Men With Breasts: Benign Condition Creates Emotional Scars

Brian Handwerk
for National Geographic News
August 11, 2006
Summertime living is not easy for boys and men who suffer from gynecomastia—a surprisingly common condition in which males grow femalelike breasts.

For sufferers, bathing suit season can be a cause for dread.

"[My breasts] first showed up around the age of 11," said San Francisco-based psychotherapist Merle Yost. "It was kind of torturous by the time I got to junior high school. They just kept growing."

Yost is the author of Demystifying Gynecomastia: Men With Breasts, a new book meant to help others deal with a condition that, while physically benign, can be psychologically devastating.

Common Bane of Teen Boys

Gynecomastia, which means "woman breast," is commonly brought on by hormonal changes in adolescent boys that can result in increasing estrogens (female hormones) and decreasing testosterone (male hormone).

Norman P. Spack is clinical director of the division of endocrinology at Children's Hospital Boston in Massachusetts, and a specialist in adolescent hormone disorders.

"In the early phases of puberty the ratio of estrogen to androgen [male sex hormones] is relatively high," he says, "and about 60 percent of teenage boys get a tender enlargement of the breast glands that may be visible or may not be.

"It usually doesn't extend beyond the region of the areola [the dark area of the nipple]. In many cases [patients] think that people can see it and are embarrassed, but often other people can't see it."

In some cases, though, the results are all too visible and result in prominent femalelike features.

But adolescent gynecomastia generally reverses itself and fades with age. The condition disappears within three years in about 90 percent of pubescent sufferers with no treatment.

The remaining 10 percent are left with a lasting, difficult problem. The condition can also affect grown men later in life, such as elderly men going through hormonal changes.

Breast growth also can be spurred in adult men by the use of certain prescription or over-the-counter medicines or illegal drugs like marijuana and steroids.

Sometimes gynecomastia's root cause lies in the genes (interactive genetics overview).

"There are genetic conditions [that cause more severe gynecomastia] … sometimes you see breast enlargement in a young person from grandfather to father to child. That can be embarrassing and difficult to deal with," Spack noted.

Liver problems can also lead to gynecomastia, because the organ is unable to metabolize estrogen effectively.

"That's a setup for the adult to get gynecomastia," Spack said.

In the obese, pure fat can be misconstrued as breast glandular tissue, creating a similar appearance with a different cause.

Psychological Damage

Gynecomastia can cause physical issues, including painful hypersensitivity, but it is generally harmless.

Sufferers are more often prone to emotional and psychological problems resulting from what they perceive as an emasculating condition.

"We don't talk about things that men may not see as masculine," Yost said. "This is tantamount to saying that you're not a man for a lot of guys."

In private, however, many men are searching for help.

Yost, who runs his own psychotherapy Web site, added a gynecomastia forum page in 1997.

The page received such overwhelming traffic that he spun off a full information and resources site three years later, where he has gathered enormous amounts of feedback.

He explains that while many men are disturbed by gynecomastia, "there are as many responses [to the condition] as there are people."

"A man's response to gynecomastia often has as much to do with his partner's response as it does his own feelings," Yost said. "If the primary partner is embracing [the patient's] chest, it may diminish that negative response."

For those men who hope to treat their condition, they must first identify its cause. Some can gain relief by losing weight or altering their medications.

Spack, of Children's Hospital, believes that some prescription medicines could block the formation of estrogen and reduce breast size, but such treatments haven't been generally used in the U.S.

Timing is also a drawback: The drugs would only be effective early in the condition's development, but embarrassed sufferers rarely seek help at that stage.

For many men with gynecomastia, surgery may be the only solution.

Yost opted for the procedure, though he cautioned that many patients—including himself—have reported less than satisfactory results.

Many surgeons are not accustomed to the procedure, he says, and he suggests that potential patients do their homework and find an experienced doctor.

Cost can be another drawback, Spack explains.

"One big problem is that it's hard to fight for this to be covered by insurance, because it's regarded as cosmetic," he said.

"But it's really awful for some of these kids who never take their shirt off at the beach or are tormented at school."

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