Why Some Men Grow Breasts

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.

But even if some older men have made peace with their manboobs, gynecomastia is no joke for many young men—particularly in a culture in which pecs of steel are the norm in the mainstream media. "The problem with adolescent onset gynecomastia is that it's happening at a time when kids are first becoming aware of their bodies," says Yost. "Kids at that point are really interested in fitting in, and this can make them targets for everything from emotional to sexual to physical abuse."

Some boys take to radical weight-loss diets or manic exercise regimens to solve the problem, while others go to extreme lengths to hide it: buying special clothes, wearing multiple layers, hunching over or wrapping themselves in Ace bandages—even gaining weight to shift the emphasis elsewhere. "I spent my teens hating the way I looked, changing in the corner for gym with my back to everyone," writes a young man on Yost's Gynecomastia.org. He says he spent "every sexual relationship" making sure his chest was never seen or touched. Another sufferer, 24, says he hated himself so much during adolescence that he "considered mutilating my chest with knives or scissors."

Impatient teens have few options. They can wait it out and hope the gynecomastia goes away as hormone levels fluctuate; most doctors say to give it two years or so. If it still persists, a doctor can prescribe an estrogen-blocker—a common one is the breast cancer drug Tamoxifen—to reverse the hormone levels. Or, as an increasingly common last resort, there's breast-reduction surgery, a procedure some 20,000 American men—including 14,000 teenagers—underwent last year, making it the fifth-most common male surgery in America, according to the American Society of Plastic Surgeons. "I hated having my shirt off, and all I did was work out," says Andre Zdanow, a 25-year-old New York college student who had suffered from gynecomastia since he was a teen and underwent the procedure last year. "The difference is really night and day."

Braunstein says he encourages teens to wait until they've passed puberty before they seek surgery, but that it can be a "very good option" for those who are cosmetically concerned. Felicia Farino, of Queens, N.Y., let her 10-year-old son go under the knife after he developed breast growth on just one side of his chest—and says it was the best decision she ever made. "Dylan had always been at the top of his game—in sports, in school, at home—and all of a sudden he was withdrawing," Farino says. "It wasn't an easy thing to go through. It was painful, it was expensive and he had to wear a corset. But immediately I saw a complete turnaround. Within a week he was back to his old self."

Plastic surgeons say the procedure today is easier, safer and more effective than it's ever been. The surgery ranges in price from about $4,000 to $10,000 and can take as little as an hour, depending on the size and makeup of the breast, which can range from puffed up nipples to more fully formed breasts. In some cases surgeons use liposuction to remove fatty deposits and glandular tissue, all through a "tiny nick in the skin"—about an eighth of an inch, says Jacobs, who has performed the surgery on more than 1,400 men. In more severe cases a surgeon may need to open up the breast to remove tissue and excess skin, and occasionally even reposition the nipple.

Of course, it's good to keep in mind that not all surgeons are created equal—and the procedure is not without risk. Many pediatricians worry that if surgery is done too early, the hormones that caused the breast enlargement could cause them to regrow. Yost says that breasts grow back following about 30 percent of surgeries. The surgery can also be expensive—and is rarely covered by insurance.

Even if the condition doesn't merit surgery, doctors are hoping that more men seek medical advice about treatment options instead of resigning themselves to a life lived with their shirts on. Talking about the problem, they say, is key. As Braunstein puts it, "Raising awareness of the condition—its causes, symptoms, treatments—will help more boys and men with gynecomastia be correctly diagnosed, and reassure them they are not alone."

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