Get Rid of Low-T, Get Rid of Man Boobs?

Key Points

• Man boobs, sometimes referred to as "moobs," can result from a number of different complications.
• One of the most common causes is a hormonal imbalance. Lower levels of testosterone and higher levels of estrogen—yes, men have that—may often be responsible.
• There are a handful of ways to get rid of your man boobs, though, depending on the underlying cause.

If there's one area of medical science in which accurate information has been overwhelmed with misinformation, it may well be the facts about low testosterone.

It seems like everywhere you turn, there's another ad for some dubious potion or powder meant to "boost your T levels."

Phony solutions aside, some common side effects of testosterone deficiency that men fear, such as muscle loss, excess body fat and enlarged breasts, can be very real.

We'll take a closer look at this last phenomenon in particular, the dreaded man boobs or "moobs," how they do and do not relate to hormone imbalances in older men and what you can do about it.

What is Testosterone Deficiency Syndrome (TDS)?

While it's tempting to characterize older men who fear they may have low testosterone as foolishly trying to escape the effects of aging, testosterone deficiency syndrome (TDS) is a real clinical condition that can have major consequences on multiple organ systems.

Hormone levels are typically kept in a tightly regulated balance. In a complex chain of events originating in the hypothalamus deep in the brain, male hormonal signals are sent first to the pituitary gland and then to the testicles, instructing them on how much testosterone to produce. Any glitch along this chain can lead to low testosterone, which can have major side effects, including the following:

• Low sperm count
• Reduced sex drive
• Erectile dysfunction (ED)
• Shrinking testicles
• Unwanted breast growth, or gynecomastia
• Loss of pubic and armpit hair
• Loss of muscle mass
• Increased body fat
• Fatigue
• Depression
• Difficulty with concentration
• Mood swings

But TDS isn't just a general feeling that you want more muscle mass, sex drive or energy. According to the American Urological Association's (AUA) guidelines, it's a clinical diagnosis consisting of:

• Two total testosterone level tests on separate occasions, taken in the early morning
• The resulting total testosterone levels are 300 nanograms per deciliter (ng/dL) or lower

Even with these benchmarks, TDS can only be diagnosed if the patient has some of the symptoms listed above.

Recommended

• Please Stop Believing These Gynecomastia Inaccuracies: No, 'man boobs' don't just develop as a result of being overweight.
• The Direct and Indirect Ways Gynecomastia Is Tied to Erectile Dysfunction: When male breast tissue proliferates, erectile dysfunction can result. The reasons are complex.
• 5 Things Every Man Should Know About Male Breast Cancer: With so much focus on breast cancer in women, too many cisgender men aren't aware of the risks.

Are man boobs a common side effect of low testosterone?

Another common misconception regarding hormone levels and testosterone replacement therapy (TRT) is that testosterone is strictly a male hormone, while estrogen is strictly a female one.

In fact, people of all genders produce both testosterone and estrogen, just at different levels. The body is designed to regulate these levels and calibrate how much of each hormone to produce to keep them in a careful balance.

"There are many causes of 'man boobs,' one of which is low-T," said Scott D. Miller, M.D., a urologist and the medical director of Wellstar Urology in Atlanta.

"Although men with low-T can develop man boobs, it certainly does not occur in all cases. It's all about the balance of testosterone and estrogen," Miller said. "When the testosterone levels are low, the estrogen can have an impact, such as increasing breast tissue."

The delicate dance between hormone levels illustrates how foolish it is for men to take anabolic steroids without medical supervision or without an actual testosterone deficiency. It's more complicated than it might appear at first glance—including the twist that some testosterone is converted into estrogen via an enzyme called aromatase.

"When I evaluate men presenting with concerns for gynecomastia, I recommend testosterone, estrogen and prolactin testing," said Amy Pearlman, M.D., a men's health specialist and co-founder of Prime Institute in Fort Lauderdale, Florida.

"When men present with gynecomastia only and elevated estrogen without concomitant symptoms of low testosterone like reduced energy, fatigue, cognitive dysfunction, mood changes, erectile dysfunction or low libido, I will consider a low dose aromatase inhibitor to reduce the conversion of testosterone to estrogen," she said. "I've had several patients report improvement in their gynecomastia with this treatment."

What is the gynecomastia pinch test?

What we refer to as man boobs may just be excess fat that may not have anything to do with a hormone imbalance. True gynecomastia, on the other hand, may develop from hormone imbalances and results in the appearance of gland tissue beneath the nipple.

One way healthcare providers can differentiate between the two is called the pinch test. They may ask you to lie on your back with your shirt off and then gently feel the area under and around your nipple.

If they detect a firm, rubbery, disk-shaped mass, it could indicate breast gland tissue and true gynecomastia. But, if there's only spongy soft tissue, this indicates the presence of fat only.

"The most common cause of man boobs is excess fat," Miller said. "However, there are multiple medical conditions and meds that can cause them as well. See your physician immediately for sudden onset of man boobs or growth that occurs only on one side or significantly more on one side, if you have any nipple discharge, bleeding, or pain, or if there is firmness or a nodule in the breast or nipple."

What can you do to get rid of moobs?

There are multiple ways to get rid of man boobs. Some are simple enough to do on your own, while others could require some help from a physician.

Testosterone booster

Some men with low-T may develop gynecomastia, but as we've discussed, this is a tricky balancing act. Only men who receive a clinical diagnosis of low testosterone should consider TRT, and they should only receive it under the supervision of a qualified healthcare provider.

Cardio exercise

"Many men preferentially gain fat tissue in breasts, love handles and belly," Miller said. "These are also the last areas that trim down during weight loss. The best way to turn the tables is with a modest calorie deficit, high-volume zone 2 cardio and one or two high-intensity cardio sessions per week."

Resistance training

Resistance training, Miller said, is crucial to raising your lean body tissue or muscle, but keep in mind that spot reduction, or trying to lose fat in one specific area of the body, isn't a real thing.

As you build more lean tissue and keep up with your cardio and caloric deficit, you'll gradually lose fat and build muscle.

Liposuction surgery

In certain severe cases of gynecomastia, liposuction or even a mastectomy might be called for to remove excess breast tissue.

Swap medication

Certain medications and recreational drugs can potentially cause man boobs. These medications include the following, according to Mayo Clinic:

• Anti-androgens to treat prostate conditions
• Anabolic steroids
• Certain AIDS medications
• ADHD medications, such as Adderall
• Anti-anxiety medications, such as diazepam
• Tricyclic antidepressants
• Antibiotics
• Ulcer medications, such as Tagamet
• Chemotherapy
• Certain heart medications
• Marijuana
• Alcohol
• Heroin
• Amphetamines
• Methadone

Will exercise turn man boobs into muscle?

Muscle cells and fat cells are two different things. When you reduce caloric intake, build muscle and increase cardio, your body breaks down some of your fat in order to use it as fuel.

If you do some resistance training at the same time, your body's increased skeletal muscle—which is more metabolically active than fat—burns more fuel, even when you're at rest.

You won't make moobs go away in a day, but yes, exercise can turn man boobs into muscle, gradually, but not directly or by spot reduction.

What other health conditions can cause male breast growth?

Remember how complex the chain of events is that leads to testosterone production? There are numerous conditions and things that can go wrong along the way that can lead to gynecomastia, such as the following:

• Hypogonadism (low-T). Pituitary problems and conditions such as Klinefelter syndrome can cause lower testosterone production, resulting in gynecomastia.
• Aging and obesity.
• Tumors. Testicular or pituitary tumors can affect hormone production.
• Hyperthyroidism. This condition involves the thyroid producing too much of the hormone thyroxine and may result in gynecomastia.
• Kidney failure.
• Liver failure and cirrhosis.
• Malnutrition and starvation. Poor nutrition can cause testosterone levels to drop while estrogen levels remain the same, sometimes resulting in gynecomastia.

The bottom line

There are many reasons why men might develop man boobs, or gynecomastia. Only a healthcare provider can tell you why you might have it.

However, any sudden growth, discharge, bleeding, pain or hardness around your nipples should warrant a prompt doctor visit.

Moobs are not destiny. There are options for dealing with the problem, depending on the cause—but you'll need medical evaluation first.