Off Their Chests

Junior high school isn't easy for anyone. But for Merle Yost, it was constant dread. He was tortured with bras hung over his locker, the constant assignment to the "skins" team during gym class, and a particularly brutal nickname ("Tits"). "I learned really early to cover up and hide, and I spent the next 20 years wearing big shirts to cover my chest," he recalls.

Two decades and two breast-reduction surgeries later, Yost, 49, is a California psychotherapist, author and host of a Web site that deals with the condition that caused him to grow abnormally large male breasts, gynecomastia. He's one of thousands of men who suffer from this common disorder—many unknowingly. It's a condition that can cause permanent damage to a guy's self esteem—especially if it occurs at a young age. "I haven't gone swimming in five years, and I have never taken my shirt off in public," says one 19-year-old in a post on Yost's site.

The condition may be most devastating to teens, but it can strike at any age. In fact, nearly 50 percent of all men will experience gynecomastia at some point in their lives, according to Glenn Braunstein, the chairman of medicine at Cedars-Sinai Medical Center in Los Angeles and the author of a recent New England Journal of Medicine article on the condition. Many sufferers don't know that gynecomastia is a medical condition caused by hormone fluctuations and weight gain. Nor do they know that exercise or weight loss alone may not be effective in getting rid of male breasts once they develop.

Before male readers start to freak, we should point out that gynecomastia is both treatable and benign, generally caused by hormonal ups and downs that can occur naturally during infancy, puberty and middle age. And while nearly 65 percent of boys in puberty will experience it to some degree, in 95 percent of those cases the condition will resolve on its own, says Braunstein. Adult-onset gynecomastia is another story. It can sometimes be hereditary but is more commonly spurred by conditions like obesity, chronic kidney disease or an overactive thyroid, as well as by certain medications like steroids that cause hormone levels to shift. And while doctors don't know why it resolves itself in some people but not in others, some studies indicate that it will eventually abate in up to 80 percent of adult men.

One of the biggest culprits for adults—and one that's easily avoidable—is weight gain. Braunstein, a hormone expert, explains that when men gain weight, they're not just getting bigger; the extra weight is actually changing their hormone production—and not in a way that most men would like. By nature, fat tissue manufactures the female hormone estrogen, which in turn stimulates breast tissue—meaning that significant weight gain will always be associated with some sort of breast growth, even in men, according to experts. A person who's overweight will be fatter all around, and maybe even develop the excessive breast fat that doctors call pseudogynecomastia—the appearance of male breasts caused by fat alone. But Dr. Elliot Jacobs, a New York plastic surgeon who specializes in gynecomastia treatment (and who suffers from the condition himself), says that most really overweight men are developing actual breast tissue, not just some extra padding. Doctors say that virtually all obese men (those who have a body mass index of 30 or greater, experience some degree of breast growth. And once that breast tissue is established, it doesn't go away on its own—no matter how much you exercise or diet, warns Braunstein. Considering that 75 percent of Americans are likely to be overweight by 2015, according to a recent John Hopkins study, men may want to think twice about supersizing that cheeseburger.

The seeming inevitability of "manboobs" has even spurred some middle-aged men to embrace the situation. How else to explain all those fleshy bare chests at the beach and sporting events? And manboobs even entered the cultural lexicon with a "Seinfeld" episode in which Kramer designs a "bro" to help with George’s father’s breast development. Today "manboobs" are celebrated on Web sites and in songs.