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Authored by: Dr. Sam Sukkar, MD on January 12th, 2026
Gynecomastia causes almost always come back to one thing: a shift in the balance between testosterone and estrogen that makes male breast tissue grow. When hormones estrogen act more strongly than testosterone in the male breast, glandular tissue beneath the nipple enlarges and can feel swollen or tender.
Most people want to know why gynecomastia is happening and what can be done to correct it. While some cases may improve over time, persistent breast enlargement often does not fully resolve on its own. When gynecomastia is linked to medications or underlying health conditions, addressing those factors is an important step, but remaining glandular tissue may still persist. In these situations, gynecomastia surgery offers a predictable and lasting solution. The procedure directly targets excess breast tissue for improved male chest definition. A careful physical exam and targeted blood tests help determine candidacy and guide the timing of surgical treatment for the most reliable outcome.
Gynecomastia is benign enlargement of male breast glandular tissue, usually in one or both breasts, caused by hormonal imbalances rather than simple weight gain.
In true gynecomastia, firm, rubbery glandular tissue forms a disc directly beneath the breast nipples, often described as a button of tissue behind the areola. This excess breast tissue is different from fatty tissue beneath the skin, which feels softer and more diffuse across the chest.
Estrogen stimulates breast tissue cells to grow, while testosterone usually restrains that growth. When estrogen levels rise, testosterone levels fall, or breast tissue becomes more sensitive to estrogen, male breast enlargement can follow. This is why estrogen and testosterone are central to all discussions about gynecomastia causes.
Gynecomastia happens in more than half of pubertal boys at some point, and it can also occur in older men. By contrast, pseudogynecomastia is simply extra fatty tissue from obesity, with no real increase in glandular tissue. A healthcare provider can usually tell the difference through a careful physical exam.
At the center of almost all causes of gynecomastia is a relative excess of estrogen effect compared with testosterone in the male body.
Hormone changes can be brief or long lasting. Temporary shifts happen in preteen or teenage child development, and sometimes after short courses of certain medications. When the hormonal swing settles, swollen breast tissue often shrinks over months.
Persistent imbalances are different. Ongoing low testosterone, chronic diseases, or tumors in the adrenal glands or pituitary gland can maintain higher estrogen levels or lower testosterone levels for years. In these cases, gynecomastia treated early with medical therapy works better than waiting until the breast tissue becomes fibrous and stable.
Hormonal imbalances can arise from primary testicular failure, Klinefelter syndrome, or secondary problems in the glands or pituitary gland that control hormone production. Anti androgens used for prostate cancer, hormone therapy, and some cardiovascular medicines can all trigger gynecomastia by blocking testosterone action or boosting estrogen effect.
Gynecomastia can appear at predictable life stages, when normal hormone shifts make estrogen briefly more influential than testosterone.
During puberty, hormone levels surge and fluctuate quickly. Estrogen and testosterone do not rise in perfect balance, so many boys develop gynecomastia around ages 13 to 14.
Pubertal gynecomastia typically presents as a small, tender lump of glandular tissue behind one or both breast nipples. The symptoms of gynecomastia in this group often peak over several months and then slowly improve over six to twenty-four months.
A teenage child with stable or slowly improving breast enlargement, normal growth, and no other health conditions usually only needs reassurance and follow-up. But, gynecomastia that begins before other signs of puberty, grows rapidly, or is associated with testicular abnormalities should prompt a full evaluation of gynecomastia causes.
In adult men, especially after age 50, testosterone levels gradually decline while body fat often increases. Fat tissue contains aromatase, an enzyme that converts androgens into estrogen.
As a result, older men may experience breast enlargement from both true glandular tissue growth and added fatty tissue. Additional health conditions, such as liver disease, chronic kidney disease, and thyroid disorders, can further disturb estrogen and testosterone balance.
Certain medications common in older adults, including heart medicines like calcium channel blockers and other cardiovascular medicines, can trigger gynecomastia. When an older man notices enlarged breasts, it’s important to carefully review his medical history and medication use before deciding on gynecomastia treatment.
Many cases of gynecomastia are linked to certain medications or substances that affect hormone levels or how breast tissue responds.
Several groups of medicines are well known to cause gynecomastia. Anti androgens and prostate cancer medicines such as bicalutamide or flutamide block testosterone action and can rapidly induce gynecomastia.
Other prostate cancer treatments, including hormone therapy with GnRH analogs, lower testosterone levels dramatically. Over time, this relative estrogen dominance can lead to swollen breast tissue and tenderness in one or both breasts.
Cardiovascular medicines like some calcium channel blockers and spironolactone can cause gynecomastia by altering hormone metabolism or blocking androgen receptors. Certain medications used as anti anxiety medications can also trigger gynecomastia in rare cases.
When gynecomastia develops after starting a new medication, the benefits are weighed against the impact of breast enlargement before deciding on next steps. Sometimes switching to another agent or lowering the dose is enough to treat gynecomastia without surgery.
Anabolic steroids are a major nonmedical cause of gynecomastia. Many anabolic steroids can be converted into estrogen-like compounds in the body, which directly stimulate breast tissue.
Men who use anabolic steroids for bodybuilding often develop firm glandular tissue beneath the nipples. Even after stopping steroids, that tissue may not fully regress, and gynecomastia surgery may be the only way to remove excess breast tissue.
Illegal drugs like marijuana have been associated with gynecomastia in some studies, though the strength of evidence varies. Heavy alcohol use contributes indirectly by damaging the liver, which normally helps break down hormones. Alcohol related liver disease and advanced liver disease interfere with normal hormone metabolism. Estrogen levels can rise, and binding proteins change, promoting male breast enlargement. Supplements that secretly contain androgens or prohormones may have similar effects, especially when used without medical supervision.
Several underlying health conditions can cause gynecomastia by altering hormone production, metabolism, or action in breast tissue.
Endocrine disorders are a key group of causes of gynecomastia.
Primary testicular failure and Klinefelter syndrome lead to low testosterone, making estrogen relatively stronger.
Tumors of the testicles, adrenal glands, or pituitary gland can secrete hormones that stimulate breast tissue growth.
Thyroid disorders, especially hyperthyroidism, raise levels of proteins that carry sex hormones in the blood. This can shift the balance toward higher free estrogen activity.
The liver and kidneys play a major role in clearing hormones from the bloodstream.
Advanced liver disease, including cirrhosis or alcohol related liver disease, impairs this process and may increase estrogen levels.
Chronic kidney disease and kidney failure can also disrupt hormone levels and reduce testosterone. Men on long-term dialysis often develop gynecomastia because of combined hormonal changes, medication effects, and metabolic stress.
Thyroid gland problems, particularly an overactive thyroid, increase the conversion of androgens to estrogens. They also change levels of binding proteins, altering how much active hormone reaches breast tissue. Correcting thyroid function is hence an important step when thyroid disorders cause gynecomastia.
Obesity is a very common contributor to gynecomastia. Fatty tissue contains aromatase, which converts testosterone to estrogen. As body fat increases, so does estrogen production.
Men with obesity often have both true gynecomastia and pseudogynecomastia. That means there is glandular tissue under the nipple plus extra fatty tissue across the chest. Thyroid disorders injury obesity, diabetes, and other metabolic issues can all worsen this hormonal environment.
Low testosterone related to obesity further increases the risk. Because weight loss mainly reduces fatty tissue, glandular tissue may remain. In some cases, gynecomastia surgery is considered after weight loss to remove persistent glandular tissue and reshape the male breast.
Men and boys should seek medical advice for breast enlargement that is painful, rapidly growing, asymmetrical, or associated with other worrying symptoms.
A detailed past health and medicine history is the first step when gynecomastia is evaluated. Questions about when the breast enlargement started, how fast it changed, and whether pain or nipple discharge is present.
All current and past medicines are review, including certain medicines, and any illegal drugs or supplements. Information about alcohol use, liver disease, chronic kidney disease, or other diseases is essential. During the physical exam, the chest is examined to distinguish glandular tissue from fatty tissue. True gynecomastia presents as a rubbery disc under the areola, while simple fat feels soft and spreads more widely.
Gynecomastia surgery is typically recommended when true glandular tissue is confirmed. Surgery may also be considered when breast tissue remains stable for several months and is unlikely to resolve on its own.
Men in Houston treat gynecomastia by first confirming whether the chest enlargement is caused by true glandular tissue, excess fat, or a combination of both. Once reversible causes such as medications, hormonal shifts, or weight gain are addressed, treatment decisions focus on whether the tissue is likely to resolve on its own or remain permanent. For many men, especially when gynecomastia has been present for several months or years, surgical treatment becomes the most reliable option.
Gynecomastia surgery is commonly used in Houston to remove excess male breast tissue and restore a flatter, more masculine chest contour. The procedure often combines liposuction to remove fatty tissue with direct excision of firm glandular tissue beneath the areola. Surgery is typically recommended when lifestyle changes or medical adjustments have not corrected the condition, or when breast enlargement causes discomfort, self-consciousness, or limits clothing choices and physical activity. When performed after the tissue has stabilized, gynecomastia surgery provides long-lasting results.
Most gynecomastia causes come from an imbalance between estrogen and testosterone, where estrogen has a stronger effect on breast tissue. This can result from normal life stages, medications, anabolic steroids, alcohol, illegal drugs, obesity, or medical conditions affecting the liver, kidneys, thyroid, adrenal glands, or pituitary gland.
In true gynecomastia, you can usually feel a firm, rubbery disc of glandular tissue directly beneath the nipple or areola. Pseudogynecomastia from obesity feels softer and more spread out across the chest.
Liposuction may be effective when excess fatty tissue is the primary cause of chest enlargement. However, when firm glandular tissue is present, liposuction alone is usually insufficient and must be combined with direct gland removal.
Gynecomastia surgery usually combines liposuction to remove excess fat with surgical excision of glandular tissue. The approach is tailored to the type and amount of tissue present and the degree of skin excess.
Most men return to light activities within a few days and resume normal routines within several weeks. Swelling and firmness gradually improve, with final chest contours becoming visible over a few months.
Gynecomastia happens when the balance between estrogen and testosterone shifts, allowing breast tissue in males to grow. This can occur at normal life stages, after exposure to certain medications or anabolic steroids, or due to underlying health conditions affecting the liver, kidneys, thyroid, adrenal glands, or pituitary gland.
Most cases are benign and many improve over time, especially in pubertal boys. But, rapid changes, significant pain, very enlarged breasts, or features suggesting breast cancer deserve timely evaluation.
Anyone noticing new male breast enlargement should discuss it with a healthcare provider rather than assuming it is only fatty tissue. A focused history, physical exam, and targeted blood tests usually clarify the main gynecomastia causes and help tailor an appropriate treatment plan in a medical office setting.
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Board-Certified Plastic Surgeon Dr. Sam Sukkar, MD, FACS, and the The Clinic for Plastic Surgery Team provide advanced surgical solutions for men struggling with enlarged or excess breast tissue.
If you are man experiencing excess chest fat, glandular tissue, or persistent male breast enlargement, we offer comprehensive gynecomastia treatment options, including:
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Dr. Sam Sukkar, MD, FACS is a highly respected Board-Certified Plastic Surgeon in Houston, Texas, known for his expertise in advanced cosmetic and reconstructive procedures. As the founder of The Clinic for Plastic Surgery, Dr. Sukkar has set a new standard for excellence, performing over 20,000 procedures with a focus on delivering natural, refined results.
Dr. Sukkar earned his Doctor of Medicine (M.D.) degree from Louisiana State University School of Medicine in 1992 after graduating summa cum laude with a Bachelor of Science in Microbiology. He then completed an intensive General Surgery Residency at the University of Texas Hermann Hospital before being selected for a highly competitive Plastic Surgery Fellowship at Northwestern University in Chicago, one of the most prestigious training programs in the country.
With more than 20 years of experience, Dr. Sukkar is a Diplomate of the American Board of Plastic Surgery and a Fellow of the American College of Surgeons (FACS). He is also an active member of the American Society of Plastic Surgeons (ASPS) and the Houston Society of Plastic Surgery (HSPS). His dedication to innovation and continuing education has solidified his reputation as a leading expert in aesthetic surgery, specializing in breast surgery, body contouring, facial procedures, and non-invasive treatments.
Dr. Sukkar’s expertise has been recognized by Houston Magazine, naming him one of Houston’s “Top Docs for Women,” and he has been featured among RealSelf’s America’s Top Doctors. Committed to his patients, he prioritizes personalized care, ensuring every individual feels informed, comfortable, and confident in their aesthetic journey.
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