Gynecomastia or commonly known as “man boobs” is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek words gyne meaning “woman” and mastos meaning “breast”. In practical terms, this means abnormally large breasts on men.

Approximately 50% of gynecomastia cases are due to drugs, the most common being high dose anabolic steroids (especially Sustanon). The least common from heart drugs (digoxin) and diuretics (furosemide) which accounts for 10% of cases.

The condition can occur physiologically in babies due to female hormones from the mother, in adolescence, and in the elderly. In adolescence and elderly it is an abnormal condition associated with disease or metabolic disorders. In adolescent boys the condition is often a source of distress, but for the large majority of boys the breast development shrinks or disappears within a couple of years.

The causes of common gynecomastia remain uncertain, although it has generally been as a result of an imbalance of sex hormones or the tissues response to hormones. Gynecomastia is not physically harmful, but in some cases can be an indicator of other more serious underlying conditions, such as testicular cancer. Growing glandular tissue, typically from some form of hormonal stimulation, is often tender or painful.

The condition may also be caused due to an imbalance of oestrogen (major female hormone) and androgen (major male hormone) effects on the breast, resulting in an increased or unopposed oestrogen action on breast tissue.


  • puberty
  • steroid abuse (“bitch tits”)
  • obesity
  • marijuana use
  • tumors
  • genetic disorders
  • chronic liver disease
  • side effects of many medications
  • castration
  • Klinefelter Syndrome
  • Gilbert’s Syndrome
  • ageing


FATTY BREASTS: Breast development can result from pure gland and or fat tissue however typically it is a combination of gland and fat. If it is only fat then it is called pseudogynecomastia or sometimes called “false gynecomastia”. This is often due to obesity whereby insulin interacts with an excess of sugars or certain carbohydrates. Diet and exercise can improve its appearance. Liposuction can remove the remainder of the fat to flatten and contour the breasts.

PURE GLANDULAR: In bodybuilders, this may be a result of the use of anabolic steroids (especially Sustanon). Excess testosterone levels from steroids is converted to oestrogen. Proper treatment of pure gynecomastia can be done only by excision of the gland. Surgical treatment of severe gynecomastia is performed through an aureola incision (cut around the nipple, see photo) so as to avoid extensive scarring. However, some scarring may be unavoidable when treating extreme cases of gynecomastia. Liposuction may be required to smooth the contours of the chest.

PUFFY NIPPLES: is the most common form of gynecomastia. This glandular tissue accumulation is concentrated under and around the areola. It can extend outside the areola forming a dome shaped appearance to the areola.

ADOLECSENT CONGENTITAL, HEREDITARY (BORN WITH IT): Gynecomastia is typically evident by the ages of 12 to 18 in boys. 30% to 60% of young boys suffer from large male breasts. As many as 30% may live with enlarged male breasts for the rest of their lives.

UNILATERAL (ONE SIDED): Unilateral gynecomastia occurs when only one breast is larger due to gynecomastia, the other breast is typically normal in both size and shape. Bilateral asymmetry occurs when gynecomastia is present in both breasts, each to a different degree.


Treating the underlying cause of the gynecomastia may lead to improvement in the condition. Treatment is usually medical or surgical. Medical treatment involves, oestrogen blockers such as Tamoxifen and Clomiphene, or aromatase inhibitors such as Letrozole, Arimadex are medical treatment options, although they are not universally approved for the treatment of gynecomastia. Surgery involves either glandular removal and or liposuction.


Puffy Nipples example

spot the scar