Help, I am a man with big breasts

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.