Dear Dr. G,

I’m a 42-year-old who has been married for many years. After the pandemic, I admit I’m not in the best shape, but my blood pressure and blood sugar levels are under control with medication. Since gaining weight, I’ve noticed I’ve started developing “moobs” (man boobs). My wife has also noticed that my chest has grown compared to before. Family and colleagues joke that I need a bra, and while I laugh it off, I feel embarrassed and self-conscious about these changes.

I’m not someone who is overly concerned with appearance, but I find it unsettling for men to develop breasts. My doctor explained that this condition, called gynecomastia, is linked to hormonal changes. I’m concerned because I thought I was too young for such changes.

What are the causes of gynecomastia? Can this be part of aging process?

Can I get rid of them with medicine? Or are there surgeries that can rectify the problem.

Finally, these moobs are really affecting my self-confidence. Do you think I should have surgery to get rid of them?

Yours truly,

Booby Bob

The excessive growth of the male breast tissue is a common benign disorder also known as gynecomastia. Common slangs or derogatory terms such as man boobs or moobs are often used, which can cause tremendous distress in men. Gynecomastia can involve one or both breasts. Such excessive growth of breast tissue is generally caused by endocrine disturbances, which can be physiological in different stages of men’s life.

Nearly all male newborns develop gynecomastia and typically resolve 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.

Another physiological cause of breast tissue growth also commonly affects men above the age of 50, known as senile gynecomastia. The prevalence of senile gynecomastia is believed to be under-reported. In older men, gynecomastia is thought to be associated with the natural decline in testosterone. The rise in prevalence of gynecomastia in recent years is not fully understood. The use of anabolic steroids, pesticides and plastics that mimic estrogen has been widely implicated.

Other causes of gynecomastia can be due to organ failure. Men with liver impairment or cirrhosis can result in defective hormonal metabolism. This is a well-established cause of gynecomastia. Apart from poorly functioning liver, renal impairment, testicular failure and hypothyroidism can also directly and indirectly affect the testosterone and estrogen balance in men. This can lead to excessive breast tissue growth.

Certain medications are also well recognised to induce excessive breast tissue growth in men. These include cardiac medications such as digoxin. Other common medications such as antifungal and antibiotics may also interfere with liver function and sexual hormone metabolism. Lastly, medications that directly impact testosterone production such as 5 alpha reductase inhibitors utilised for hair growth and prostate enlargement will also directly suppress male hormone production and inducing male breasts.

Although gynecomastia is generally not life threatening, the swellings in the chest can cause mild discomfort and emotional embarrassment amongst affected men and heightened anxiety about breast cancer. Breast cancers indeed affect men too, but this is exceedingly rare. However, in some rare cases of gynecomastia, the etiology can derive from hormone producing cancerous cells, especially in the testicles.

Gynecomastia is generally treated conservatively, as they post no medical or oncological threats. Men with mild cases of man boobs are assured and advised to exercise with a balanced diet. Moderate or severe cases may require medical or surgical interventions. There are medications prescribed to tackle gynecomastia on an “off label” basis. These are the same medications used for breast cancer such as Tamoxifen. However, the success in breast tissue reduction with the medication is not consistent.

Radiation and surgery, 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.