Enlarged breasts in boys, men can be a sign of gynecomastia
About 40-60% of Indian males experience gynecomastia at some point in their lives, as per data from the National Institute of Health (NIH). A relatively common disorder in which the amount of breast gland tissue increases, gynecomastia is common in newborns, boys going through puberty, and older men. This benign (noncancerous) enlarged breast (chest) tissue in males may develop due to natural changes in hormone levels.
According to Dr Quazi Ghazwan Ahmad, consultant, plastic surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, this condition leads to the appearance of male breasts or “man boobs.”
However, the stigma, embarrassment, and lack of awareness are affecting the treatment of gynecomastia in boys and men.
“This occurs due to an imbalance between the hormones estrogen (which promotes breast tissue growth) and testosterone (which inhibits it). It may affect one or both breasts, sometimes unevenly, and is not related to body fat,” Dr Ahmad clarified.
He, however, said that it is often confused with pseudogynecomastia, where the chest appears enlarged due to excess fat deposits rather than actual glandular proliferation. True gynecomastia involves the presence of firm or rubbery breast tissue beneath the nipple and areola.
The NIH data show, among adolescents, about 50% of boys may develop gynecomastia during puberty, though over 90% of these cases resolve spontaneously within two years. Globally, the lifetime prevalence of gynecomastia among adult men is estimated at around 65%, and it increases as they age.
In contrast, Indian studies consistently report higher rates, especially among those seeking medical attention or surgical correction, said Dr Anushtup De, senior consultant and head of general and minimally invasive surgery at Sarvodaya Hospital, Faridabad.
According to Dr Monika Sharma, senior consultant of endocrinology at Aakash Healthcare, Delhi, gynecomastia can occur at various stages of life. “Most commonly, it is observed during puberty between the ages of 10-14 and again in later adulthood, particularly between 50-60 years of age or older. In most cases, it does not pose serious health risks but may require medical evaluation to rule out other conditions.”
Despite it being a common problem, many boys and men don’t address it due to stigma, embarrassment, and lack of awareness.
It is far more common than people realise, particularly among adolescents and adult men who are active in fitness, bodybuilding, or undergoing hormonal shifts, said Dr De. “Despite being benign in most cases, it often goes undiscussed due to stigma, self-consciousness, or misinformation,” he added.
With the rise of fitness culture in urban India, more young men are approaching plastic surgeons for correction. Still, the number of sufferers remains underrepresented in public discourse, added Dr Ahmad.
“It is increasingly seen in urban Indian males due to rising obesity, hormone-disrupting chemicals, and steroid use. In clinical practice, many cases go undiagnosed or are brought to medical attention only when the patient experiences discomfort, embarrassment, or cosmetic concerns,” he said.
Symptoms
If you have swelling or enlargement of breast tissue in either of the breasts; feeling tenderness or pain in the breast; either firm or rubbery tissue beneath the nipple; asymmetrically sized breasts; distress (emotional or psychological owing to physical appearance), then chances are you may be suffering from gynecomastia.
In some instances, tenderness or pain may develop, especially when touched or when there is friction from clothing. Less common symptoms are nipple discharge, changes in nipple shape, or alterations in the overlying skin may be seen.
“Any bloody discharge or abnormal skin changes must be investigated further to rule out male breast cancer, which can have similar symptoms,” added Dr Sharma.
Hormonal imbalance
The main cause is an imbalance in hormone levels - like low testosterone and high estrogen levels. The other is obesity, which leads to increased estrogen production.
The use of medications can also be another reason. The usage of steroids, anti-androgens, antidepressants, ketoconazole, cimetidine, spironolactone, antipsychotics, and some antihypertensive drugs has been known to induce gynecomastia.
Those suffering from medical conditions like underlying liver cirrhosis, degenerative kidney disease, and thyroid conditions alongside tumours may also develop gynecomastia. Experts also said that substance use - alcohol, marijuana, heroin and amphetamines - is also a reason for men to develop male breasts.
Some herbal products and supplements can have estrogen-like effects and could lead to gynecomastia, added Dr Ahmad.
Can it be prevented?
While diet and exercise are generally healthy, they don't directly prevent gynecomastia. Natural bodybuilding with discipline and nutrition is a far safer route than shortcuts via steroids which may offer short-term gains but long-term hormonal side effects.
According to Dr Srinivasa P Munigoti, consultant of endocrinology at Fortis Hospital, Bannerghatta Road, Bengaluru, there is no scientific evidence to support the prevention of gynaecomastia through workouts or fitness exercises.
It has been seen that for gym-goers and fitness enthusiasts, the primary risk factor for gynecomastia is the use of anabolic steroids - a chemical substance that increases the size of the muscles. These can disrupt the body's natural hormonal balance, often leading to increased estrogen levels as the body tries to compensate.
Also, one must be cautious with over-the-counter supplements, which may contain prohormones or unregulated ingredients.
The best is to maintain hormonal balance through natural bodybuilding, adequate sleep, stress management, proper nutrition, limiting alcohol, and avoiding recreational drugs, which can disrupt liver function and hormone metabolism.
Another important point is not to train excessively or restrict calories severely, as it can lead to hormonal imbalances.
Maintaining a healthy weight can have a positive impact on the condition. “Around 90% of puberty-related gynecomastia resolves on its own. Still, it's important to consult a doctor to identify the underlying cause and receive appropriate treatment,” Dr Munigoti added.
Treatment options
The first step is to identify the medical condition early. Some medications can be used to treat gynecomastia, particularly if it's in the early stages and caused by hormonal imbalances. These might include drugs that block the effects of estrogen or reduce its production.
Male breast reduction surgery, also known as gynecomastia surgery, is also a possibility.
Dr Ahmad said that if gynecomastia is severe, long-standing, or doesn't respond to medication, surgery may be an option. “The two main types of surgery are liposuction, which removes excess fat tissue in the breast, and the second is excision, in which glandular breast tissue is cut out. Often, a combination of both techniques is used.”
Experts said timely medical consultation is encouraged to eliminate the need for surgery. “With proper treatment, lifestyle adjustments, or discontinuation of the triggering drug, the condition can be managed successfully, allowing the affected individuals to regain their confidence,” added Dr Sharma.
Also needed, Dr Ahmad said, is increased awareness, open conversations, and access to safe, non-judgmental healthcare. "These can encourage more individuals to seek help early and improve outcomes."