Gynecomastia Classification and Grading
Posted February 18, 2026 in Services for Men by Josef Hadeed, MD
Do you have “man boobs?” While they’re often made fun of, the reality is that having excess breast tissue as a man can be an embarrassing, confidence-crushing concern. While the culprit could be extra fat, it could also be a medical condition known as gynecomastia. Gynecomastia is more common than many people realize, yet it’s often misunderstood or dismissed as a simple weight issue. In this blog, we’ll go over what gynecomastia is, how doctors classify its severity, and available treatment options to help you determine your next steps.
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Understanding Gynecomastia and Breast Tissue
Gynecomastia is a diagnosable medical condition characterized by the enlargement of glandular tissue in the male breast. The root cause of this breast enlargement is a hormonal imbalance between estrogen and testosterone, often due to decreased testosterone production or testosterone secretion, increased estrogen activity, or both. This imbalance can result from a variety of medical or lifestyle factors, including conditions such as liver disease, kidney (renal) failure, and hyperthyroidism, which disrupt hormone levels.
Unlike excess chest fat (pseudogynecomastia), true gynecomastia involves an increase in glandular tissue that cannot be resolved with diet or exercise alone. Pseudogynecomastia is commonly associated with obesity and can be differentiated from gynecomastia by physical examination, as gynecomastia presents with a soft, compressible, and mobile mass under the nipple, while pseudogynecomastia is primarily excess fat tissue.
Gynecomastia is extremely common, affecting up to 65% of adolescent males and approximately 30–40% of adult men at some point in their lives. It can develop during puberty (adolescent gynecomastia), adulthood, or later in life and may be influenced by genetics, medications (including drug-induced gynecomastia), medical conditions, or natural hormonal changes.
Men can develop gynecomastia due to androgen deficiency, estrogen excess, or increased sensitivity of breast tissue to hormones. Prostate cancer patients may develop gynecomastia as a side effect of certain treatments. The risk of breast cancer is increased in men with gynecomastia, especially those with Klinefelter syndrome or other risk factors. While lifestyle and medication adjustments can occasionally address mild cases, more severe cases may require gynecomastia surgery to correct.
Gynecomastia Diagnosis and Evaluation
When a man experiences breast enlargement in one or both breasts, a careful and comprehensive diagnosis is essential to determine the underlying cause and guide the most effective treatment for gynecomastia. The evaluation process not only helps confirm the presence of true glandular breast tissue but also rules out more serious conditions, such as male breast cancer, that can sometimes present with similar symptoms.
The first step to diagnose and treat gynecomastia involves a detailed medical history. During your consultation, Dr. Josef Hadeed will ask about any medications you are taking, as some medications can be associated with gynecomastia. He will also inquire about substance use, family history of breast cancer, and any symptoms such as breast pain, nipple discharge, or changes in the skin over the breast tissue.
A physical exam will also be included in your consultation, during which Dr. Hadeed will assess the size, consistency, and location of the breast tissue. The presence of firm, irregular, or fixed masses may prompt further investigation to rule out male breast cancer.
Laboratory tests can be ordered to evaluate hormone levels to identify any hormonal imbalance that could be causing breast tissue proliferation. Additional tests may be performed to assess liver and kidney function, as chronic liver disease and chronic kidney disease are both associated with gynecomastia.
Ultimately, diagnosing and evaluating male gynecomastia requires a personalized approach that considers all possible contributing factors. By working closely with a knowledgeable healthcare provider like double board-certified plastic surgeon Dr. Hadeed, men can receive an accurate diagnosis and a tailored treatment plan—whether that involves medical treatment, surgical therapy such as gynecomastia surgery, or addressing underlying health issues—to restore comfort, confidence, and peace of mind.
How Does the Gynecomastia Grading System Work?
Gynecomastia is classified into grades used to describe how much breast tissue is present, how far it extends across the chest, and whether excess skin or sagging has developed. As the grade increases, the condition becomes more visible and more emotionally and physically impactful. Chronic gynecomastia refers to cases that have persisted for more than six months, often characterized by fibrotic, less tender breast tissue that is less responsive to medical therapy and may require surgical intervention. If gynecomastia does not resolve within two years, or if it causes embarrassment, pain, or tenderness, treatment is warranted. The gynecomastia grading system allows doctors to determine whether your condition may resolve on its own, respond to medical management, or require surgery to achieve optimal results.
What Are the Grades of Gynecomastia?
Grade 1 Gynecomastia
Grade 1 gynecomastia is the earliest and mildest stage of the condition. It involves a small amount of excess breast tissue growth that is typically limited to the area directly beneath the areolas. At this stage, your chest will still have a normal masculine contour, and any breast enlargement will not be noticeable through your clothing.
This stage of gynecomastia can develop due to temporary hormonal fluctuations (including puberty), certain prescription medications, or underlying health conditions. In some cases, no clear cause can be identified. Because Grade 1 gynecomastia may resolve on its own, treatment is not always necessary. However, if you choose to treat at this stage, your options may include hormone-regulating medications, targeted liposuction, or surgical removal of glandular tissue.
Grade 2 Gynecomastia
Grade 2 gynecomastia involves a moderate increase in glandular breast tissue, with enlargement extending beyond the areolas but remaining within the natural borders of your chest. The breast bud typically measures up to two centimeters in diameter, making the condition more visible, especially in fitted clothing or while shirtless.
Men with Grade 2 gynecomastia may experience breast tenderness, sensitivity, and reduced self-esteem, especially if they are adolescents. Treatment for this stage of gynecomastia may include medication aimed at reducing breast tissue growth. However, surgical excision is usually recommended to restore a flatter, more masculine chest shape if the tissue doesn’t respond or continues to grow.
Grade 3 Gynecomastia
If you have Grade 3 gynecomastia, you have likely noticed a pronounced increase in the size of your chest combined with noticeable excess skin. Your chest may look more feminine, and the nipple-areola complex may be drooping lower on your chest. Skin laxity and sagging are both prominent at this stage.
This level of gynecomastia can significantly affect your daily life, causing physical discomfort, interfering with physical activity, and making it difficult to find clothing that fits properly. Emotionally, it is common to experience embarrassment or lack of confidence. Treatment for Grade 3 gynecomastia almost always involves surgery, combining the removal of excess breast tissue with skin excision. Liposuction may also be used to further restore your masculine chest contour.
Grade 4 Gynecomastia
Grade 4 gynecomastia is the most advanced and severe form of the condition. At this stage, the excess glandular tissue is heavy, causing your breasts to hang below the natural breast crease, and significant sagging skin is present. The nipples have also moved downward and often point toward the floor.
At this stage of gynecomastia, men frequently experience chronic discomfort, reduced physical mobility, and a profound impact on their self-esteem. Surgical intervention is necessary and may involve a mastectomy-style approach, as well as skin removal, liposuction, and nipple repositioning. Dr. Hadeed often combines multiple techniques to restore a more balanced, masculine chest contour in his gynecomastia patients.
Does Non-Surgical Treatment Work For Gynecomastia?
Non-surgical treatments may help address early or temporary cases of gynecomastia, especially if you are categorized as Grade 1 or as a mild Grade 2. Pubertal gynecomastia often resolves on its own within several months to two years as adolescent hormone levels stabilize. If your gynecomastia is drug-induced or hormonally driven, discontinuing use of anabolic steroids, alcohol, recreational drugs, or adjusting certain medications may resolve the issue. However, it’s best to talk to an experienced surgeon (like Dr. Hadeed) to ensure that you treat gynecomastia in the safest, most effective way. For persistent or severe cases, male breast reduction is a surgical option that can provide effective and lasting results.
Schedule Your Gynecomastia Surgery Consultation in Beverly Hills
If you’re struggling with gynecomastia and want to restore a more masculine chest contour and reclaim your confidence, it’s time to schedule a consultation with Dr. Josef Hadeed. To understand your gynecomastia classification and learn about your treatment options, make an appointment today by calling (310) 970-2940 or requesting a consultation online.
