Male Breast Enlargement

By David Freeman
WebMD Feature

Reviewed by Louise Chang, MD

Elliot W. Jacobs, MD, knows a thing or two about enlarged breasts in men, and not just because he specializes in treating the condition. "My own breasts became enlarged when I was a teenager," says the New York City-based plastic surgeon. "It was very embarrassing. When I was being fitted for my bar mitzvah suit, the salesman said, 'A little chesty, aren't you?' I dreaded playing shirts-and-skins basketball in gym class, because I hated running up and down the floor without a shirt, my chest bouncing. Once, I went to my locker after gym class and saw that a classmate had hung a bra on it."

Jacobs is just one of countless men to suffer the embarrassment of male breast enlargement, a.k.a. man boobs or moobs or, in medical parlance, gynecomastia. Whatever name it goes by, the condition has been the butt of countless jokes: Remember the 1995 episode of Seinfeld in which Kramer comes up with a brassiere for men (and has trouble deciding whether to call it a "bro" or a "mansiere")? Of course, for the millions of men and boys who have enlarged male breasts, there's nothing funny about the condition.

'Man Boobs' Affect Males of All Ages

Gynecomastia affects up to two-thirds of pubescent boys and half of all men. Male breast enlargement that arises in puberty often resolves on its own, within a matter of months, as hormone levels normalize. When the condition arises in adulthood, it tends to persist. Here's why: As men age, they tend to lose testosterone and gain weight. The former contributes to gynecomastia (which is actually defined as enlargement of glandular tissue within the breasts), the latter to a related condition known as pseudogynecomastia, in which enlargement is caused by deposits of fatty tissue under the breasts, explains Jacobs. What's more, scientists now know that fat cells produce small amounts of estrogen, which further fuels male breast enlargement. As far as a man's risk for breast enlargement is concerned, experts tell WebMD that obesity is a double whammy.

Having 'Man Boobs' Can Cause Psychological Trauma

Because prominent breasts are so closely identified with the female form, men with gynecomastia are often seen -- and see themselves -- as freaks. And they try all sorts of secret stratagems to mask their freakishness: wearing baggy shirts, never going shirtless in public, wriggling into compression garments, binding their chests with athletic tape or bandages, and so on. Some men with enlarged breasts shun physical exercise. Some never go to the pool or beach.

"Men with gynecomastia often have extremely limited sexual experiences, because they are afraid to take their shirt off in front of a partner," says Jacobs. "I've even seen men gain lots of weight on purpose, just so their breasts won't appear so prominent."

Aside from the psychological trauma it can cause (in some cases, accompanied by transient breast pain or tenderness), gynecomastia is generally a benign condition. But after adolescence, it can be evidence of a serious underlying disorder, such as low testosterone (hypogonadism), an overactive thyroid, cirrhosis of the liver, a genetic abnormality, or cancer of the breast, lung, adrenal gland, or testes. For this reason, experts say it's prudent to have a board-certified endocrinologist evaluate male breast enlargement, even if it hasn't been particularly bothersome.

In many cases, gynecomastia can be diagnosed solely on the basis of a physical exam and medical history. By examining the breast, a doctor can often distinguish gynecomastia from pseudogynecomastia, as well as examine for signs of breast cancer. In gynecomastia, the excess breast tissue surrounds the areola area and tends to be rubbery or firm. Breast tumors are generally hard. In pseudogynecomastia, the excess tissue under the breasts feels spongy, without any defined mass.

The location of the excess tissue offers another diagnostic clue, says Glenn D. Braunstein, MD, chairman of the department of medicine at Cedars-Sinai Medical Center in Los Angeles and the author of "Gynecomastia," a definitive article on the condition published in the Sept. 20, 2007 issue of the New England Journal of Medicine.

"Gynecomastia is always concentric to the nipple," he says. "Breast cancer is usually eccentric," meaning outside the nipple/areola area. Breast cancer may also have other findings such as discharge from the nipple or dimpling of the skin.

If the doctor cannot make a diagnosis on the basis of the exam, a mammogram and other diagnostic tests may be in order. As it turns out, a large proportion of cases of gynecomastia are idiopathic -- meaning the cause is unknown.

Drugs Can Cause Male Breast Enlargement

In addition to various illnesses, certain medications can cause gynecomastia. Common culprits include anabolic steroids, as well as the stomach acid drug cimetidine (Tagamet), the heart drug spironolactone (Aldactone), the anti-androgen prostate cancer drug bicalutamide (Casodex), and several other medications.

In many cases, discontinuing the offending drug and switching to another helps reduce enlarged breasts, experts say. Abuse of alcohol and marijuana can also contribute to gynecomastia.

How to Treat 'Man Boobs'

What else can be done about enlarged breasts? If an underlying condition is causing gynecomastia, treating it may help. If pseudogynecomastia is the problem, weight loss is often the first step, says Braunstein. But even a significant reduction in weight may not bring a significant reduction in breast size. "If a man has gained a lot of weight, the breasts don't always go back to normal," he says. The stretched-out skin will remain.

Doctors have had some success treating gynecomastia with the estrogen-blocking drug tamoxifen, which is commonly used in breast cancer treatment for postmenopausal women, but is not approved for treatment of gynecomastia. "Three months of 20 milligrams a day reduces breast tenderness and size in about 80% of the men who try it," says. Braunstein.