If you’ve caught the movie Fight Club, you might recall the ex-wrestler and bodybuilder (remember the rallying call, “His name was Robert Paulson”?) who developed breasts caused by steroid abuse and testicular cancer.
But unlike Paulson’s pendulous pair, most cases of gynaecomastia or enlarged breast tissues in boys or men are “a rubbery or firm mass that starts from underneath the nipple and then spreads outwards over the breast area”, according to the Singapore General Hospital (SGH) website. And there may be accompanying discomfort or tenderness.
Although man boobs may feel different from women’s, all breasts consist of fat, connective tissue, glands and ducts, said Dr Mok Shao Feng, consultant endocrinologist with the National University Hospital (NUH). “In men, the excessive growth of the same glandular tissue (that is, the glands and ducts) results in the enlargement of the breasts, giving rise to gynaecomastia,” he said.
Hormonal disruption can be one of the causes of male breasts – and it needn’t be caused by substance abuse, like Paulson.
Gynaecomastia may affect just one instead of both sides of the chest.
“Medications, organ damage (for instance, kidney or liver failure) or some rare forms of cancers may lower the levels or activity of the male hormone testosterone. Or they may elevate levels of the female hormone oestrogen in the male patient,” said Dr Mok.
Weight gain is the most common reason why men grow boobs. But it isn’t just because of the increased fat; there’s also a hormonal link. Being overweight may increase a man’s levels of oestrogen, which can cause breast tissue to grow, noted the UK health website NHS.com.
However, Dr Mok termed such weight-related cases as pseudo or false gynaecomastia. “The distinction can only be made by a doctor via physical examination of the breast. Sometimes, an ultrasound scan may be necessary to confirm the diagnosis,” he said.
And yes, it can be “breast” as gynaecomastia may affect just one instead of both sides of the chest, according to NHS.com.
EVEN MALE NEWBORNS CAN GET BOOBS
Males of any age can develop man boobs, even newborns, according to the SGH website. Male babies may have high oestrogen levels at birth as the hormone passes through the placenta from their mothers to them. However, this is temporary and will disappear a few weeks after the baby’s delivery, noted the website.
By and large, the majority of patients tend to be boys “at about 18 to 21 years old” and “almost all are puberty and obesity related,” said Professor Lee Kok Onn, senior consultant at NUH’s Division of Endocrinology.
Dr Mok added that for these adolescents, the boobs are caused by puberty’s fluctuating testosterone and oestrogen levels, and “usually resolve spontaneously within six to 12 months”.
Usually, teenage man boobs clear up on their own after the hormonal levels stabilise. They are uncommon beyond the age of 17 years, as mentioned on the SGH website.
All races and all lifestyles can be affected, and the main factor is the excess fat tissue in the chest.
But the risks of developing male breasts aren’t limited to this stage in life. “All races and all lifestyles can be affected, and the main factor is the excess fat tissue in the chest,” said Prof Lee. “It can be from the fat redistribution that happens with ageing and a decrease in activity. This can happen as early as 60 years old.”
The most extreme case that Prof Lee has encountered is a male patient with cup D-sized breasts. And if you’re wondering, man boobs aren’t measured in terms of bra sizes. At least not medically.
Fat redistribution aside, men also produce less testosterone with age. This, coupled with more oestrogen from the accumulated body fat, means another round of hormonal upheaval that can cause excess breast tissue growth, according to the NHS website.
WHEN SHOULD YOU SEE A DOC?
Man boobs are less reason to be concerned with if they occur during late puberty or in someone in his 70s who used to be overweight, said Prof Lee. Having said that, it is not usual for males to develop gynaecomastia, he added. “It is always good to see a family doctor if a man is worried, no matter his age.”
If no medical condition is behind the breast development and the patient isn’t too bothered by their appearance, the doctor may advise to leave them be, said Dr Mok.
“There is currently no evidence to suggest that gynaecomastia alone raises the risk of breast cancer. Breast cancer is generally rare in men and accounts for less than 1 per cent of all breast cancer worldwide.”
However, there is cause for concern if there are symptoms such as pain and/or rapid breast enlargement with “distinct and hard lumps which may suggest underlying cancer disease”, said Dr Mok, who urged them to seek early medical attention.
The treatment depends on what the medical cause is, continued Dr Mok, who explained that surgery is usually the last resort. “For example, men found to have inadequate testosterone levels may receive testosterone replacement.
"If excessive oestrogens are found to be contributing to the problem, the patient may be prescribed oral tamoxifen to block the effects of the hormone. Tamoxifen is the same medication used in some female patients in the treatment of oestrogen-sensitive breast cancer.”
According to the SGH website, up to 50 to 80 per cent of patients have managed to partially reduce their breast size with such medications. The website also mentioned that when surgery is used, the breast is either partially or completely removed while preserving the nipple and the overlying skin. Liposuction may or may not be used.
“Since many men present with pseudo gynaecomastia related to obesity, the best prevention is weight management with regular physical activities and a balanced diet that provides calories to match the patient’s daily requirements,” said Dr Mok.
However, Prof Lee warned that if the diagnosis is true gynaecomastia, surgery may be the only viable way as there isn’t much that weight loss and medicines can do. “Gynecomastia usually consists of a mixture of fibrous tissue, fat tissue, and some glandular tissue, so exercise will not help.”
And gents, like women's breasts, man boobs can also worsen with time and gravity, said Prof Lee.