Gynecomastia is diagnosed by the appearance of female like breasts in a male. The number 1 cause of gynecomastia is tissue leftover from the changes of puberty. The second most common cause arises from the use of hormones / prohormones and supplements in the body building or fitness community. Bodybuilders gynecomastia is distinctly different from all other forms of gynecomastia. The presentation and treatment are different, and I will explain how I manage these patients at the Austin Gynecomastia Center and how their gynecomastia surgery must be approached differently..
Do steroids and prohormones cause gynecomastia in bodybuilders?
A notable side effect of hormone used in bodybuilders is the appearance of gynecomastia. We do not know the number of cases of gynecomastia caused by steroids used in body building, nor do we know who is most likely to develop gynecomastia. The use of supplements and hormones in body building and fitness has not been rigorously studied regarding their effectiveness and safety and yet there is no lack of personal testimony and advice available on the Internet regarding these powerful substances. All my bodybuilder patients know a “guy at the gym” who is the “expert”. My advice is to exercise caution and common sense and fully appreciate that hormones, in general, are powerful medical substances that you need to respect.
How do steroids and prohormones cause gynecomastia?
One of the most notable unwanted side effects of steroid use is the development of gynecomastia. It is theorized that these unnatural hormones cause a local imbalance in the levels of estrogen and testosterone in the area of the nipple-areola complex (where both men and women have breast tissue), and this causes growth of tissue. This is particularly disturbing to body builders as their goal is the ultimate masculine form. The development of gynecomastia starts as a tingling sensation behind the nipples followed by pain and mass formation with puffy nipples. The use of estrogen blockers like Tamoxifen (Nolvadex) while cycling is not uncommon and its effectiveness in halting the development of gynecomastia is unknown (except by the “guy at the gym”).
Is gynecomastia in bodybuilders different from that of other gynecomastia patients?
Gynecomastia in bodybuilders is very different in appearance and treatment compared to the typical case. Body builders think they have a “smaller, less difficult case” than others they have seen on the Internet, but this could not be the furthest from the truth. They have a lot of gland and very little body fat. The tissue is very adherent on top of a large muscle and it’s often tender because of inflammation. Treatment is more challenging because it is harder to remove the adherent, vascular glandular tissue through a tiny incision at the areola border. There is also a lack of fat that I usually work with to ensure a smooth contour after mass removal. Surgeon experience is very important in the treatment of bodybuilder gynecomastia.
What is the best treatment for established gynecomastia in a bodybuilder?
Once gynecomastia is established and present for months, it will not disappear with diet, weight loss or medications. Additionally, contrary to rumor, exercise will not get rid of gynecomastia. I have educated the world on my experience that I have NEVER known a patient who had gynecomastia one day and it was gone the next with any treatment other than surgery. The best and only treatment for gynecomastia is the removal of the offending tissue. Highly experienced surgeons who care for gynecomastia patients routinely can remove this burdensome condition in short order with very satisfying results that are permanent. Recurrence of gynecomastia after appropriate surgical removal is extremely rare. The most common cause of gynecomastia recurrence is incomplete removal at treatment. At the AGC, my main objective is to remove ALL the tissue while sculpting a masculine chest my patients can be proud of (this may sound easy but it isn’t—that is why surgeon choice is critical to your personal success).