Gynecomastia (gyno), also commonly known as “man boobs,” is a condition characterized by an excessive amount of fat on the chest, puffy – often sensitive – nipples, and/or a small, hard lump behind the nipples. Gyno is not typically a painful condition and it doesn’t increase the risk of any diseases. It is, however, often psychologically painful – especially in adolescents who face the ridicule of their peers – and corrective measures are typically sought out as a means of enhancing body image and self-esteem.

Types of Gynecomastia

  • Adolescent. Occurs predominantly in boys ages 10-19. It can be the result of various hormonal abnormalities (low free T, low DHEA-S, high estrogens, etc.). The condition will usually recede within 1-3 years, but for 7% the condition will persist into adulthood.
  • Adult. Gyno as an adult can be due to persistent or uncorrected adolescent gyno or as the result of using anabolic steroids.
  • Unilateral. Unilateral gyno is when excess adipose tissue or glandular tissue is present on only one side of the chest.
  • Pseudogynecomastia. This condition is the presence of excess adipose tissue only (there is no gland behind the nipples). In many cases, this is simply the result of being overweight or obese.
  • True gynecomastia. When most people think of gyno they think of enlarged male breasts. True gyno, however, is the presence of glandular tissue (a small, hard lump) behind the nipples regardless of excess fat. This gland is what causes puffy, sensitive nipples.

Causes of Gyno

  • Altered androgen:estrogen ratio. Adolescent gyno is the result of high amounts of estrogen and/or low amounts of testosterone in utero and throughout early childhood. An altered hormone ratio is also the reason why many men develop gyno during or after the use of anabolic steroids. In most cases, they fail to properly manage estrogen levels (through the use of an aromatase inhibitor). If you are considering pharmacological methods of enhancing testosterone, it is extremely important that you regularly test estrogen levels.
  • Overweight/Obestiy. Excess fat can make gyno appear worse than it is, and in the case of pseudogynecomastia might actually be the only problem.
  • Other. Testicular and adrenal tumors, antiretroviral therapy, medications for prostate cancer, Klinefelter’s syndrome, and alcoholism can all cause gynecomastia.

Gynecomastia Treatment

  • Drugs and supplements. Nolvadex (tamoxifen) is a powerful aromatase inhibitor that can reduce gynecomastia. Correcting testosterone:estrogen imbalances can also help, especially reducing excess estrogens.
  • Fat loss. In many cases, losing weight and adding lean mass can sufficiently hide or even eliminate the problem, depending on the type and severity of the condition.
  • Surgery. Lipoplasty is sufficient for most cases of gyno without a hard nodule under the nipple. A cannula is inserted near the armpit and the fat is suctioned out. There is only a small, inconspicuous scar. For more extreme cases, a mastectomy may be necessary. For those with true gyno (a hard lump under the nipple), surgical excision near the areola is necessary to remove the gland.