I’m fortunate to have treated several thousand patients with gynecomastia surgery at the Austin Gynecomastia Center. Beyond the physical symptoms of gynecomastia, there simply isn’t much scientific research addressing the true cause of this condition, other than the basic observation that almost all patients have an imbalance of the sex hormones estrogen and testosterone. One of the most common questions I get asked deals with the relationship between gynecomastia and fat. Often, the confusing term pseudogynecomastia comes up.
What is the incidence of gynecomastia in obese men? Does gynecomastia go away with weight loss? What is the cause of gynecomastia in overweight men? What is the treatment of gynecomastia in overweight men? What is pseudogynecomastia? If the term pseudogynecomastia means a female-looking breast in an overweight man caused by excess fat, why does it not go away after weight loss? Is there something else that is happening in the chest area of overweight men other than fat accumulation?
In morbidly obsess men, testosterone levels tend to be lower than average, while estrogen levels are higher. We can measure this in their blood. Theoretically, there is peripheral conversion of testosterone to estrogen that is accelerated in those who are obese.
More fat = more conversion of testosterone to estrogen = an imbalance of the “normal” ratio seen in men = ideal environment for the development of gynecomastia.
All men have some breast tissue beneath their nipple-areola complexes. This tissue is unique and unlike normal fatty tissue elsewhere throughout the human body. This tissue is sensitive to changes in the testosterone-estrogen balance. In men, testosterone predominates and the tissue does not grow. In women, estrogen dominates and their breast tissue grows, leading to the appearance of fuller breasts. In men, this tissue can grow with exposure to excess estrogen and cause gynecomastia. Not in all men, but in some. Cases due to hormone imbalance can vary, as tissue can have varying degrees of sensitivity to estrogens.
Based on this understanding of how hormones work, you can imagine that as a man accumulates more fat, there is more conversion of testosterone to estrogen and that this can stimulate their chest tissue to grow, in addition to the accumulation of normal fatty tissue in the chest area. Over time, this tissue becomes stable gynecomastia tissue that doesn’t change with weight loss. Imagine that during weight loss the normal fat is lost but the stable gynecomastia tissue remains. This helps explain why thousands of emails that I get from all over the world are from guys who have heard the term pseudogynecomastia and who had lost weight but are perplexed by the remaining chest fullness. In many cases, this makes the gynecomastia appear more pronounced, as it is no longer camouflaged by the fatty tissue elsewhere.
You can certainly make the argument that obesity is a risk factor for developing gynecomastia. Unfortunately, diet, exercise and pills will not make it go away. The only known definitive treatment for gynecomastia is the removal of the offending tissue. This is our only hope to live a life without the mental burden that is associated with gynecomastia. If this sounds like you, it’s in your best interest to find yourself a qualified gynecomastia surgeon and put an end to it.