Painful nipples in men: causes and when it might be gynecomastia

Nipple pain in men is more common than you think

Most men don’t talk about nipple pain. It feels like one of those symptoms that’s either too minor to mention or too awkward to bring up. But if you’re here because your nipples hurt when touched, or you’ve noticed soreness that won’t go away, you’re not alone. Dr. Moeinolmolki hears about this symptom regularly at his Los Angeles practice, and the causes range from completely harmless to medically significant.

Let’s go through the most common reasons, starting with the ones that are easiest to fix.

Friction and irritation

The simplest and most frequent cause of sore nipples in men is physical irritation. Runners know this well. There’s even a name for it: jogger’s nipple. During long runs, your shirt rubs against your nipples thousands of times. The friction creates irritation, chafing, and sometimes actual bleeding. It’s painful and it looks alarming, but it’s not dangerous.

This doesn’t just happen to runners. Men who wear tight synthetic shirts, especially during workouts, can experience the same thing. So can men who work physical jobs where their clothing rubs against their chest all day.

The fix is usually straightforward. Apply petroleum jelly or anti-chafe balm before exercise. Wear moisture-wicking fabrics. Use adhesive bandages over the nipples during long runs if needed. If the irritation has already happened, keep the area clean and dry and give it a few days to heal.

Dry skin and eczema

The skin on and around the nipple is thin and sensitive. Dry air, hot showers, and harsh soaps can strip the natural oils from this area, leaving the skin cracked and painful. Eczema (atopic dermatitis) can also affect the nipples specifically, causing redness, flaking, and a persistent itch that turns into soreness.

Contact dermatitis is another possibility. If you recently switched laundry detergents, started using a new body wash, or wore a shirt with a fabric you don’t usually wear, your nipples might be reacting to the chemical contact. This type of irritation usually affects both sides equally and clears up within a week or two once you identify and remove the offending product.

Over-the-counter hydrocortisone cream (1%) applied sparingly for a few days typically resolves mild cases. If the skin is cracked or weeping, see your primary care doctor to rule out infection.

Hormonal causes

Hormones are behind a surprising number of cases of nipple pain in men. And this is where things get more interesting from a medical perspective.

Puberty

Between 60% and 90% of adolescent boys experience some degree of breast tenderness during puberty. This happens because testosterone and estrogen levels are both fluctuating rapidly, and estrogen can temporarily stimulate breast tissue growth. The tenderness is usually bilateral (both sides), comes with a small firm area behind the nipple, and resolves on its own within 6 to 18 months. It’s normal. It’s not a sign of anything wrong. But it can be very distressing for a teenager who doesn’t understand what’s happening.

Testosterone fluctuations in adults

In adult men, declining testosterone levels (which begin gradually after age 30) can shift the testosterone-to-estrogen ratio. When estrogen becomes relatively more dominant, it can stimulate breast tissue and cause nipple sensitivity. This is one reason why some men notice increasing chest fullness and nipple tenderness as they get older, even if their weight hasn’t changed much.

Men on testosterone replacement therapy (TRT) can also experience this. Exogenous testosterone gets partially converted to estrogen through a process called aromatization. If the dose isn’t properly calibrated, estrogen levels can spike, leading to breast tenderness and tissue growth.

Medications that cause nipple pain

Several commonly prescribed medications can cause nipple soreness and breast tissue changes in men. The mechanism varies, but the result is similar: hormonal disruption that stimulates breast tissue.

• Finasteride (Propecia, Proscar), used for hair loss and enlarged prostate, blocks the conversion of testosterone to DHT. This can shift the hormonal balance toward estrogen.
• Spironolactone (Aldactone), a blood pressure and heart failure medication, has anti-androgenic effects and is one of the most common drug causes of gynecomastia.
• Certain antidepressants, particularly SSRIs like sertraline and paroxetine, can affect prolactin levels and contribute to breast changes.
• Proton pump inhibitors (PPIs) like omeprazole, used for acid reflux, have been associated with gynecomastia in case reports, though the mechanism isn’t fully understood.
• Anabolic steroids, whether prescribed or used recreationally, frequently cause breast tissue growth due to aromatization of excess androgens to estrogen.

If you started a new medication and noticed nipple pain within a few weeks to months, that connection is worth discussing with your prescribing doctor. Don’t stop any medication on your own, but do bring it up.

Infections

Nipple infections in men are less common than in women, but they do happen. Bacterial infections can occur when bacteria enter through cracked or irritated skin. You might notice redness, warmth, swelling, and pain that gets worse over time rather than better. There may be discharge that’s cloudy or yellowish.

Yeast infections (candidiasis) can also affect the nipple area, particularly in men who are overweight, have diabetes, or sweat heavily. The signs are redness, itching, and a slightly shiny or macerated appearance to the skin. This is more common in skin folds and in men with larger chests where moisture gets trapped.

Both bacterial and yeast infections need medical treatment. Bacterial infections typically require antibiotics, either topical or oral depending on severity. Yeast infections respond to antifungal creams. If you suspect an infection, don’t wait it out. See your doctor.

Gynecomastia: when nipple pain means breast tissue growth

Here is what Dr. Moeinolmolki wants to emphasize from his experience as a surgeon who treats gynecomastia regularly. Tender, sore nipples are often the first symptom that brings men into my office. They come in thinking something is wrong because their chest hurts when they bump into something or when their shirt brushes against their nipples. On examination, I find glandular breast tissue beneath the areola.

Gynecomastia-related nipple pain has a specific character. It’s usually centered directly behind the nipple and areola. It feels like a bruise-like tenderness. The area may feel swollen or puffy. When you press on it, you can often feel a firm disc of tissue that’s different from the surrounding soft fat. Some men describe it as a “button” behind the nipple.

This tissue growth happens because of hormonal imbalance, whether from natural fluctuations, medications, weight gain, or other medical conditions. The tenderness occurs because the tissue is actively growing and stretching the surrounding structures. Once the tissue is established and the growth phase slows, the pain often decreases, but the tissue itself doesn’t go away.

Many patients tell me they assumed the tenderness would pass. Some waited years before seeking evaluation. The earlier you have it assessed, the more options you have. You can read more about the difference between a gynecomastia lump and something more concerning.

Male breast cancer: rare but real

I include this section not to alarm you but because men deserve to know. Male breast cancer accounts for less than 1% of all breast cancer diagnoses, according to the American Cancer Society. About 2,800 new cases are diagnosed in men in the United States each year. It’s uncommon, but it’s not impossible, and late diagnosis is a problem because most men don’t even consider it.

Warning signs that should prompt a visit to your doctor include a painless hard lump under or near the nipple (gynecomastia lumps are usually somewhat tender; cancer lumps are often painless), nipple retraction or inversion that’s new, bloody or clear discharge from one nipple, skin changes like dimpling or puckering over the breast area, and swollen lymph nodes under the arm on one side.

Risk factors include age over 60, family history of breast cancer (male or female), BRCA2 gene mutations, Klinefelter syndrome, liver disease, and radiation exposure to the chest. If you have any of these risk factors and notice changes in your chest or nipples, get evaluated. A mammogram or ultrasound can provide clarity quickly.

When to see a specialist

Most nipple pain in men is caused by friction, skin irritation, or minor hormonal fluctuations. But you should see a doctor if:

• The pain has persisted for more than 2 weeks without an obvious cause
• You can feel a lump or firm tissue behind one or both nipples
• There’s any discharge from the nipple, especially if bloody or from one side only
• The skin over or around the nipple has changed in color, texture, or shape
• You recently started a new medication and the symptoms followed

In my practice, the evaluation is straightforward. A physical exam takes about 10 minutes and can usually distinguish between gynecomastia, fat, and anything that needs further workup. If there’s any question, an ultrasound provides definitive information without radiation exposure.

Dr. Babak Moeinolmolki, MD, FACS, is dual board-certified by the American Board of Cosmetic Surgery (ABCS) and American Board of General Surgery. He sees patients in Los Angeles who are dealing with nipple pain, breast tenderness, and gynecomastia. Many of his patients initially came in for nipple discomfort and discovered that glandular tissue growth was the underlying cause. If that sounds familiar, a consultation can give you a clear answer and a plan.

Frequently asked questions

Is it normal for a man’s nipples to be sore?

Occasional nipple soreness from friction, dry skin, or minor irritation is common and usually not concerning. However, persistent tenderness that lasts more than a couple of weeks, especially if you can feel a lump behind the nipple, warrants medical evaluation. It could indicate gynecomastia or another condition that benefits from diagnosis.

Can tight shirts cause nipple pain?

Yes. Tight-fitting shirts, especially those made from rough or synthetic fabrics, can cause friction-related irritation. This is essentially the same mechanism as jogger’s nipple. Switching to softer, moisture-wicking fabrics and applying a protective barrier like petroleum jelly during physical activity usually resolves it.

Does finasteride cause nipple pain?

It can. Finasteride blocks the enzyme that converts testosterone to DHT, which can shift your hormonal balance and lead to breast tissue growth. Nipple tenderness is a known side effect reported by roughly 1% to 2% of users in clinical studies. If you’re taking finasteride and noticing breast tenderness or growth, talk to your prescribing physician before making changes.

How can I tell if nipple pain is gynecomastia or cancer?

Gynecomastia typically presents as a tender, somewhat movable lump centered behind the nipple, often affecting both sides. It’s usually associated with some degree of swelling or puffiness. Breast cancer in men more commonly presents as a painless, hard lump that may be off-center, and it typically affects one side. Any lump should be evaluated by a doctor, but the presence of tenderness is actually somewhat reassuring in that it’s more consistent with gynecomastia than cancer.

Will nipple pain from gynecomastia go away on its own?

The pain often decreases over time as the tissue stops actively growing. However, the glandular tissue itself does not go away on its own in adults. It stays there, and many men continue to have sensitivity even after the acute tenderness fades. Surgical excision is the only reliable way to permanently remove established glandular breast tissue.

Should I see my regular doctor or a specialist for nipple pain?

Start with your primary care doctor if the symptoms are new. They can rule out infections, skin conditions, and medication-related causes. If they suspect gynecomastia or if the issue persists despite initial treatment, a referral to a surgeon who specializes in gynecomastia is the next step. A specialist can perform a targeted physical exam and imaging to determine exactly what’s going on and discuss treatment options.