Have you ever seen a man who, according to you, would be capable of filling a C-cup with his ‘ample bosom’? Or have you ever sniggered at the only man in the ‘power pump’ class too shy to remove his tracksuit top... Man-boobs may be more common than you think!
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Gynaecomastia (often referred to as 'man-boobs') is the enlargement of male breast tissue, and can happen in males of any age or weight. Obese men sometimes appear to have man-boobs due to the fat tissue all over their bodies, including their breasts, but this is not true gynaecomastia.
Gynaecomastia is very common in boys going through puberty, occurring in more than half of all normal adolescent males, but resolving itself in most cases. In older men, enlargement of the breast tissue happens in one- to two- thirds of men.
But what causes it? All men have the male sex hormone testosterone as well as low levels of the female hormone oestrogen which controls breast tissue growth. When the testosterone-to-oestrogen ratio changes (favouring relatively higher amounts of oestrogen), breast tissue can grow. Sixty to ninety per cent of newborn male babies have enlarged breast tissue because of the transfer of oestrogen from the mother during pregnancy. As these high levels of oestrogen disappear after birth, this type of gynaecomastia is only temporary.
As well as the natural hormonal changes that happen during puberty and ageing, gynaecomastia can also be caused by genetic problems, chronic diseases (especially of the kidney and liver) or various drugs. Men who take anabolic steroids to enhance their sporting performance or to help with body building often develop gynaecomastia. Very rarely, gynaecomastia can be caused by oestrogen-secreting tumours of the testes and the adrenal glands. Another possible cause is exposure over time to oestrogens that may be present in the environment.
Klinefelter’s syndrome affects one in every 650 males, and is the main genetic cause of gynaecomastia. Males with Klinefelter’s syndrome have an extra X- chromosome and do not produce enough testosterone for the body to function normally. Male physical and reproductive development is affected, and men with Klinefelter’s have small testes, are usually infertile and often develop gynaecomastia.
Men with Klinefelter’s syndrome have an imbalance in their oestrogen-to- testosterone ratio because they have low testosterone levels. Testosterone replacement therapy increases the amount of testosterone in the body, correcting the imbalance in hormones. The degree of gynaecomastia can be reduced, but often persists and may need surgical intervention.
A doctor can examine enlarged breast tissue to check whether it is gynaecomastia or excess fat. In true gynaecomastia, a rubbery or firm mound of tissue the same shape as the nipple can be felt. Once a diagnosis of gynaecomastia is confirmed, it is important for the doctor to review all medications the man may be taking which could be linked with the condition.
Whether further testing is needed depends upon the patient’s unique situation. A short history of rapidly enlarging and/or tender breasts and swelling in an otherwise healthy man requires the testing of sex hormone levels and a blood marker test for testicular cancer. If there are irregularities or lumps within the breasts, mammography and/or breast ultrasound may also be helpful. Biopsy of a suspicious lesion may be needed to exclude the rare but very serious diagnosis of cancer. Men with gynaecomastia have been known to be at more than twice the risk of breast cancer, as breast cancer is linked with conditions that increase the amounts of oestrogen in the body.
What are the treatment options? Treatments for gynaecomastia often depend on several factors, including the underlying cause, whether the condition is expected to continue and cosmetic concerns. Watching for further development is usually the preferred choice as in the majority of cases the condition goes away over time. If gynaecomastia has been caused by drug use, the enlarged breast tissue will usually reduce within one month of stopping the drug. Surgery can also be useful in the management of long- standing gynaecomastia or when drug treatments have not been successful.
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