Grades and Types of Man Boobs

“True gynecomastia” is a combination of breast tissue and fat, and can affect one or both breasts. However, some men experience what is known as “pseudo-gynecomastia.” Pseudo-gynecomastia is man boobs that are caused by fat alone. True gynecomastia is categorized into 4 grades with grade 1 being very mild with just a button of breast tissue behind the areola. Grade 4 is the most extreme type of moobs where a man has severe and visibly feminine breasts with skin redundancy. Physicians will establish the grade and type of man boobs to determine the best approach for resolution.

Adolescent Gynecomastia

As young men go through puberty, it is normal for their estrogen levels to increase. Although hormonal imbalance is a temporary situation, it can lead to the unwanted side effects of breast development for up to 60% of young men. Within a few months to 2 years, the boy’s breasts should return to normal without any treatment. However, if after 2 years their breasts remain; it is probable it has become a permanent condition that can only be corrected by surgery. Due to the psychological devastation moobs can cause young men, it is possible surgery can be considered at a young age. Parents should seek the advice of a gynecomastia specialist for their son. In addition, parents can find support for their son through the forums available on

Adult Gynecomastia

As much as 25% of adult men have man boobs that are unresolved from adolescence. For other adult males, the increase in the development of breasts in older men is due to a natural drop of testosterone, the onset is usually between 40 to 80 years of age. This period is referred to as “andropause” and similar to “menopause” for women in that there are life changes due to a decline in sex hormone levels. However, it is a dramatic drop for women, and for men, it is very gradual.

Pure Glandular Gynecomastia

Pure glandular man boobs are common with bodybuilders and lean men. Most of the time moobs are due to the use of anabolic steroids. These men have very low levels of body fat, and therefore their breast development is purely glandular in nature without fatty tissue.

What type of Gynecomastia do you have?

Unilateral Gynecomastia

Man boobs usually develop equally on both sides of the chest, but just like for women, one side may be much larger than the other. This condition is referred to as unilateral or asymmetric gynecomastia. Most people are relatively symmetric so for a man to have one breast obviously larger than the other can be very distressing.

Severe Gynecomastia

Sometimes extreme man boobs are seen in adolescent boys due to hormonal imbalance. Some young men may have breasts equivalent to women’s “D” cup or larger. This can be extremely traumatizing for boys and surgery might be considered even before waiting to see if their moobs will return to their normal size on their own. The downside to proceeding with surgery is the possibility (although rare) the breasts may continue to grow necessitating additional surgery in the future. Other cases of extreme gynecomastia can be due to the loss of elasticity of the skin in older men, especially those who are or have been obese.


Both “True Gynecomastia” and “Pseudo-Gynecomastia” cause male breasts, but the reason for development is very different and require different solutions. Pseudo-gynecomastia is the result of a build-up of fat on the male chest and in most cases affects men who are overweight or obese, in more rare cases; it may affect a man of normal weight. Pseudo-gynecomastia does not include the over-development of male breast tissue as found in “true gynecomastia”.

Men should not attempt to “self-diagnose” what form of man boobs they have, but seek the expertise of a gynecomastia specialist.

The 4 Grades of True Gynecomastia

  • Grade 1 – Very Mild

    Grade 1 may be preceded by itching around the nipple and then develop to a button size of tissue that can be felt under the nipple/areolar complex but does not extend beyond it. This may be accompanied by some tenderness, but not particularly painful. If the swelling does not increase many men may choose to live with grade 1.

  • Grade 2-Mild to Moderate

    Grade 2 is probably the most common, with no excess skin. The glandular tissue typically is firm and beneath the areola with fatty tissue more likely extending beyond. Generally, it is not noticeable under a loose fitting shirt.

  • Grade 3-Moderate to Severe

    Grade 3 has breast tissue that extends beyond the areola boundary with redundant skin. This grade may be noticeable to others.

  • Grade 4-Severe

    Grade 4 is the most extreme form of man boobs with female type breasts that sag. The position of the areola is below the chest fold (inframammary fold), which is the meeting point of the chest and the breast.

The 7 Types of True Gynecomastia

Besides the 4 grades of gynecomastia, there are 7 types which help physicians determine their best course of treatment. The different types reflect more excess skin rather than volume, the more excess skin, the more breast sag.

The types are:

Type 1“Puffy Nipples” are about the size of an egg and generally made up glandular breast tissue, and located behind the areola/nipple complex.
Type 2Excess breast tissue below the areola is firm, and the skin is relatively taut.
Type 3The skin is no longer taut, and the excess tissue is beginning to sag. The nipple is starting to move lower.
Type 4There is significant sagging and is very noticeable.
Type 5The considerable sagging is now below the chest fold with the bottom of the areola above the chest fold.
Type 6Severe breast sagging with the chest fold extending under the armpit and continuing around to the back. The top of the areola is above the chest fold.
Type 7The most extreme type of moobs with the most breast sag. The top of the areola is below the chest fold with the nipples pointing down.

Not all man boobs will continue to grow; it is not known why some men’s breasts will go to grade 4 and others may stay at grade 1, just like it is not known why some women will develop larger breasts than others.

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