Man Boobs in Men Over 35: The Estrogen-Testosterone Tug of War

By MHI Editorial Team | Medical review: Dr Rui Graça, MD, Urologist & Founder | 30 April 2025

• Real case insight:
  

At 45, John was facing embarrassment he never anticipated - man boobs. Despite exercising regularly, the chest fat persisted. A visit to Dr. Rui revealed an unexpected hormonal battle: too much estrogen, not enough testosterone. Learn how simple changes restored his confidence and health.

Man Boobs in Men Over 35: The Estrogen-Testosterone Tug of War

Scene 1: The Moment of Embarrassment

John sat across from Dr. Rui, visibly uncomfortable. "Doctor, this is embarrassing. I used to be in great shape, but now I've developed... well, man boobs. It's really affecting my confidence."

Dr. Rui nodded understandingly, reassuring him, "You're not alone. Hormonal imbalances often creep up unnoticed, especially in men over 40. Let's figure this out."

Gynecomastia (commonly called "man boobs") affects approximately 30% to 60% of men over the age of 35, depending on body fat, medication use, and hormone status. Often dismissed as excess fat or aging, it's frequently due to underlying hormonal imbalances involving testosterone and estrogen.

Scene 2: The Right Questions & the Right Tests

Dr. Rui began with targeted questions: "Have you experienced other symptoms like fatigue, mood swings, or weight gain around the abdomen?"

John responded, "Yes, to all. I’ve also noticed lower libido and energy."

"Let's get a clear picture," Dr. Rui suggested. He ordered a comprehensive panel: testosterone, estradiol, SHBG (Sex Hormone Binding Globulin), liver function, cortisol, and metabolic markers.

Mini-explainers: - Why measure estrogen (estradiol)? High estrogen levels can lead to breast tissue growth in men. - SHBG: This protein binds testosterone, reducing its availability. High SHBG can worsen symptoms. - Cortisol & Metabolic Markers: Stress and metabolic dysfunction increase estrogen production and fat storage.

Your Next Step: From Guessing to Clarity

If your energy, hormones, or performance feel off, blind guessing won’t cut it.

Start by answering 12 simple questions to uncover your most likely imbalance:

(It’s free, confidential, and gives you an instant self-assessment)

45-sec Men's Health Quiz

Scene 3: The Real Diagnosis: A Hormonal Battle

A week later, Dr. Rui had answers: "Mr. X, your estradiol is elevated, and your testosterone is on the low side. High SHBG levels mean the testosterone you have is less available. Excess body fat, especially around your abdomen, is increasing aromatase activity, turning testosterone into estrogen."

Mr. X was surprised. "So my body is basically working against me?"

"Precisely," Dr. Rui explained. "We’ll address this naturally through targeted lifestyle changes, weight loss strategies, and micro-dosed Testosterone Replacement Therapy (TRT) to correct this imbalance safely."

Excess fat, especially visceral belly fat, boosts aromatase, an enzyme that converts testosterone into estrogen, fueling gynecomastia and other symptoms of hormonal imbalance. Losing visceral fat and optimising testosterone levels can significantly reverse these effects.

Scene 4: Progress, Doubts & Course Correction

Six weeks later, John had lost weight but felt uncertain. "The chest fat reduced, but slower than I'd hoped. Is this normal?"

"Absolutely," reassured Dr. Rui. "Hormonal rebalancing takes time. Let’s slightly adjust your TRT dosage and fine-tune your nutrition to further reduce aromatase activity."

Resolution: 12 Weeks of Transformation

At 12 weeks, John was back, visibly happier and confident. "I feel amazing. My chest looks normal again, I've lost 6kg and significant belly fat, and my energy and libido are back. It feels like a second chance."

Quick Takeaways: - Man boobs often indicate a hidden hormonal imbalance. - Visceral belly fat exacerbates estrogen dominance in men. - A combination of weight loss, targeted nutrition, and hormone optimisation can restore both health and self-image.

Disclaimer: This article is for educational purposes only and does not constitute medical advice. Consult a licensed physician for personalised care. Clinical details are composite and privacy-protected. Story reviewed by Dr Rui Graça, MD.

45-sec Men's Health Quiz