Gynecomastia
Gynecomastia refers to the benign enlargement of male breast tissue and can occur in men undergoing testosterone replacement therapy (TRT).
Although TRT is used to correct low testosterone levels, changes in hormonal balance — particularly increased oestradiol (estrogen) — may occasionally contribute to breast tissue sensitivity or enlargement.
It is important to note that much of the management advice for gynecomastia during TRT is based on clinical experience rather than definitive clinical trials.
Differentiating Gynecomastia from Fat Accumulation
One of the most common issues is distinguishing true gynecomastia from fat accumulation (pseudogynecomastia).
Gynecomastia involves glandular tissue growth beneath the nipple and typically feels firm or rubbery.
Fat tissue, by contrast, is soft and lacks glandular density.
Accurate identification requires a physical examination by a qualified doctor. Misdiagnosis can lead to unnecessary treatments — for example, using anti-estrogen medications when no true glandular enlargement exists.
Transient Chest Sensations
Some men on testosterone therapy experience temporary sensations in the chest area such as tingling, burning, or mild soreness.
These symptoms do not necessarily indicate gynecomastia and are often transient. Persistent swelling or the presence of a palpable, firm mass should prompt medical evaluation to rule out true glandular growth or other causes.
Use of Selective Estrogen Receptor Modulators (SERMs)
SERMs (e.g., tamoxifen or raloxifene) are sometimes used under medical supervision to help manage breast tenderness or early gynecomastia symptoms.
However, long-term or unsupervised use is not recommended. Potential side effects can include mood changes, depression, and an increased risk of blood clots.
These medicines should only be used for short-term, targeted management and under direct medical oversight. They are not a substitute for adjusting the underlying testosterone therapy.
Aromatase Inhibitors (AIs) and Their Limitations
Aromatase inhibitors (AIs), such as anastrozole, reduce the conversion of testosterone into oestradiol.
While they can be helpful in select cases, overuse or long-term reliance carries risks including:
Reduced HDL (“good”) cholesterol
Possible cardiovascular strain
Joint or tendon discomfort
To minimise these risks, doctors generally aim to maintain the lowest effective testosterone dose rather than relying heavily on AIs to control oestradiol levels.
Adjusting Testosterone Dosage and Injection Frequency
In some men, reducing the overall testosterone dose or using smaller, more frequent injections (“microdosing”) can help stabilise hormone levels and limit oestradiol fluctuations.
This approach should only be made following pathology review and medical guidance, as hormone balance is highly individualised.
Surgical Options
When gynecomastia is persistent, severe, or causes distress, surgical options may be discussed.
These include:
Liposuction – removes excess fatty tissue.
Mastectomy – removes glandular breast tissue.
Surgery is typically reserved for cases where medical adjustments or observation have not been effective.
Monitoring and Ongoing Care
Regular hormone testing, physical examination, and communication with your prescribing doctor are essential.
Early identification of changes in breast tissue allows timely adjustments to treatment and reduces the need for more invasive interventions.
This content is provided for educational purposes only and does not replace medical advice, diagnosis, or treatment.
All testosterone therapies and related management strategies should be prescribed and monitored by an AHPRA-registered doctor.
Responses to treatment vary; any concerns about breast tenderness, swelling, or changes in appearance should be discussed directly with a healthcare professional.