice in San Francisco, California. He was voted the “Best Plastic Surgeon of 2017-2021.”

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The content on is for educational purposes only. It is not intended as medical advice. It does not replace the need to meet with a physician who will accurately diagnose your condition and suggest treatment options.

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