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Health condition · Clinically reviewed

Gynaecomastia, causes, hormonal workup and when surgery makes sense.

Common, often benign, and rarely dangerous - but almost always worth investigating properly. A stepped medical and surgical approach beats guesswork.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against endocrine society, BAPRAS and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including medication review, hormonal workup and specialist surgical options.

Key facts

Gynaecomastia at a glance.

The essentials, in plain English - what it is, why it happens, and how it is treated in the UK today.

  • What it is

    Benign enlargement of glandular breast tissue in men, distinct from fatty pseudogynaecomastia.

  • How common

    Affects up to 30 to 50 per cent of adult men at some point, with three physiological peaks across life.

  • Physiological

    Neonatal (60 to 90 per cent of newborns), pubertal (around half of adolescent boys) and senile forms usually settle or need reassurance.

  • Pathological

    Medications, hormonal disorders, liver or kidney disease, and rarely a hormone-secreting tumour.

  • True vs pseudo

    True gynaecomastia is a firm, rubbery, subareolar disc of glandular tissue; pseudogynaecomastia is fat only.

  • Treatment

    Treat the cause, watch and wait, use a SERM like tamoxifen early, or refer for specialist surgery when persistent.

Why this guide matters

A stepped plan, not a snap decision.

Gynaecomastia is common, treatable and - with the right workup - usually easy to explain. The three points below shape everything else on this page.

  • Find the cause first

    Medications, hormonal disorders and systemic illness explain most adult cases - imaging and surgery come after the workup, not before.

  • True or pseudo matters

    Fatty pseudogynaecomastia and true glandular disease look similar but respond to very different treatments.

  • Timing changes options

    Medical treatments like tamoxifen work best in the first 12 months; longstanding fibrotic tissue usually needs surgery.

How the diagnosis is made

From first exam to a clear plan.

The steps a UK GP, endocrinologist or plastic surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and timeline

    Age of onset, pubertal stage, tenderness, rate of change, family history, alcohol, cannabis and anabolic steroid use.

  2. 02

    Assessing

    Medication review

    Spironolactone, digoxin, cimetidine, antiandrogens, oestrogens, antipsychotics, PPIs, HAART and calcium channel blockers are common culprits.

  3. 03

    Assessing

    Focused examination

    True glandular disc versus soft adipose tissue, plus testicular exam, thyroid, liver stigmata and virilisation signs.

  4. 04

    Confirming

    Hormone bloods

    Morning fasting testosterone, LH, FSH, oestradiol, prolactin, TSH, LFTs, U and Es, and beta hCG and AFP where a tumour is possible.

  5. 05

    Confirming

    Imaging where indicated

    Breast ultrasound or mammogram if the lump is unilateral, firm, irregular or suspicious - to exclude male breast cancer.

  6. 06

    Preparing

    Selective testicular ultrasound

    When examination or hCG suggests a hormone-secreting testicular tumour, or in Klinefelter syndrome.

  7. 07

    Preparing

    Specialist referral

    Endocrinology for hormonal causes and plastic surgery for refractory, cosmetic or psychosocial disease.

Typical timeline: a first consultation to a settled plan in a few weeks.

Symptoms

What gynaecomastia actually feels like.

The classic subareolar disc, the pattern of tenderness, and the features that mean it is time to investigate more urgently.

  • Subareolar disc

    A firm, rubbery, mobile ridge of glandular tissue directly under the nipple - the hallmark of true gynaecomastia.

  • Tenderness in early phase

    Newer lesions often feel sore or sensitive; longstanding tissue is usually painless and fibrotic.

  • Bilateral, often asymmetric

    Both sides commonly involved but rarely identical in size - asymmetry does not automatically mean cancer.

  • Unilateral or hard lump

    A one-sided, hard, fixed or irregular mass needs mammography or ultrasound to exclude male breast cancer.

  • Pseudogynaecomastia

    Soft, diffuse fatty enlargement without a glandular disc - common with weight gain and treated differently.

  • Hormonal features

    Low libido, erectile difficulty, small testes or reduced body hair point to hypogonadism as the driver.

  • Psychosocial impact

    Cosmetic and confidence effects are real, particularly in adolescence - and are a legitimate reason to seek help.

  • Red flag features

    Rapid growth, nipple discharge, skin change, fixed mass, or systemic symptoms need urgent review.

Treatment

How gynaecomastia is treated in the UK.

Treat the cause first, consider a SERM early, and refer for specialist surgery when the tissue is persistent, cosmetic or refractory.

  • Treat the underlying cause

    Stop or switch an offending medication, treat thyroid or liver disease, and replace testosterone in confirmed hypogonadism.

  • Watchful waiting

    Pubertal gynaecomastia usually resolves over one to two years - reassurance and review beat rushing to treat.

  • Tamoxifen

    A selective oestrogen receptor modulator used off-label - most effective within the first 12 months of onset.

  • Raloxifene

    An alternative SERM with a similar mechanism, sometimes used when tamoxifen is not tolerated.

  • Aromatase inhibitor

    Anastrozole is less effective than a SERM but occasionally considered in specific hormonal contexts.

  • Liposuction and lipo-excision

    Best for pseudogynaecomastia and fatty-predominant cases - contours the chest without removing glandular tissue.

  • Subcutaneous mastectomy

    Open or endoscopic removal of glandular tissue for persistent or refractory true gynaecomastia - specialist plastic surgery.

  • Multidisciplinary care

    Endocrinology, plastic surgery and psychology working together for the best cosmetic and hormonal outcome.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, endocrinologist or plastic surgeon knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • Endocrine Society. Clinical practice guideline on gynaecomastia evaluation and management.

  • British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). Guidance on male chest surgery.

  • NICE Clinical Knowledge Summary. Gynaecomastia.

  • MHRA. Drug safety updates relevant to antiandrogens, spironolactone and finasteride.

Red flags

When gynaecomastia needs urgent attention.

Most gynaecomastia is benign. These are the situations that are not - and where a specialist opinion is needed quickly.

  • Unilateral hard fixed mass

    Any one-sided, firm, irregular or immobile breast lump needs urgent imaging to rule out male breast cancer.

  • Nipple discharge or skin change

    Bloody discharge, retraction, dimpling or ulceration deserves same-week specialist assessment.

  • Rapid growth over weeks

    Quick enlargement in an adult man raises concern for a hormone-secreting tumour or malignancy.

  • Testicular mass or asymmetry

    A palpable testicular lump alongside breast tissue can signal an hCG or oestrogen-secreting testicular tumour.

  • Klinefelter syndrome

    Small firm testes, tall stature and infertility should prompt karyotyping - and lifelong breast cancer awareness.

  • Anabolic steroid use

    Non-prescribed androgens aromatise to oestrogen and drive gynaecomastia - honest disclosure changes management.

  • Systemic illness

    New gynaecomastia alongside jaundice, ascites, weight loss or fatigue needs a full liver, kidney and thyroid workup.

  • Adolescent distress

    Persistent low mood, avoidance or bullying deserves supportive care alongside a clinical plan - not dismissed as vanity.

  • BRCA family history

    A strong family history of breast or ovarian cancer changes the threshold for imaging and genetic referral.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference - accurate perspective, patience with pubertal forms, honest disclosure, and asking for help early.

A quiet reminder

The right diagnosis unlocks the right treatment.

True and pseudo gynaecomastia respond to different plans - a careful clinical exam is worth more than any new supplement.

  1. 01 Perspective

    Most cases are benign

    Physiological gynaecomastia is common and often self-limiting - a clinical exam usually settles the biggest worry.

  2. 02 Patience

    Give pubertal forms time

    Around 75 to 90 per cent of pubertal cases resolve within one to two years without any treatment.

  3. 03 Honesty

    Disclose all substances

    Anabolic steroids, cannabis, alcohol and supplements matter clinically - your clinician needs the full picture.

  4. 04 Support

    Ask for help early

    If the impact on confidence is real, say so - surgery and psychological support are legitimate options.

Frequently asked

Everything we get asked about gynaecomastia.

Quick answers on causes, bloods, tamoxifen and surgery.

  • What is gynaecomastia?

    Benign enlargement of the glandular breast tissue in men, felt as a firm rubbery disc under the nipple. It is distinct from pseudogynaecomastia, which is fatty tissue only. Up to half of adult men experience it at some point across the physiological peaks of infancy, puberty and older age.

  • What causes it in adults?

    The three big categories are medications (spironolactone, antiandrogens like finasteride and bicalutamide, digoxin, cimetidine, some antipsychotics and PPIs), hormonal imbalance (hypogonadism, hyperthyroidism, hyperprolactinaemia and hormone-secreting tumours) and systemic illness (cirrhosis, kidney failure, malnutrition). Anabolic steroids, cannabis and alcohol are also common drivers.

  • Could it be breast cancer?

    Male breast cancer is rare but real, particularly with Klinefelter syndrome or BRCA mutations. Warning features are a unilateral, hard, fixed or irregular lump, nipple discharge, skin change or a family history. Any of these deserves prompt imaging with mammography or ultrasound.

  • Do I need blood tests?

    Usually yes when the cause is not obvious. A standard panel includes morning fasting testosterone, LH, FSH, oestradiol, prolactin, TSH, liver and kidney function. Beta hCG and AFP are added if a hormone-secreting testicular tumour is possible.

  • Will it go away on its own?

    Neonatal and pubertal forms usually resolve without treatment - most pubertal cases settle inside one to two years. Adult and drug-induced forms may resolve if the cause is treated within the first year, but longstanding fibrotic tissue rarely regresses without surgery.

  • What are the surgical options?

    Two main approaches, often combined. Liposuction or lipo-excision handles fatty predominant tissue and is enough for pseudogynaecomastia. Subcutaneous mastectomy - open or endoscopic - removes glandular tissue for true, persistent or refractory cases and is done by a specialist plastic surgeon.

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