Important Men's Health News
M.E. Woltjer, PhD | July 30, 2009

Gynecomastia vs. Pseudogynecomastia

In an age when the number of obese Americans is continuing to grow, we are also hearing about a condition called gynecomastia, more commonly known as enlarged male breasts. For some men the increase in breast size is so great that it limits their participation in activities that will call attention to their breasts. But there is a difference between gynecomastia and pseudogynecomastia, both in terms of causes and treatment options.

It is typical to see breast size change in males periodically in their life. For example, male infants usually have pronounced breasts due to their exposure to their mother’s hormones while in utero. After a few months, their breasts generally slim down. We again can expect to see some increase in breast size during puberty when hormone fluctuations take place. If the adolescent male is not overweight, his breast size will revert back to that considered normal for a male once his hormones are in balance. Naturally, this experience can be difficult for a teenager who is focused on peer approval and his developing masculinity. If a boy is overweight to begin with, his breast size can be reduced through diet and an exercise program.

In men who are not overweight to begin with, gynecomastia (which means woman’s breast) is almost always caused by a medical condition or a medication the man is taking and should be checked out. Possible medical causes include testicular tumors, hyperthyroidism, Klinefelter syndrome, and certain diseases of the hypothalamus or pituitary glands. Other causes of breast enlargement in men are the abuse of anabolic steroids, heroin, marijuana, and alcohol. Some medications can also result in enlarged breasts. These include Dilantin, Amyloidal, Valium, and Tagament.

In gynecomastia the breast tissue itself has increased in size and amount. With pseudogynecomastia, the fat cells in the breasts have become more abundant, causing them to enlarge. It is referred to as “pseudo” because the larger breasts resemble those seen in a male with gynecomastia, but the cause is different. In obese people, regardless of gender, fat cells tend to accumulate more noticeably in certain areas of the body. One of these areas is the breast. Most obese males are not only packing on the fat cells, they are also developing actual breast tissue. Doctors say that virtually all obese men having a BMI of 30 or higher experience some growth in breast tissue. And once it is there, it doesn’t go away. If we lose weight, we will lose some of our breast fat, but not our breast tissue. Even if we focus exercises on building up the pectoral muscles lying under the breasts, the breast tissue will remain.

One of the reasons female hormones have been linked to the issue of “man boobs” is because it involves breast tissue, an area of the anatomy usually associated with women. But when you realize that estrogen and fat cells have a unique relationship, the issue of breast size and obesity takes on a new twist. Fat cells can release signals instructing your body to produce estrogen. In turn, the presence of extra estrogen in the body can cause fat cells to grow. Research is taking a look at the fact that some of this extra estrogen appears to be entering our body from the foods we eat. The use of growth-enhancing hormones mixed in food fed to cows is just one way this has happened.

There has also been some attention given to foods containing phytoestrogens (plant-produced estrogens), such as soybeans. While soy is very similar in chemical structure to human estrogen, it is weaker. The relationship of fat-estrogen-food is a complex one and it would be a knee-jerk response to eliminate such a healthy food as soy from our diets until we learn more. In fact, endocrinologist Eugene Shippen, M.D. states that soy food acts as a weak anti-estrogen by competing with the hormone, estrogen, for receptor sites in the body and, in this way, blocking their action. Also, individuals whose estradiol level is too low will feel fatigued and it can interfere with metabolism. So, while soy products could produce excessively high levels of estrogen in some men, this is generally not the cause of breast fat and breast tissue in most men.

According to a recent John Hopkins study, it is estimated that 75 percent of Americans are going to be overweight by 2015. If we don’t take steps to correct this upward trend, the issue of “man boobs” will be the least of our problems.
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