Help, I am a man with big breasts

Weight gain in the chest area in men can sometimes resemble breasts and is usually a result of obesity.

What you need to know:

For most men with enlarged breasts, this condition reeks of embarrassment. Some experts have also attributed it to rising levels of female hormones in the environment.

Dear doctor: I have big breasts and want to know if it is curable. If it is, where can I get the treatment from? I have had them since I was 11 years old. They told me they would eventually disappear within a year or two, but this has not happened. I am now 20 years old and I still fear looking at my reflection in the mirror. What can I do to get rid of these enlarged breasts?

Martin O.

Development of breasts in men (gynaecomastia) can be a source of great distress in adolescent boys especially so when the breasts produce milk.
Breast prominence can result from increase in breast tissue, chest skin or fat tissue or a combination of all of them. Today, many boys have big breasts because of obesity with excessive fat in the breast area (pseudogynaecomastia).
Gynaecomastia can occur physiologically in newborns, adolescents, and in the elderly due to related imbalance in sex hormones. Female hormones (Oestrogens) lead to development of breast tissue and male ones (testosterone) suppress this. If male hormones reduce as it happens with ageing, castration and obesity (fat changes male to female hormones) or female hormones increase, breast development inevitably occurs.
In adolescence, gynaecomastia is common and may affect one breast which may even be painful. It usually disappears on its own within one to two years.

As puberty sets in, there is a rise of both male and female hormones at the same time though there is a much bigger surge of male hormones compared to the female ones.
However, if there is a relatively delayed male hormone (testosterone) surge in relation to the female ones (oestrogen) or a temporary increase in aromatase enzyme activity gynaecomastia results. Aromatase enzyme occurs in many tissues but is much more in fat tissue so that obese adolescents are likely to have much more increased aromatase activity.

Aromatase enzyme converts male hormone into the female one.
Breast enlargement, therefore, is mostly benign requiring only counselling.
That said, the enlargement has to be investigated and addressed appropriately according to the cause.
Where gynaecomastia is related to puberty but not due to obesity, the breast development shrinks or disappears with time. With obesity, one has to cut weight to reduce the problem, but one may never regain a flat chest.
In case the breasts do not shrink hence causing much distress, surgery to remove excess breast or fat tissue may be appropriate.

Investigations of the cause will include, side effects of medication, such as anti-ulcer drugs or medication for heart disease, illegal drugs, such as cannabis or anabolic steroids, drinking too much alcohol, a health abnormality, such as kidney failure or liver disease, Klinefelter’s syndrome - a rare genetic disorder, and lumps or infection in the testicles. These however, usually cause gynaecomastia beginning in adulthood.
You need to know the condition is not unique and can be treated .You should approach any health centre for help.

Dear doctor: I have had a persistent cough for the last five years. It is dry and even with medication; it goes for a few days only to resurface. What bothers me is that when I am in a lift with others or a taxi and the windows are closed I tend to suffocate. I also get chest pain. What could be wrong?

Malinga Tolbert

Cough, much as we may not like it, is one way the body naturally expels mucus laden with germs or irritants from the airway so that it does not interfere with breathing.
This is why people may cough out mucus. Since breathing is an important body function, without which we cannot survive, the airway is sensitive to the contents of the air we breathe.
This is the reason why even without mucus if the airway detects anything in the air it deems destructive to the body, one will cough to deny this air entry.

Sometimes, the airway may cause cough under the false impression that the air contents are dangerous. This may happen in some individuals but not everybody and this is called an overreaction or allergy.
That said, it is likely that you have an allergic cough, and this could be the reason why you have chronic cough.
Today, there are lots of coughs due to allergies. Such coughs may be confused with tuberculosis and cancer of the lungs.
Also asthma is on the rise and in many cases when it is mild, it is under diagnosed.

Feeling like suffocating when in a lift or taxi shows that you could be overreacting to breathing in stuffy air; that requires investigation by your doctor.
Chest pain with a cough and “suffocation” points to an inflammatory process in your lungs.
In such a case, you could be having allergic bronchitis or even mild asthma which comes with cough, wheezing and breathlessness and therefore requires to be checked out by a doctor.
Claustrophobia, the fear of confined places with panic attacks and breathlessness, should also be considered especially if you have a personality of worrying over small issues.

Doctor: I have a friend who started to discharge sperms last year and up to now he still does that. I am worried that this will cause him problems in future.

Anonymous
Sperm production in the testicles usually begins around 12-13 years of age and continues throughout life.
The number of sperms produced varies with the size of the testicles, but averages about 100 million sperm per day per testicle, and decreases with age.
Since a man releases between 200 to 600 million sperms per ejaculation, he will be able to release enough sperms for normal fertility even if he releases sperms every day.
However, most of the released sperms then may not be mature to cause fertilisation. It takes about 70 days for a single sperm to mature.

Low sperm count is the major source of male infertility. A man is considered to have low sperm count when he has less than 20 million spermatozoa per one ml of ejaculate.
Sperm production and fertility do not always follow mathematics and even if a man has few sperms due to everyday release, it is likely to improve with two or three days of abstaining.
Therefore, discharging sperms everyday may not be a problem but the way you do it may be the problem (if it is through unprotected sex with many partners or through masturbation).