A commonly prescribed heart medication has drawn renewed attention after a 76-year-old man developed enlarged breasts following years of treatment, underscoring an unexpected side effect that can affect male patients.
The case, recently detailed in The New England Journal of Medicine, involved a man who sought medical attention after experiencing eight months of breast tenderness and swelling. Doctors ultimately traced the condition—known as gynecomastia—to spironolactone, a drug he had been taking for several years to manage heart failure.
Gynecomastia occurs when hormonal imbalances cause breast tissue to enlarge in men. While the condition can develop naturally during puberty or aging, it is also a known side effect of certain medications. In this case, spironolactone was identified as the trigger.
Spironolactone is one of the most widely prescribed drugs in the United States, with more than 12 million prescriptions issued nationwide. Approved by the U.S. Food and Drug Administration, it is commonly used to treat high blood pressure, heart failure, and a range of hormone-related conditions. The medication works in part by suppressing the production of male sex hormones such as testosterone.
While many of spironolactone’s side effects—such as dehydration, dizziness, headaches, and fatigue—are well documented, others may come as a surprise to male patients. Breast tenderness and tissue growth are less common but far from rare, with studies suggesting that up to 10% of men taking the drug may experience some degree of breast enlargement.
Medical experts note that reducing the dosage or switching to an alternative medication can often reverse medication-induced gynecomastia. However, when breast growth persists or is caused by factors unrelated to drugs, surgical options may be considered.
According to the American Society of Plastic Surgeons, male breast reduction has become the most common cosmetic procedure among men in the United States. Surgeons performed 26,430 male breast reduction procedures in 2024, a significant increase from 20,955 in 2019.
“Since 2020, I’ve definitely seen a steep increase in men seeking consultations and moving forward with gynecomastia surgery,” Dr. Claudia Kim, chief medical officer and lead cosmetic surgeon at New Look New Life in Manhattan, previously told The New York Post.
Surgical treatment typically involves liposuction to remove excess fat, excision to remove glandular tissue, or a combination of both, depending on the severity and cause of the condition.
The case serves as a reminder that even well-established medications can carry unexpected effects, highlighting the importance of ongoing monitoring and open communication between patients and their healthcare providers.
