Dear Dr. G,
I am a 52-year-old and have been married for many years.
We have two grown up children and generally happy with our lives.
Although I am not in my fittest of health, my blood pressure, sugar and weight seems to be under control with medications.
Perhaps one thing that I have noticed recently and upset with myself is that I started growing a pair of moobs (Man Boobs).
I am beginning to also notice my breasts have grown a lot compare to the past.
My family and colleagues are making fun of me, saying I “need” a pair of bras.
Although I laughed and brushed off the “wife bra sharing” jokes, I still feel embarrassed and get very moody with the changes in my body.
Don't get me wrong, I am not the metrosexual man who moisturises and obsessed with their look. Truthfully, I am also worried about breast cancer in men.
My doctor tells me this is called gynecomastia and it is related to hormonal changes. Does that mean I am having male menopause?
I know I may miss Pink October to address issues of breast cancer, but I still hope to put Dr. G on the spot about my man boobs.
What are the causes of gynecomastia? Whys is this happening to me?
Can I get rid of them with medicine? Or are there surgeries that can rectify the problems.
I read somewhere men can get also get breast cancer, are the man boobs the early signs of breast cancer?
Finally, these moobs are really affecting my self-confidence. Do you think I should have an operation to get rid of them?
Man Boobs Bob
The excessive growth of the male breast tissue is the most common benign disorder of the male breast, also known as gynecomastia. Common slangs or derogatory terms such as man boobs or moobs are often used, which can cause tremendous distress in self-conscious men. Gynecomastia is generally caused by endocrine disturbances, which can be physiological in the different stages of a man’s life. Newborn gynecomastia occurs in almost all male infants, and resolves naturally. Persistent adolescent breast swelling is documented in 70% of teenage boys, which can be a source of embarrassment and distress, in addition to other growing pain.
Gynecomastia can involve one or both breasts. Man boobs are also commonly found in men above the age of 50, known as senile gynecomastia. The prevalence of senile gynecomastia is believed to be under-reported, although it has seen a rise in recent years. The exact cause and the epidemiology are not fully understood. The utilisation of anabolic steroids, pesticides and plastics that mimics the estrogen has been widely implicated.
In older men, gynecomastia is thought to be associated with the natural decline in testosterone. Although gynecomastia is generally not life-threatening, the swellings in the chest can cause mild discomfort, emotional embarrassment amongst affected men and heightened anxiety about breast cancer. Breast cancers indeed affect men too, but this is exceedingly rare.
Male breast cancer is generally quoted to constitute about 1% of all breast cancer cases. It is estimated about two thousand new cases of male breast cancers are diagnosed in the US. The incidence of such cancer is rising, perhaps attributed to the genetic testing in female family members affected by the cancer.
The pathogenesis of such cancer is similar to female breast cancer, the etiology are predominantly hereditary genes of BRCA mutation, radiation exposure and alcohol abuse. The lack of awareness generally would delay seeking medical attention. Besides, the development of male breast cancer is generally less contained, as the lesion has less tissue to infiltrate before spreading. On that basis, the presence of excessive breast tissues in men with gynecomastia is arguably protective!
Gynecomastia is treated conservatively in most men, as they pose no medical or oncological threats. Men with mild cases of man boobs can rest assure and are advised to exercise while adopting a balanced diet. Moderate or severe cases may require medical or surgical interventions. There are medications prescribed to tackle gynecomastia in an “off label” basis. These are the same medication utilised for breast cancer such as tamoxifen. However, the success in the breast tissue reduction with the medications is not consistent. Radiations and surgeries, such as liposuction and mastectomy have also been carried out to help men cope with such embarrassment. However, the interventions are invasive and may not get the optimal results in many men.
We are leaving the month of Pink October Breast Cancer Awareness Month, and venturing into Blue Men’s Health November, when many more serious Men’s Health topics will be put in the limelight. While outlining rare breast cancer risks in men, it is also crucial to highlight the psychological impact of man boobs affecting certain men. Many men are troubled by the sight of protruding sagging chests, and quest for the perfect physique. It is natural to be tempted by the quick fix and surgical modifications. In reality, a healthy lifestyle and regular exercise are often the solution for balanced hormone to sustain the firm chest. Stay tune for more Men’s Health Matters in the Month of November (onlymencan.com).
Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. This column is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at firstname.lastname@example.org