Nipple tenderness in males, medically termed mastalgia, is a common experience. The chest area contains highly sensitive nerve endings, making the sensation of soreness or pain quite pronounced. While the symptom can feel alarming, the majority of causes are benign and easily addressed. Understanding the reason behind the discomfort is the first step toward finding relief. This sensitivity can stem from external irritation, internal biological shifts, or, in rare instances, more serious underlying conditions.
Common Causes Related to Friction and Activity
The most frequent reason for nipple discomfort is mechanical friction against clothing, commonly known as “runner’s nipple.” This irritation occurs when loose or coarse fabrics repeatedly rub against the skin, particularly during repetitive activities like running, cycling, or weightlifting. The constant motion can quickly break down the delicate skin barrier, leading to chafing, soreness, and sometimes cracking or bleeding.
Sweat exacerbates this friction by introducing moisture and salt, which increases the abrasive effect of the fabric. Prevention is often simple and involves creating a physical barrier between the skin and the shirt. Applying a protective lubricant, such as petroleum jelly or specialized anti-chafing balm, before activity can reduce the potential for irritation.
Covering the nipples with an adhesive bandage or specialized athletic tape provides a direct physical shield. Wearing tight-fitting, moisture-wicking synthetic fabrics can also minimize movement and friction. Soreness can also be a sign of contact dermatitis, which is an allergic reaction to substances like laundry detergents, fabric softeners, or body soaps used on the skin.
Physiological Changes Due to Hormones
If soreness is persistent and not linked to external friction, the cause is often related to internal glandular changes, such as gynecomastia. This is the benign enlargement of male breast glandular tissue, which can feel firm or rubbery beneath the nipple and is associated with tenderness. Gynecomastia results from an imbalance in the ratio of sex hormones, specifically an increase in estrogen relative to testosterone.
This hormonal fluctuation is common and often transient during certain life stages, such as male puberty, where up to 70% of boys experience temporary gynecomastia. It also occurs in aging men as testosterone levels decline, shifting the hormonal balance. Certain prescription medications, including anti-androgens, steroids, and some heart or ulcer drugs, can disrupt hormone regulation and trigger glandular tissue growth.
True gynecomastia involves the proliferation of firm, glandular tissue and is the condition that typically causes the sensation of soreness or pain. Pseudogynecomastia involves soft, fatty tissue that is generally painless and is often related to weight gain rather than a hormonal imbalance. Identifying the tissue type is an important step, as glandular tissue does not respond to diet and exercise alone, unlike fatty tissue. A doctor can often differentiate between the two by a physical examination, noting if the tissue under the nipple is firm and dense or soft and spread out.
Signs That Require Medical Attention
Certain accompanying symptoms warrant consultation with a healthcare provider. Any pain or tenderness localized to a single side that is accompanied by a lump or mass should be evaluated immediately. Although rare, male breast cancer presents as a firm, often painless, lump felt beneath the nipple or in the armpit.
Other suspicious signs require professional investigation:
- Noticeable changes to the skin on the chest, such as dimpling, puckering, scaling, or ulceration.
- Nipple discharge, especially if it is clear or bloody.
- A change in the nipple’s appearance, such as turning inward (inversion).
- A persistent, eczema-like rash on the nipple or areola.
Soreness combined with symptoms of infection requires medical treatment, which may include antibiotics. Signs of a localized infection, which can occur after significant chafing or injury, include severe redness, warmth, swelling, or the presence of pus. Systemic symptoms like an unexplained fever or chills accompanying the chest pain are also red flags.