Treatment Options for Gynecomastia

Gynecomastia is a common condition that causes enlargement of breast tissue in males. It can occur during puberty, but it also develops in adulthood due to hormonal imbalances, medications, medical conditions, or lifestyle factors. For many men, the condition leads to self-consciousness, physical discomfort, and concerns about what may be happening internally.

The good news is that gynecomastia is often treatable once the underlying cause is identified. Dr. Kehinde Folawewo, MD, a double board-certified endocrinologist at Hilltop Internal Medicine & Endocrinology in Oxon Hill, specializes in diagnosing and treating the hormonal causes of gynecomastia. The most effective treatment depends on age, hormone levels, medical history, symptom severity, and the amount of breast tissue present. Knowing the available options helps patients make informed decisions before their first medical visit.

 

What Is Gynecomastia?

Gynecomastia refers to the enlargement of glandular breast tissue in males, which is different from a buildup of chest fat. The tissue typically feels firm and is concentrated around the nipple rather than spreading evenly across the chest.

The condition most commonly affects adolescent males during puberty, when hormone levels shift temporarily. It can, however, develop at any age and may persist into adulthood if the cause goes unaddressed.

A medical evaluation is the right starting point. It confirms whether the enlargement is true gynecomastia, rules out other conditions, and guides the decision on whether treatment is needed.

 

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What Causes Gynecomastia?

Gynecomastia develops when the balance between testosterone and estrogen shifts in a way that allows breast tissue to grow. Identifying the root cause is critical because treatment success depends on addressing what triggered the condition.

Hormonal Imbalances

Hormonal causes are among the most common drivers:

• Testosterone deficiency (hypogonadism): When testosterone levels drop, estrogen’s effects on breast tissue become more pronounced. Low testosterone can stem from aging, testicular disease, pituitary disorders, or metabolic conditions.
• Elevated estrogen levels: Excess estrogen promotes breast tissue growth. This may result from increased estrogen production, reduced estrogen breakdown, or conditions that heighten estrogen sensitivity.
• Hormonal fluctuations: Temporary imbalances during puberty or aging can trigger gynecomastia. In adolescents, the condition often resolves as hormone levels stabilize.

Medications

Certain medications can cause or worsen gynecomastia by disrupting hormone balance. Common examples include:

• Blood pressure medications such as spironolactone, verapamil, and ACE inhibitors
• Anti-androgens prescribed for prostate conditions
• Some psychiatric medications, including antipsychotics and antidepressants
• Anabolic steroids and testosterone supplements
• Opioids and certain cancer treatments

Medical Conditions

Several underlying health conditions raise the risk of gynecomastia:

• Thyroid disorders: Both hyperthyroidism and hypothyroidism can disrupt hormone metabolism. Hashimoto’s thyroiditis and Graves’ disease are common contributors.
• Hypogonadism: Conditions that impair testosterone production, including pituitary disorders and metabolic syndrome, frequently cause gynecomastia.
• Liver disease: Cirrhosis and hepatitis impair the liver’s ability to clear estrogen, leading to hormonal buildup.
• Kidney disease: Reduced kidney function affects hormone metabolism and can trigger imbalances.
• Pituitary disorders: Prolactinomas and other pituitary tumors disrupt the hormonal signals that regulate breast tissue.

Lifestyle Factors

Behavioral and environmental factors also play a role:

• Alcohol use: Chronic drinking damages the liver, lowers testosterone production, and raises estrogen levels.
• Substance use: Marijuana, cocaine, and anabolic drug use can alter hormone balance.
• Weight gain: Excess body fat converts androgens to estrogen through adipose tissue, which can trigger or worsen gynecomastia.

For a broader look at the hormonal mechanisms involved, the National Institutes of Health (NIH) provides a detailed clinical overview at NCBI Bookshelf: Gynecomastia: Etiology, Diagnosis, and Treatment.

 

Why an Endocrine Evaluation Matters

Many men consider surgery before exploring whether a hormonal or medical cause is responsible. An endocrine evaluation from a specialist like Dr. Kehinde Folawewo, MD, often reveals a treatable condition that surgery alone would not fix.

Identifying the Underlying Hormonal Cause

A detailed medical history and physical examination help uncover what triggered the condition. Questions about medications, family history, symptoms, and lifestyle narrow down the most likely causes.

Comprehensive Lab Testing

Blood tests measure testosterone, estrogen, prolactin, thyroid hormones, and related markers. These results surface hormonal imbalances that may not be obvious from symptoms alone. Testing also screens for thyroid disease, liver dysfunction, kidney disease, and pituitary disorders.

Hormone Assessment and Personalized Treatment

A complete hormone panel identifies whether low testosterone, elevated estrogen, or another imbalance is responsible. That information shapes a treatment plan built around the individual’s specific results and medical history. Some patients benefit from medication adjustments or hormone therapy; others may need surgery only after medical options have been fully explored.

Determining Whether Treatment Is Necessary

Gynecomastia can sometimes be a symptom of an underlying endocrine disorder that requires its own management. An evaluation determines whether active treatment is medically necessary or whether watchful waiting is the safer approach. This distinction is especially important in younger patients whose gynecomastia may resolve on its own.

 

Treatment Option 1: Observation and Monitoring

Not every case of gynecomastia requires active treatment. Watchful waiting is appropriate in several situations.

• Pubertal gynecomastia: Adolescent males commonly develop temporary breast enlargement as testosterone levels fluctuate during puberty. In most cases, the condition resolves within one to two years without intervention.
• Mild cases: Minimal enlargement that causes no pain, tenderness, or emotional concern may not need treatment. Some men prefer to monitor the situation rather than pursue medical or surgical options.
• Temporary hormonal changes: If gynecomastia followed a specific event such as a medication change, weight gain, or illness, observation may show whether it improves once the trigger is addressed.

An endocrinologist can determine whether observation is safe or whether evaluation for an active medical condition is warranted.

 

Treatment Option 2: Treating the Underlying Cause

This is often the most effective and least invasive path forward. When the root cause is identified and treated, gynecomastia frequently improves or clears entirely.

Adjusting Medications

If a medication is responsible, the physician may reduce the dose, switch to an alternative, or stop the drug when medically appropriate. This approach works well for patients whose gynecomastia appeared after starting a new prescription.

Treating Thyroid Disorders

Both hypothyroidism and hyperthyroidism raise the risk. Treating the thyroid condition with appropriate medications often leads to gradual improvement in breast tissue over time.

Managing Testosterone Deficiency

Men with documented low testosterone may benefit from testosterone replacement therapy under medical supervision. Restoring normal testosterone levels can reduce the relative influence of estrogen on breast tissue.

Addressing Hormonal Imbalances and Weight

When testing confirms elevated estrogen or another hormonal imbalance, medications that block estrogen’s effects or support testosterone levels may be considered. Weight loss reduces overall body fat, which lowers estrogen production. For men whose gynecomastia is linked to excess weight, even a modest reduction can produce noticeable improvement.

 

Treatment Option 3: Medical Therapy

When observation and lifestyle changes are not enough, medications may help reduce breast tissue growth or slow its progression.

When Medications May Be Considered

Medical therapy tends to work best early in the condition’s development, when breast tissue is still responsive to hormonal changes. Established fibrotic tissue typically does not shrink with medication alone, which is why early evaluation matters.

Hormone-Based Treatment Approaches

Medications that block estrogen activity or support testosterone levels may be prescribed based on hormone test results and the underlying cause. These approaches require individualized assessment and regular monitoring. No specific medication should be started without a physician’s evaluation.

Research published through the National Library of Medicine supports treating the underlying cause first, with medical therapy reserved for persistent cases before surgery is considered.

 

Treatment Option 4: Lifestyle Modifications

Lifestyle changes support hormonal health and can improve gynecomastia, especially when combined with medical treatment. They are rarely sufficient on their own to resolve established glandular tissue, but they matter as part of a broader plan.

• Weight loss: Reducing excess body weight decreases estrogen production and improves overall hormone balance.
• Exercise: Regular physical activity, particularly strength training, supports testosterone levels and helps maintain a healthy weight.
• Nutrition: A diet built around whole foods limits inflammation and supports normal hormone metabolism.
• Reducing alcohol: Limiting or stopping alcohol intake improves liver function and helps restore testosterone levels.
• Avoiding hormone-altering substances: Stopping the use of marijuana, anabolic steroids, and similar substances often leads to gradual improvement in hormone balance.

Lifestyle modifications alone rarely eliminate established gynecomastia, but they support the effectiveness of medical treatment and help prevent the condition from progressing.

 

Treatment Option 5: Gynecomastia Surgery

Surgery addresses breast tissue that has not responded to medical treatment or lifestyle changes. It is appropriate when gynecomastia is persistent, causes significant distress, or has not improved after the underlying cause has been treated.

When Surgery May Be Appropriate

A surgical consultation is typically considered when medical treatment has been tried without adequate improvement, hormonal causes have been identified and managed, breast tissue remains enlarged despite lifestyle changes, or the condition causes ongoing physical discomfort or psychological distress.

Persistent and Fibrotic Breast Tissue

Fibrotic, long-standing breast tissue often does not respond to medication. In those cases, surgical removal may be the only option to achieve a meaningful reduction.

The Importance of Pre-Surgical Endocrine Evaluation

Before scheduling surgery, patients should complete a comprehensive endocrine evaluation to confirm that no treatable hormonal cause has been missed. Surgery removes tissue, but it does not address a hormonal imbalance that may cause the condition to return.

 

Gynecomastia vs. Pseudogynecomastia

Understanding the difference matters because treatment approaches vary significantly between the two conditions.

 

Feature	Gynecomastia	Pseudogynecomastia
Tissue Type	Glandular breast tissue	Fatty tissue
Primary Cause	Hormonal imbalance	Excess body weight
Location	Around the nipple area	Spread across the chest
Texture	Firm, defined	Soft, diffuse
Hormonal Involvement	Common	Minimal
Treatment Approach	Hormone evaluation and medical therapy	Weight loss and lifestyle changes
Responds to Weight Loss	Variable	Usually improves
May Need Surgery	Yes, if medical treatment fails	Less common

 

True gynecomastia requires medical evaluation to identify hormonal causes. Pseudogynecomastia often improves with weight loss but can still benefit from lifestyle changes and exercise.

 

When Should Men See an Endocrinologist?

Certain symptoms and situations call for a prompt evaluation by a hormone specialist.

• Sudden breast enlargement: Rapid onset over weeks or months suggests an acute hormonal change or medication effect that needs investigation.
• Breast pain or tenderness: Active inflammation or tenderness in breast tissue often signals a hormonal change worth evaluating.
• Hormonal symptoms: Fatigue, reduced sex drive, erectile dysfunction, mood shifts, or unexplained weight changes alongside gynecomastia may indicate an underlying hormonal problem.
• Symptoms of low testosterone: Reduced energy, muscle loss, or mood changes combined with gynecomastia are strong indicators of hypogonadism.
• Persistent gynecomastia: Breast enlargement lasting more than two years in an adult warrants an endocrine evaluation to rule out ongoing medical conditions.
• Recent medication changes: If gynecomastia appeared after starting a new drug, prompt evaluation can determine whether the medication is the cause and whether alternatives exist.

Why Choose Hilltop Internal Medicine & Endocrinology?

Hilltop Internal Medicine & Endocrinology, led by Dr. Kehinde Folawewo, MD, takes a thorough, evidence-based approach to gynecomastia. Rather than defaulting to surgery, the practice focuses on understanding what caused the condition in the first place.

• Comprehensive hormone evaluations: Dr. Folawewo conducts detailed hormone testing and physical assessments to identify the root cause, so treatment targets the problem rather than just the symptom.
• Endocrine expertise: As a double board-certified endocrinologist with fellowship training, Dr. Folawewo has hands-on experience diagnosing and managing complex hormonal disorders, including hypogonadism, thyroid disease, and pituitary conditions that contribute to gynecomastia.
• Personalized treatment plans: No two patients are alike. Treatment is built around each person’s hormone levels, medical history, and goals, whether that means medication adjustments, hormone therapy, or lifestyle changes.
• Root-cause approach: Hilltop Internal Medicine & Endocrinology investigates why gynecomastia developed rather than jumping to cosmetic solutions. This reduces the chance of recurrence and often eliminates the need for surgery.
• Patient-centered care: Dr. Folawewo takes time to listen, explain findings clearly, and work through options at a pace that suits each patient. Flexible appointment options include telemedicine consultations, and the practice accepts Medicare, most private insurance plans, and self-pay patients.
• Convenient Oxon Hill location: The office is at 6130 Oxon Hill Road, Suite 204, with dedicated parking, no stairs, and easy highway access. Hours run Monday through Saturday, 9 AM to 5 PM.

 

Schedule a Gynecomastia Evaluation Today

Breast enlargement, tenderness, or any concern about hormone-related symptoms deserves a proper evaluation, not a guess. A comprehensive endocrine assessment at Hilltop Internal Medicine & Endocrinology can identify the underlying cause and map out the most appropriate path forward.

Many cases of gynecomastia improve significantly once the hormonal imbalance, medication effect, or medical condition driving it is identified and treated. Surgery is one option, but it is rarely the only one. Dr. Kehinde Folawewo, MD, helps patients understand their condition fully before any decision is made.

To book an appointment, call 240-752-0307 or visit Hilltop Internal Medicine and Endocrinology 

Taking the first step toward a proper diagnosis is the most important thing a patient can do.

Frequently Asked Questions

Can gynecomastia go away on its own?

Pubertal gynecomastia often resolves naturally within one to two years as hormone levels stabilize. Adult-onset cases are less likely to clear without some form of intervention, though addressing the underlying cause, adjusting medications, or losing weight may lead to improvement.

What is the best treatment for gynecomastia?

The most effective treatment depends on what caused the condition. Identifying and treating hormonal imbalances, thyroid disease, or medication side effects typically produces the best results. Medical therapy and lifestyle changes support that process, while surgery is reserved for tissue that does not respond to medical options.

Can low testosterone cause gynecomastia?

Yes. When testosterone levels fall, estrogen’s effects on breast tissue become more dominant. Testosterone replacement therapy under medical supervision can improve gynecomastia in men with confirmed hypogonadism.

Can exercise get rid of gynecomastia?

Exercise helps with weight management and supports healthy hormone levels, which can improve gynecomastia in men where excess weight is a factor. It rarely eliminates true glandular gynecomastia without also addressing the underlying hormonal cause.

Do I need surgery for gynecomastia?

Surgery is not always the answer. Many cases improve with medical treatment, medication adjustments, or lifestyle changes. Surgery is typically considered only after medical options have been tried and breast tissue remains enlarged.

What tests are used to diagnose gynecomastia?

Blood tests measuring testosterone, estrogen, prolactin, thyroid hormones, and other markers help identify hormonal imbalances. Imaging such as ultrasound or MRI may be used to evaluate breast tissue and rule out other conditions. Additional testing is ordered based on initial results.

When should I see an endocrinologist?

Schedule an evaluation if gynecomastia appears suddenly, persists beyond two years, comes with pain or hormonal symptoms, or developed after starting a new medication. An endocrinologist can determine whether a hormonal imbalance or medical condition is responsible and recommend the appropriate next step.