Many of Dr. Christopher T. Chia’s patients carry painful memories into his office. They’re often men in their 20s and 30s who recall being taunted as adolescents for having “man boobs” and needing a bra. Such can be the life of a teenage boy with gynecomastia — enlarged breast tissue around the nipples of adolescent males and men that makes it appear they have breasts.
Dealing with self-consciousness over having “man boobs” at any age can cause anxiety and stress. “It’s especially poignant for young boys who are coming into puberty,” says Chia, the surgical director of bodySCULPT, a plastic surgery group in New York City. “That’s a complicated period of life anyway. You add to that how kids could be merciless. A lot of these boys [with gynecomastia] don’t want to take their shirts off. They won’t change in front of their peers in the locker room, they wait until everyone leaves. Or they won’t shower after their gym class, their self-consciousness is that great.”
The severity of the condition varies. “Gynecomastia creates a fullness under the breast or under the nipple which could be mild to severe,” says Dr. Rady Rahban, a plastic surgeon in Beverly Hills, California. In adolescents, gynecomastia is caused by hormone changes during puberty, according to the Mayo Clinic. The hormones testosterone and estrogen control the development of sex characteristics in men and women. Testosterone controls male characteristics, such as body hair, muscle mass and a deepening voice. Estrogen is responsible for female sex characteristics, such as the development of breasts and the regulation of the reproductive system and menstrual cycle.
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Many people believe estrogen is an exclusively female hormone, but males produce it, too — usually in small amounts. In males, the presence of estrogen levels that are too high or out of balance with testosterone levels can cause gynecomastia. Many males have excessive breast tissue from birth that never becomes an issue. For example, more than half of male infants are born with enlarged breasts, attributable to the effects of their mother’s estrogen, according to the Mayo Clinic. Typically, swollen breast tissue in male babies goes away two to three weeks after birth.
Gynecomastia caused by hormone changes in adolescent boys is also relatively common. The enlarged tissues typically occur in boys between the ages of 12 and 14, says Dr. Nolan S. Karp, professor of plastic surgery at NYU Langone Health in New York City. As many as 50 to 75 percent of adolescent boys get gynecomastia, which typically goes away without treatment in six months to two years. Gynecomastia doesn’t usually occur in younger adult males, but it spikes again for men between the ages of 50 and 69, when testosterone levels decline. About 25 percent of men in this age group are affected by gynecomastia.
While hormonal changes are associated with most cases of gynecomastia, a small percentage are caused by medication. According to the Mayo Clinic, medications associated with gynecomastia include anti-androgens used to treat an enlarged prostate or cancer of the prostate; anabolic steroids, which some athletes use to build muscle mass; some AIDS medications, like highly active antiretroviral therapy; anti-anxiety drugs like diazepam; antibiotics; ulcer medications; some heart medications, like calcium channel blockers; and chemotherapy. The condition is also associated with alcoholic liver cirrhosis and testicular and thyroid tumors, says Dr. Steven Davis, a plastic surgeon based in Cherry Hill, New Jersey.
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The effects of gynecomastia are strictly aesthetic, and the condition isn’t associated with any other ill effects. In recent years, changing men’s fashion styles have prompted an increasing number of men to seek breast reduction procedures, Davis says. Male breast reductions are typically elective, outpatient procedures that cost between $6,000 to $10,000; prices vary in different regions and from physician to physician. Many plastic surgeons have payment plans if you can’t cover it all at once. Because these procedures are usually considered cosmetic, they’re typically not covered by insurance. In highly unusual cases, like when a tumor is developing along with the breast tissue and the growth poses a serious health threat, insurance companies may provide coverage, according to gynecoma.com, a website that provides information about gynecomastia and treatments for it. “I am seeing many more men in my practice than I have seen before,” Davis says. “With the tighter-fitting suits and clothes that are in fashion, many men are very self-conscious about any breast protrusion, and they seek to treat this area.”
If you’re afflicted with gynecomastia and wondering whether you should seek treatment, experts recommend these strategies.
Talk to your doctor. Your primary care physician can identify whether your gynecomastia is caused by medication, and whether discontinuing the meds could correct the condition, Chia says. Your doctor can also “reassure you that this is an extremely common condition and that you are not alone,” he says. Knowing how common gynecomastia is and that it’s not associated with other health effects can help you keep the condition in perspective.
Weigh how much it affects you. When it comes to deciding whether to get treatment for gynecomastia, the question is simple, Rahban says. “How much does it bother you? It is essentially a cosmetic concern? If a young boy has some slight gynecomastia and it doesn’t bother him whatsoever, then there is no need to remove it. If someone has some moderate gynecomastia and it’s causing him great grief and a tremendous amount of embarrassment and affecting his quality of life, then with a relatively simple procedure, we can improve his quality of life.”
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If it will make you feel better about yourself, and you can afford it, seek treatment. Harold, now 32, developed what he characterized as a “medium” case of gynecomastia in high school, about the time he was 14. (Harold isn’t his real name. The New York state man asked to use a pseudonym because he’s self-conscious about his experience with gynecomastia.) His condition made him feel very uncomfortable, especially when he and friends would play pickup basketball. “We had to take off our shirts to play shirts and skins,” he says.
Harold’s self-consciousness persisted into his adult years. Though he’s always been on the slender side, he lost 30 pounds to try to get rid of his man boobs, to no avail. In recent months, he had liposuction, conducted by a doctor in New York City who used a liposuction method called BodyTite, which is supposed to not just get rid of the excess breast tissue but tighten the skin, Harold says. Harold says he’s happy with his results. “It was one of the best decisions I’ve made for me,” he says. “It’s something I don’t have to worry about anymore.”
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Strategies for Coping With ‘Man Boobs’ originally appeared on usnews.com
