Private gynaecomastia clinic in London, same-day men's health.

True gynaecomastia or fat?

True gynaecomastia is firm, rubbery glandular tissue felt as a disc directly beneath the nipple, often tender. Pseudogynaecomastia is fatty tissue without a distinct disc, related to weight, and improves with weight loss. The distinction matters because they respond to entirely different things — losing weight will not shift glandular tissue, and no amount of chest exercise removes either.

Common causes

• Puberty — affects most boys, usually settles within one to two years without treatment.
• Older age, with falling testosterone and rising body fat.
• Medicines — spironolactone, finasteride and dutasteride, cimetidine and omeprazole, some antipsychotics and antidepressants, calcium channel blockers, and treatments for prostate cancer.
• Anabolic steroids and testosterone — a very common cause in gym users, and often the reason for presentation.
• Alcohol and cannabis; opioids.
• Liver disease, kidney disease, an overactive or underactive thyroid.
• Low testosterone from any cause, and rarely hormone-secreting tumours.

What assessment involves

• Examination of the breast tissue, and of the testicles — which should always be part of it.
• Blood tests: testosterone, LH, FSH, oestradiol, prolactin, hCG, liver, kidney and thyroid function.
• Review of every medicine, supplement and substance.
• Ultrasound where the tissue is asymmetric or a lump is felt, and mammography in some cases.
• Testicular ultrasound if the examination raises any question.

Treatment

• Treat the cause — stop or switch the responsible medicine where possible, reduce alcohol, correct thyroid or testosterone problems. This alone resolves many cases if done early.
• Medication such as tamoxifen can reduce recent, tender gynaecomastia, and is most effective within the first year.
• Surgery — removal of the glandular disc, with or without liposuction — is the definitive treatment for established tissue, and is the only thing that works once it has become fibrous.
• Weight loss helps pseudogynaecomastia and improves the result of any surgery.