Can You Get Rid of Gyno Without Surgery?

Let’s get real: For a man, there’s nothing more unattractive than having gynecomastia, also known as “gyno”, “man boobs” or “b*tch tits”.

It cripples men to the point where they avoid dating or swimming in public pools.

But it’s no longer a rare condition: In Denmark alone, there is believed to be a 5-10x INCREASE in the incidence of gynecomastia between 1998 and 2017!

And based on comments left on medical forums, the men suffering from gyno are fully aware of how debilitating it can be to have an effeminate physique.

Yet there’s a silver lining in all of this: Gynecomastia can be safely treated and permanently eliminated if you follow a few key steps from start to finish while avoiding the mistakes made by 99% of men (and doctors). 

By the end of this article, you’ll know exactly how to get rid of gyno once and for all.

Helping me write this definitive guide on a growing men’s health issue is none other than world-renowned board-certified plastic surgeon Dr. Joseph Cruise based in Newport Beach, California. Having treated well over 5,000 patients with an extraordinarily high success rate (including yours truly), it would be a crime to call him anything less than the foremost subject matter expert on gynecomastia. 

I also have some experience in this matter as I’ve personally suffered from gynecomastia itself and had it fixed by Dr. Cruise.

Also, if you’re short on time and you want the Cliff Notes of this entire guide, please watch the two short summary videos below:

What Is Gynecomastia?

Much of what needs to be known about gynecomastia has already been written in The TOT Bible within Chapter 11, “Eliminating Gynecomastia Permanently”.

But I’ll tell you everything you need to know as succinctly as possible.

Gynecomastia can be defined as the over-development (i.e. swelling/enlargement) of male breast tissue that has been present for at least two years.

Or to put it more clinically:

“Gynecomastia is defined clinically as generalized enlargement of male breast tissue, with the presence of a rubbery or firm mass extending concentrically and symmetrically from the nipple, accompanied by histopathologically benign proliferation of glandular male breast tissue. It usually occurs bilaterally and is the most common breast condition in male”

(NOTE: This happens to females too but we’re going to focus exclusively on men for this article)

There are a wide variety of hormonal changes related to estrogen production that are responsible for this happening:

“Gynecomastia is a complex process resulting from many hormonal changes in the body. Estrogens strongly stimulate and androgens weakly inhibit mammary gland growth.

The imbalance between estrogen actions relative to androgen action at the level of breast tissue is believed to be the main etiology.

Various hypotheses have been put forth by a number of investigators explaining the etiology of gynecomastia, including: elevated estrogen levels; lowered free testosterone; abnormal testosterone-to-estrogen ratio; increased peripheral conversion of testosterone to estrogens by higher aromatase activity in periglandular fat and stroma; lower dehydroepiandrosterone sulfate-to-estrogen ratio; and altered local action or breast tissue sensitivity”

To be clear: We are specifically talking about an excess of breast gland tissue, NOT an excess amount of chest fat.

The latter case is what many experts refer to as “pseudogynecomastia”:

“Adipomastia, also known colloquially as fatty breasts, is a condition defined as an excess of skin and adipose tissue in the breasts without true breast glandular tissue. It is commonly present in men with obesity, and is particularly apparent in men who have undergone massive weight loss. A related/synonymous term is pseudogynecomastia.

The condition is different and should be distinguished from gynecomastia (“women’s breasts”), which involves true glandular breast development in a male. The two conditions can usually be distinguished easily by palpation to check for the presence of glandular tissue. Another difference between the conditions is that breast pain/tenderness does not occur in pseudogynecomastia.

Sometimes, gynecomastia and pseudogynecomastia are present together; this is related to the fact that fat tissue expresses aromatase, the enzyme responsible for the synthesis of estrogen, and estrogen is produced to a disproportionate extent in men with excessive amounts of fat, resulting in simultaneous glandular enlargement”

(Source)

For more info on the differences between these two conditions, I recommend reading the associated articles from Gynecomastia.org and CrazyBulk.

Gynecomastia can express itself at various stages of life including pre-puberty, puberty, and randomly at any age.

“In newborns, gynecomastia is caused by estrogen from the mother. Breast buds are common in baby boys. Breast buds tend to go away gradually by 6 months of age, but they can last longer in some babies.

In preteen boys, gynecomastia can also be caused by an estrogen-producing tumor. Breast buds are common during puberty. The buds may last up to 2 years, but they tend to go away within the first year.

In teen boys, gynecomastia is caused by the hormonal changes of puberty. Gynecomastia occurs in many boys during early puberty to middle puberty. It usually goes away within 6 months to 2 years.”

Despite gynecomastia being a non-life-threatening medical problem, it is treated with a “that’s just how it is” perspective and it will slowly emasculate millions of men into a lower quality of life.

Physical outcomes of gyno are few in number and include breast swelling, breast pain, and possible nipple discharge.

But the REAL damage comes from the grave effects on men’s mental health. 

As Dr. Cruise has explained to me, the concerns around gynecomastia are far more than mere aesthetics concerns about having man boobs vs pecs:

“The emotional and psychological effects of this condition run deep and strip away self-confidence like cancer. It’s scary how unknown and mysterious this condition is. There is a psychological component to the suffering that should not be overlooked.

The world is more concerned about hiding it than learning about how to fix it. I feel a sense of obligation to shine a spotlight on gynecomastia, so that all men affected can seek treatment.”

The emotional and psychological trauma experienced by gyno suffers is devastating and it is heartbreaking to see how much the condition dramatically impacts their lives.

And bear in mind this isn’t the mere opinion of one doctor — we have more than enough clinical evidence showing how young and older men are negatively impacted by gynecomastia:

“Studies performed on adults and adolescents, with gynecomastia, have reported significant negative impact on psychosocial aspects, such as well-being, social functioning, mental health and self-esteem.

The main theory behind this correlation is that at the age of adolescence children solidify their body image, self-esteem and sexual identity.

The abnormal development of the breast tissue could, in this period, impact these domains and be an anatomic stressor. In a study by Li et al., 94.8% of patients reported psychological stress because of their gynecomastia”

Poor self-esteem, constant rejection, disordered eating, diagnoses of clinical anxiety and depression, outright emasculation, confused sexual identity… need I go on?

Unfortunately, most men will suffer from gynecomastia in silence because of how growing breasts negatively affects a man’s self-confidence.

With confidence completely stripped away, many men are too afraid to remove their shirts in public.

Causes Of Gynecomastia

Many people ask the question “Can you get rid of gyno without surgery?”, not taking into account the causes of gynecomastia and how it appears in the first place.

Sadly, gynecomastia is a LOT more common than you may believe:

“It has been estimated that 30–70% of males will experience gynecomastia at some stage in their life. Statistics from the USA show that 36% of adult young men and 57% of older men will have this condition in any of its different grades of severity.

It can therefore be deduced that it can be as common as one in every three adult men and one in every two elderly men.

Thirty to sixty percent of boys will experience pubertal gynecomastia but this is usually transient and resolves spontaneously whereby only 8% will have persistent pubertal gynecomastia after 3 years. Thirty to 50% of the cases present as bilateral gynecomastia (i.e., it can also present unilaterally). In Klinefelter syndrome (KF) gynecomastia is seen in about 80% of cases.”

It’s difficult to pinpoint the rise of this growing epidemic in Western society down to a singular reason due to how many factors can simultaneously increase a man’s chances of having it.

With the average male becoming more overweight over time, men are experiencing breast tissue growth that is made worse by poor nutrition, stress, additional body fat, inadequate sleep, and a combination of high estrogen and low testosterone.

Here’s just a small sample of them:

• The use of growth hormone-releasing peptides (as they concomitantly raise IGF-1, Cortisol and Prolactin)
• Alcohol (via liver damage that results in suboptimal hormone production)
• DHT-inhibiting hair loss drugs such as Finasteride
• Herbal products containing plant estrogens
• Various disease states (ex. liver disease, starvation, hyperthyroidism, male hypogonadism, type 1 diabetes, etc.)
• Many common medications and drugs (ex. HIV drugs, anti-anxiety drugs, ulcer drugs, select antibiotics and chemotherapeutics, heart medications, marijuana, etc.)
• Other hormonal imbalances, such as IGF-1 
• Too much insulin in the diet from high carbs and simple sugars

There are many more for physicians and patients to be aware of, which are covered in two excellent scientific reviews (here and here).

Clearly, systemic inflammation can destroy both the insides AND the outsides of your body!

Six Types Of Gynecomastia

Gynecomastia can get complicated due to the many variations that exist:

(Images provided by Dr. Joseph Cruise)

Don’t get overwhelmed — when you see a competent plastic surgeon who can fix gyno, as I’ll explain later, you’ll know which type you are.

But for most people reading this, and especially those on therapeutic testosterone, the first three types of gynecomastia are what concerns you most:

“Type 1 Gynecomastia – described by puffy nipples (with tight skin) and a predominantly visible gland;

Type 2 Gynecomastia – described by an increase in fat and a high gland-to-fat ratio (mild skin laxity with breast rounding)

Type 3 Gynecomastia – represented by an even higher gland-to-fat ratio (almost 2/3 fat, moderate skin laxity with nipple descent)”

As I wrote in The TOT Bible, these three types appear as a result of the surrounding skin losing its elasticity:

“Over time, the surrounding skin loses its elasticity. If there is no excess breast tissue left to hold, this loss of elasticity is relatively unnoticed.

However, if that skin is holding the weight of gynecomastia, it will eventually fail.

In this case, a patient has gone from a Type 1 or 2 (which requires incisions that are not noticeable) to Type 3 or Type 4 (which requires progressively higher levels of skin tightening and hence, longer incisions are necessary).”

With this information in hand, let’s go over what doe NOT work for removing gynecomastia so we know how to reverse gyno properly.

Gynecomastia Treatment Without Surgery: Does It Work?

Before I talk about how to get rid of gyno, you have to be well aware of the solutions which simply fail to treat the problem of gynecomastia.

The ineffective fixes fundamentally boil down to a complete misunderstanding of how gynecomastia works.

Concealment And Avoidance

This option involves exactly what you think it does: Helplessness through the acceptance of what you will soon discover is entirely treatable.

I’ve written about this before, but to summarize:

“Patients usually wear two shirts at the same time and have the outer shirt oversized to make sure their chest contour isn’t revealed. No tight shirts or white shirts. They also slightly hunch their shoulders to cover the chest, which can cause serious medical problems with shoulders, back, and posture in the long-term. Plus, men also often pull at the shirt to ensure it doesn’t cling to their chest.”

Dr. Cruise has referred to this as the “Gynecomastia Routine” as it reflects how gyno suffers dress to hide, rather than to impress.

You can obviously imagine how this emasculates even the most masculine of men, forcing them to avoid the joys of life so they don’t have to put themselves in a potentially revealing situation.

Which naturally leads to these unfortunate men becoming bullied, teased, and sometimes reaching the point of considering suicide.

No going to the beach without a shirt on, missing out on pool parties, never removing your shirt at the gym… it’s not a life worth living.

To make matters worse, you have articles on the Internet that actively ENCOURAGE using specialized shirts to hide gyno:

“Gynecomastia compression shirts are made specifically for men dealing with this condition and come in t-shirts, tank tops, vests, and even areola sticky’s that cover puffy areolas. You can wear the vests or tank tops under your favorite sweater or button up to hide the appearance of gynecomastia, or wear the t-shirt on its own.”

“They use nylon and spandex to flatten your stomach and torso, creating a flattering silhouette and remaining practically invisible when worn under another shirt. This will increase your confidence in work meetings, out on dates, or even running errands out of the house. Gynecomastia compression shirts are an immediate answer to the insecurity that can arise from dealing with this condition”

If anybody tells you this and truly believes it, run as fast as you can in the opposite direction!

Don’t let useless medications, horror stories of bad surgery outcomes, contradictory opinions, and misinformation online be your excuses for never getting rid of gynecomastia

Failure #2: Living A “Clean” Lifestyle

Now, I do want to start off this section with a caveat from Dr. Cruise himself:

“Unquestionably, the single best way to ‘treat’ gyno is to avoid it altogether, or minimize it before it becomes a problem.”

“I have zero doubts about the positive effects of optimizing your testosterone under the supervision of an experienced physician, and it’s certainly possible to lose fat in (and around) the chest area by building muscle. But it’s only in rare instances where I’ve seen this achieved in men with previous existing conditions of gynecomastia.”

Ideally, therapeutic testosterone is the non-surgical remedy that treats gyno as increasing the testosterone levels in the body under professional medical supervision helps you lose fat around the breast area (and turn it into muscle over time when combined with exercise).

This is something you should be doing regardless of whether you have gyno or not.

Eating a clean diet, training intelligently and doing cardio, sleeping well at night… the three basic tenets of good health and naturally increasing muscle mass through lowering inflammation and visceral body fat.

In a technical sense, biohacking weight loss would be “gynecomastia treatment without surgery”.

Yet there are some caveats worth mentioning which will show you why being fully optimized MAY NOT lead to the elimination of gynecomastia.

First, some men will be oversensitive to the conversion of testosterone into DHT, leading to mild gland growth around the nipple:

“Optimal T levels should not increase gyne. In fact, the improved T:E ration may help. However, there is the sub set of men who are so sensitive to T and its conversion to DHT that they will experience mild gland growth. The positives, however, are so overwhelming that the tradeoff is so worth it.

Even for the body builders who I treat so often; patients that abuse anabolics with total disregard for how they are doing it and what is really happening to their body, even these patient’s get a “free pass” of sorts considering that once the gland has been properly removed, it can never come back. They will damage their body in other ways but gynecomastia is not one of them.”

(As you’ll see later on in this article, this is likely what happened to me when I suffered from gyno)

Second, getting your health in order will only eliminate your “b*tch tits” if you are suffering from the condition of “pseudogynecomastia” mentioned earlier. 

If what you believe is gynecomastia turns out to be high body fat levels in the chest combined with a lack of chest muscle, you may be one of the lucky ones.

But if not, and living a fully optimized lifestyle doesn’t fix your problems, you’ll need to get serious and start exploring the proven fixes for getting rid of gynecomastia.

Ancillary Medications

Here is where things can go seriously wrong; at best your gynecomastia will remain as it is, and at worst you will damage your hormonal health to a significant degree while still not knowing how to get rid of gyno.

So make sure you’re well aware of these commonly suggested treatments and why you should avoid them…

Aromatase Inhibitors (AIs)

Many doctors operate under the false belief that using AIs (Arimidex, Aromasin, etc.) to block estrogen as a means of suppressing gyno, slowing its progression, or eliminating it altogether.

But long-time readers already know about the dangerous effects of artificially lowering estrogen levels.

Here are the takeaway bullet points explaining why AI use is ill-advised:

• AIs do nothing but temporarily mask the issue, sometimes temporarily suppressing the expression of the inflamed glandular breast tissue, which is guaranteed to come back or express again once you stop using the medications
• Gynecomastia is a genetic condition (more on that later), and thus those pre-disposed to it will find AIs to be useless
• The long-term adverse effects are numerous: Lower bone mineral density leading to fractures, cardiovascular damage, sexual dysfunction, cognitive decline, and much more
• You’re NOT trying to lower your estrogen when you’re on therapeutic testosterone; You’re trying to lower your inflammation and your visceral body fat because lowering your estrogen is actually reducing the positive effects that estradiol confers to your biological systems when cleaved enzymatically from therapeutic testosterone.
• Estrogen will find its natural level when a man is on therapeutic testosterone seeking optimization. What this means is some men who are inflamed and have too high a body fat are gonna have their estrogen level ‘appear to be higher’ than the standardized laboratory range values. Their Doctor will then have to find a balance where they don’t have negative symptoms or side effects-which was never from the  estrogen level anyways. These symptoms and side effects normally stem from their systemic levels of inflammation brought on by high levels of visceral body fat and a poor diet and lifestyle.

Not only does suppressing your estrogen levels have no effect on getting rid of gynecomastia in the big picture, but it also ends up killing both your short and long-term health!

Selective Estrogen Receptor Modulators (SERMs)

The issues with SERM use (Clomid, Toremifene Citrate, Novaldex, Raloxifene, etc.) are largely the same as the ones you’ll see with AI use.

So let me reiterate what I previously said…

Often times SERMs do offer some glandular tissue suppression (i.e. reduction in the size of the swollen breast tissue), but the suppression is not permanent and the gyno will “flare up” again once you stop using them.

The majority of physicians who prescribe SERMs for gynecomastia fail to understand its etiology (i.e. genetic causes) and as such the medications will never offer a final solution.

Thus, the overprescribing of SERMs is rampant and clinically incorrect (Not to mention the massive and widespread misuse in the bodybuilder/bro communities while ‘on cycle’).

Especially for adolescents who suffer from gynecomastia:

“Twelve boys, aged 12 to 19 years, with persistent gynecomastia were treated with the antiestrogen, clomiphene citrate, at a dose of 50 mg/day by mouth for one to three months. The mean breast size decreased by 0% to 36%, with only five boys experiencing a reduction of greater than 20%.

Five boys subsequently required reduction mammoplasty. Levels of urinary gonadotropins, serum testosterone, and estradiol increased significantly during therapy.

Since the ratio of testosterone to estradiol remained unchanged during treatment, the antiestrogen effects were achieved primarily at the level of breast tissue. Clomiphene citrate in a dose of 50 mg/day resulted in only small decreases in persistent pubertal gynecomastia and was not a satisfactory medical therapy for the condition.”

But overall, all you end up doing is causing great harm to your health in the long term as suppressing estrogen, systemically or selectively, compromises your biological systems in numerous ways.

Stop using SERMs and AIs because they don’t work anyway… if you have gyno, you’ll soon see why surgical removal is the only real way out of your predicament.

Androgenic/Anabolic Steroids (AAS)

This small section is especially important for the bodybuilders reading this article.

While there are numerous downsides to using high levels of AAS, one of them just so happens to be the exacerbation of gynecomastia.

In short, using supra-physiologic dosages of androgens and way to high dosages of AI’s/SERM’s to block what is perceived as the “symptoms” of excess aromatization (water retention, bloat, etc.) is extremely harmful to your biological systems and especially your vascular, neurological and bone health.

Using supra-physiological levels of AAS/AI’s/SERMS or anything that changes your baseline hormone levels can cause the increased expression of the gynecomastia condition via inflaming the breast tissue leading to the growth of fatty cysts or swollen tissue-especially in the men genetically predisposed to this happening.

High dose Androgens and AI’s/SERM’s is a guaranteed recipe for disaster.

Getting Rid of Gynecomastia: Proven Treatments