The most common cause of gynecomastia seen at the AGC is residual chest fullness that doesn’t go away after puberty as it usually does in 85 percent of males. This is a bummer. It’s particularly difficult for a growing boy who is learning about life and sexuality between the ages of ten and 15. During these years, it becomes quite clear to them that having breasts is associated with girls, not boys. It won’t be long before they realize that they are different and that their peers are noticing this difference and even calling them out on it. This sets the stage for the “mental anguish” characteristic of gynecomastia that can lead to maladaptive behaviors.
The second most common cause of gynecomastia is the overuse of prohormones and hormones in body builders and those who believe hormone use will combat the effects of aging. These hormones and supplements are directly related to the sex hormones that we all have or they are converted to them by the body into sex hormones. Though the pathology and rate of occurrence are unknown, some users develop gynecomastia from hormone use. Popular magazines and websites for bodybuilders and bikers sometimes discuss techniques to prevent gynecomastia development, but there is no scientific evidence. There are no published studies by scientific researchers to help provide us with guidance regarding the benefits and risks of these hormone supplements drugs, or how to use them safely.
Gynecomastia that develops from the use of prohormones is typically quite different than gynecomastia that develops at puberty. The tissue is more glandular rather than fibrofatty. From the patient’s perspective, glandular tissue is firmer, well-localized beneath the nipple-areola complexes and can be easily felt as a discrete mass. To make matters worse, it’s common in patients who are typically in good shape, which makes it more obvious to see, even while clothed. You have a situation where a man has a sculpted, masculine outline with what appears to be female breasts. This contrast is confusing, embarrassing, humiliating, frustrating and only leads to mental anguish.
If this happens to you, what are your options to treat it? As I have learned from many patients at the AGC, hormone-induced gynecomastia shows up pretty quickly after starting them. The breast becomes larger, the tissue is more easily felt and it can cause great pain or discomfort. This is because the hormone supplements stimulate rapid growth of breast tissue. Once the tissue has been “worked up” by these chemicals, the process of proliferation or enlargement is set in place and even if you stop taking the hormones, the process continues for some time. This inflammation of the tissues is what can cause the pain and discomfort.
Other hormones like anti-estrogens can be taken to theoretically resist this growth, but it is unlikely to adequately halt the process or make the mass go away. It may get smaller but you will almost certainly have some residual fullness. Taking hormones to counter other hormones sounds reasonable to most people but there are no medical studies that support this. You are basically on your own when you are in this situation unless you seek the advice of a Board Certified Endocrinologist who is a real doctor with expertise in all things hormone-related.
Often, patients who have gynecomastia from using prohormones suffer alone, or they share their experience with a select few in their body building community who have some experience, or they turn to the Internet. In all cases, they will find recommendations and suggestions galore, lots of pills to take that promise relief, but ultimately the persistent gynecomastia can only be cured with a procedure to remove the mass because the tissue growth eventually “burns out,” becoming fibrotic and unresponsive to any chemical treatment. In addition, it won’t respond to diet or exercise because it is simply a rock that sits behind the nipple areola complex. And just as a rock in your shoe can bother you all day, the only way to take care of the problem is to remove it, plain and simple.
The treatment of gynecomastia from prohormones can be a bit different from that provided to males who suffer from gynecomastia related to puberty. Aside from being firmer and more glandular, the tissue in hormone-induced gynecomastia is often stuck to the skin above and the muscle below, with very little fat. In other words, there is less room for error. The procedure must be exacting and precise: more care needs to be taken to remove the gland and more focus needs to be placed on making the final result smooth and even. The goal is to have complete removal of the gland so that there is no remaining mass or tissue that can grow in response to future hormones. This sounds simple, but it took me several hundred cases to become unwaveringly confident in my ability to achieve all of these goals.
The history of the Austin Gynecomastia Center has always been focused on patient education and treatment of this condition, especially the mental consequences. No one should be treating this condition if they don’t also understand the psychological issues involved. The goal of gynecomastia treatment is to remove the gynecomastia, to contour the chest, and to help patients fully recover from the mental burdens of this condition so they can live normal lives. I research the psychological aspects of gynecomastia, as I hope one day to answer the most fundamental questions regarding gynecomastia and to develop the most appropriate therapy for both the body and the mind.
Despite the fact that I have educated patients for years that established gynecomastia is ONLY treated with a surgical procedure to remove it, they continue to experiment with Internet remedies and use diet and exercise as the first line of treatment. There is a false yet persistent belief that anything is better than surgery. If it were possible to cure gynecomastia by any other means than surgery, I would not be offering this treatment. I have spent much of my time perfecting the art of gynecomastia treatment with surgery so that the downsides to treatment are dwarfed by the upsides of treatment. At the AGC, treatment is fast, effective, affordable, with low risk of complications and a high satisfaction rate.