Troubled by man boobs (gynaecomastia)? If you – or someone in your life – has more male breast than manly chest, read on for the science behind this possibly embarrassing condition… and what you can do about it. Dr Marco Faria Correa discuss causes, testosterone levels and male breast reduction surgery.
Gynaecomastia is fairly common, says Singapore-based plastic surgeon Dr Marco, affecting up to 20 percent of teenagers and one in four men aged 50 years or older. Nevertheless, it can be embarrassing and even cause psychological distress.
The normal male breast contains only minimal amounts of fat and glandular tissue. Gynaecomastia is the medical term used for enlarged or feminised male breasts, either on one side or both. The main cause is a hormone imbalance: too-high levels of oestrogen or progesterone relative to testosterone.
“When it occurs in later life,” says Dr Marco, “it appears that everything from our lifestyles, eating habits and agricultural practices, to common medications and the ageing process may all play a part.”
Oestrogen vs testosterone levels
We tend to think of oestrogen as the female hormone, and testosterone as the male hormone, but that’s an over-simplification. Both hormones are vitally important in both sexes.
In fact, oestradiol – the main form of oestrogen – has an essential role in many areas of men’s health, from energy metabolism, bone strength and muscle mass gain to preventing heart disease, supporting brain health and regulating mood. (That’s right – preventing GOMS, or Grumpy Old Man Syndrome.)
Once again, it’s a matter of balance; in this case, the proper balancing of oestrogen and testosterone levels. Overly high oestrogen not only causes gynaecomastia, but can also affect a man’s sex drive, erectile function and fertility. What’s more, it’s associated with mood swings, anxiety and depression, along with night sweats and poor sleep.
Why it’s a growing concern
Studies show a steadily increasing imbalance between testosterone and oestrogen in males since the 1980s. There are a number of potential reasons for this.
Carrying excess fat raises levels of aromatase, an enzyme that converts androgens such as testosterone into oestrogens.
Ironically, men on testosterone replacement therapy (TRT) may be at increased risk for gynaecomastia. That’s because TRT also boosts oestrogen production. So, keep a close watch on your levels and ask your health provider about aromatase inhibitor drugs, or natural antioestrogenic compounds like quercetin, grapeseed, ground flaxseed and bioflavonoids.
As with many other sky-rocketing chronic conditions, the environment has a lot to answer for. Not only oestrogens, but xenoestrogens (oestrogen mimickers) are literally inescapable in our industrialised world. They’re in exhaust fumes, pesticides, industrial waste products, plastics, soaps, fabric treatments and much more.
Excess alcohol increases aromatase (mentioned before). And binge drinking over-stresses the liver, blocking the essential pathways for oestrogen metabolism. As for beer, the hops it’s made from contain potent phyto-oestrogens that mimic the effects of oestrogen at receptor sites. (The same goes for cannabis – still illegal in Singapore, by the way!)
After the age of 30, testosterone levels in men normally drop by about one percent a year, leading to a relatively lower ratio of testosterone to oestrogen over time.
Top tips for balancing hormones
#1 Ensure good quality sleep so as to give the endocrine system a chance to optimise hormone levels.
#2 Choose food containing nutritional com pounds that enhance oestrogen metabolism, including:
- Vitamins B6, B12 and folate (vitamin B9) in meat, fish, eggs, nuts, seeds and leafy vegetables
- Indole-2-carbinol and diindolylmethane (DIM) in broccoli, cabbage, cauliflower and other cruciferous vegetables
- Omega-3 fatty acids in fish, eggs, avocados, nuts and flaxseed
- The mineral zinc in meat, shellfish, legumes and seeds
#3 Minimise soy products, which contain oestrogen-like compounds.
#4 Avoid bisphenol-A (BPA) used in plastic bottles and tin-can linings; it has an oestrogenic effect on the body.
#5 For the same reason, never heat food or drinks in plastic or polystyrene containers.
Male breast reduction – the surgical option
Breast reduction surgery is a cosmetic surgery that can improve the appearance and the shape of the male breast, by removing excess fat and breast tissue, through surgical incisions, liposuction or a combination of the two. Indicated for anyone who would like a flatter, more masculine chest, Dr Marco says it’s on the rise, and is fast becoming one of the most popular plastic surgery procedures for men.
“Men, as much as women, take pride in their appearance,” he adds. Especially over the past few years, he is seeing increased demand from men for plastic surgery to maintain and restore a youthful and healthy physique.
However, the decision to undergo gynaecomastia surgery is extremely personal, and each patient has to understand not only what’s involved, but whether the outcome will achieve his goals. Importantly, it’s a procedure that is customised to each individual patient.
Who is the ideal candidate?
The best candidate has realistic expectations about the possible results. He should:
- have enlarged breasts that cannot be treated without surgery;
- be 16 years or older;
- have a stable and relatively normal body weight; and
- be healthy, with no life-threatening illnesses.
What is involved?
The initial consultation is to discuss and explain the procedure and answer any questions or concerns. Dr Marco aims to “tailor treatments specifically to the male aesthetic,” he explains, “by considering male anatomy and the patient’s goals for treatment. Generally, the goal is to improve body image, self-esteem and confidence.”
Advances in medical techniques have meant minimally invasive procedures with minimal downtime. Where the main problem is excess fatty tissue, liposuction alone can be effective.
In cases where glandular breast tissue or excess skin need to be removed, surgical excision will be required. In cases of massive weight gain and subsequent loss, there may be pockets of excess breast fat and sagging skin. Again, surgical reduction – and sometimes liposuction alone – can work to achieve a flatter-looking chest. Any surgical treatment to correct gynecomastia will require incisions. The procedure takes from one to about three hours, and involves either general anaesthesia or intravenous sedation, plus local anaesthesia.
Most patients can return to work within a week. Strenuous activities should be avoided for three to six weeks, depending on your rate of recovery and state of health. Most swelling and bruising will disappear after three to six months.
It’s an outpatient procedure, and the result is both immediately visible and permanent – a chest that is more sculpted, contoured and flatter. The satisfaction rate is high, and Dr Marco’s patients generally report feeling more comfortable revealing their chests, with or without a shirt on. A good result can restore the desire to get out and interact with others, and many men find that they are more sexually confident than before.
This article first appeared in the July 2023 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!
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