Getting the troubling moobs off the chest

Dear Dr. G,

In the spirit of Pink October, I am hoping to get troubling matters off my chest.

I am a 53 year-old-man who has always been overweight.

One of the best things that has happened to me during the Covid-19 pandemic lockdown was the determination to get myself healthy again.

During the MCO, I started exercising and watching my dietary intake.

Believe it or not, my weight managed to drop from 100kg to 80kg in two years.

Although I cannot quite see the six-pack, even the love handles are gone.

Despite all that, I still do not have the confidence to go shirtless in the gym due to the persistent man boobs.

I went to the doctors who reckoned this was the result of my previous obesity.

My wife thinks I am too vain and should be grateful I am no longer obese.

However, I am just determined to put Dr. G on the spot, helping to get these troubling moobs off my chest.

Can you tell me how common are breasts in men?

Why exactly do men get man boobs?

Are these normal in all men? Can this signify underlying health conditions?

The doctor I went to recommended surgery to rectify them.

Do you think I should get a quick fix to get my ugly monstrosities off my chest?

Hope you can really help me to get the troubling issues off my chests.

Regards,

Man-Boobs Matthew

Gynaecomastia (also colloquially known as “man boobs” or “moobs”) was a term coined in 1881 from the word gyneco- (meaning women) plus the Greek word masto- (meaning breast). This condition of a man having breasts like women is characterized by excessive growth of benign tissues in one or both male breasts. The common endocrine disorder in men is caused by hormonal imbalance between oestrogen and androgen, which can appear physiologically and pathologically during a man’s life.

Although the condition is largely benign, gynaecomastia can cause significant psychological distress and unease.

Gynaecomastia is the most common benign disorder of the male breast tissue affecting one third of all men.

The most common ages of gynaecomastia are between 50 and 69, with estimated prevalence up to 70%.

On the other hand, transient physiological gynaecomastia also occurs in newborns and adolescents.

Nearly 90% of newborn male babies present with breast protrusions due to residual maternal oestrogen.

These tend to be transients and resolve within two weeks after delivery.

Man-boobs are also physiological in two thirds of boys during puberty.

Up to 70% of adolescent boys develop gynaecomastia, with three quarters being transient and resolve within two years.

The prevalence of gynaecomastia in men may have increased in recent years, with the epidemiology of the disorder is not fully understood.

The increased use of anabolic steroids, exposure to chemicals that mimic oestrogen in plastic and cosmetic products, and organochlorine pesticides have been suggested as possible factors driving this increase.

Other factors such as genetic conditions, obesity, metabolic syndrome and side effects of certain medications may also contribute to the overall rise in prevalence of gynaecomastia.

Gynaecomastia is common in genetic conditions such as Klinefelter Syndrome.

This is due to an extra X-chromosome inducing excessive oestrogen in men.

The side effects of certain medications such as cimetidine and ketoconazole can also interfere with metabolism of sex hormones in the liver.

Other conditions such as alcoholism, liver cirrhosis and metabolic syndrome are well-recognized to interfere with the hormonal metabolism, resulting in the decline of testosterone production.

Gynaecomastia can also be associated with hormone producing tumours such as lung, pituitary, adrenal and testicular cancers known to excrete oestrogen, however the excessive breast tissues itself rarely progress to breast cancer.

Most gynaecomastia is treated conservatively as the condition is predominantly benign and self-limiting.

Mild cases of gynaecomastia in adult men may be rectified with lifestyle changes such as proper diet and exercise.

More severe persistent cases of gynaecomastia can be a source of psychological distress, treatments such as medication or surgical intervention may be necessary to improve overall quality of life.

Gynaecomastia responds well to medical treatment when initiated within two years of onset breast enlargement.

These include selective oestrogen receptor modulators (SERM) such as tamoxifen usually used in breast cancers.

Although not approved by FDA for the use of gynaecomastia, some studies even demonstrated good outcomes in combination therapy of tamoxifen and radiation therapy to the chest, especially in Gynaecomastia in men suffering from androgen deprivation therapy for prostate cancer.

Surgical treatment is usually considered if the medical intervention fails, causing physical discomfort or psychological distress.

The American Association of Plastic surgeons recorded nearly 25,000 men who underwent corrective Gynaecomastia breast surgeries in 2019. This accounts for a 19% increase since 2000.

The American Board of Cosmetic Surgery also reported surgery as the “most effective known treatment for gynaecomastia.”

Surgical approaches to the treatment of gynaecomastia include subcutaneous mastectomy and laser-lipolysis with or without liposuction.

Complications of mastectomy may include surgical wound infection, breast asymmetry, changes in sensation in the breast, accumulations of blood clots and painful scars.

Therefore, this should be considered as a last resort and not taken lightly.

Gynaecomastia is generally a benign condition that reflects an imbalance of sex hormones.

Some clinicians even consider such breast enlargement in older men to be a natural progression of ageing.

Many men who are defying such bodily changes often put Dr. G on the spot for answers and solutions and he says that finding a quick fix to get the troubling man boobs off his chest may not necessarily be a clever move!