How to know if your ‘moobs’ are killing you
As a teenager, my friend Lorin was regularly subjected to merciless teasing (“You’ve got girl tits!”) over a slight chest enlargement on his otherwise skinny frame. Sadly, men with even the faintest hint of ‘moobs’ have always been a source of amusement within my social circles – especially in my university years when the ‘droopy moobs’ of an unfortunate middle-aged lecturer would prompt muffled sniggers around the lecture theatre.
But with our ever-advancing understanding of how hormonal shifts can arise and affect our physiology, it has become increasingly clear that moobs are no laughing matter. A new study in the British Medical Journal has reported that men with enlarged breast tissue or gynaecomastia, to use the technical term, have a 37 per cent increased risk of death.
“We started looking at gynaecomastia in our clinic some years ago as an increasing number of patients were being referred to us,” says Prof Anders Juul, a clinical professor at Copenhagen University Hospital. “We found that very little research has been done on this topic. We consider gynaecomastia as a canary in the coalmine – reflecting some underlying disease or use of medication.”
Moobs can also impact mental health. Reports abound of the body confidence issues which they cause, and plastic surgery clinics have reported increasing numbers of men looking to treat the problem by going under the knife. According to the London-based cosmetic clinic Karidis, the number of men showing interest in gynaecomastia surgery has increased by 45 per cent since 2019.
Having seen many patients with the condition, Dr Omar Tillo, a clinical director at the CREO Clinic, says that the psychological impact of moobs should not be underestimated. “The majority of people we see have some kind of moderate protrusion that sticks out under their T-shirt, making them self-conscious,” he says. “They’re not comfortable taking their T-shirt off when swimming or going on holiday. They feel almost like they have semi-breasts.”
So why do moobs form, and what exactly is the link between them and your state of health?
The secret life of moobs
Research indicates that moobs are very common, affecting somewhere between 32 and 65 per cent of the male population. However, doctors say there is a critical distinction to be made between cases which simply reflect a general accumulation of body fat – known as pseudo gynecomastia – and those where the breast tissue has actually enlarged.
These latter cases are caused by an imbalance between the female sex hormone oestrogen – which men also have in low levels – and the male sex hormone testosterone, which drives sexual development during puberty.
Dr Ma’en Al-Mrayat, an endocrinologist at University Hospital Southampton NHS Foundation Trust, says that gynecomastia can occur at any age from newborn babies through to later life.
“Babies are exposed to high levels of oestrogen in the uterus and, when they’re born, there’s still a lot of it in their bodies,” he says. “This can cause an enlargement in the breasts which settles after a few months. Some adolescent boys can also have a surge in oestrogen due to the changes in puberty, so they develop this gynecomastia for two to three years and then it settles in their early twenties.”
In a minority of cases, ‘man boobs’ can be hereditary, however, the chances of developing genetic gynecomastia are extremely rare.
Doctors are more concerned about cases which occur in middle age and later life, as these reflect physiological changes taking place in the body, usually driven by the hormonal impact of obesity. Al-Mrayat explains that the layers of fat which men accumulate around the belly area can actively convert testosterone to oestrogen, changing the balance of hormones in their bloodstream and leading to the growth of breast tissue.
“Low testosterone levels are very common in men with obesity,” says Prof Pappachan Joseph, a consultant endocrinologist at Lancashire Teaching Hospitals NHS Trust. “Around 30 to 35 per cent of the population across the globe are now obese, and this causes male hormones to reduce, and some of those hormones will be converted to female hormones.”
However it is not just obese men who suffer from gynecomastia. There are other factors which can impact testosterone and lead to the development of moobs, even in skinny men.
The role played by drugs and stimulants
In his study, Juul found that men with gynecomastia who face the greatest risk of serious health problems are those where the hormonal changes leading to gynecomastia are being driven by the use of certain drugs.
These can range from prescription medications such as spironolactone, which is given to treat kidney disease, to the anabolic steroids some men use to quickly gain muscle, and recreational drugs such as cannabis and alcohol.
“As it breaks down in the liver, alcohol can actually generate oestrogen as a byproduct,” says Dr Sandhya Pruthi, an internal medicine physician in the Mayo Clinic Breast Diagnostic Clinic. “With steroids it’s the same concept, while marijuana is a drug which also can stimulate breast tissue growth through inducing various hormonal changes, although that’s not quite as clear-cut as alcohol and steroids.”
Other consequences for health
In some cases, there can be even more sinister causes for the sudden appearance of moobs, such as an underlying cancer. Around 400 men are diagnosed with breast cancer every year, and Al-Mrayat says that a sudden shift in hormone levels can be caused by testicular tumours. “Fortunately, these pathological cases are a very small fraction of all gynecomastia cases,” he adds.
There are also some associations which scientists do not yet understand, such as Juul’s finding that men with gynecomastia are more vulnerable to liver disease. “Men diagnosed with gynaecomastia have a five-fold increased risk of dying from liver disease,” he says. “Why is that? I do not know. More research is needed to unravel these associations.”
Doctors also report that men can experience pain through the development of moobs. “Pain is the biggest complaint that I hear from patients,” says Pruthi. “It hurts them, especially when they touch this extra tissue filling up the space between their chest wall muscle and fat – tissue which is causing pressure.”
What can you do about moobs?
Al-Mrayat says that the initial step is to identify and remove the potential trigger which seems to be causing the problem, whether that’s quitting a particular drug or shedding excess belly fat.
While Men’s Health magazine recommends chest exercises as a potential solution, Al-Mrayat says this will not completely eliminate the problem – and some men with gynecomastia notice that exercise in fact makes the condition look worse.
“Any form of exercise will help in terms of reducing body mass index,” he says. “It will possibly make some muscles more prominent and as a result, the gynecomastia may look proportionally less”.
Sometimes doctors will prescribe medication, in particular a tablet called tamoxifen which is more conventionally used as a breast cancer drug in both men and women. It works by reducing the effects of oestrogen on the tissue in the chest region.
“It’s only given for a short period, around three months, and some patients can benefit from it,” explains Al-Mrayat.
The final and most extreme option is some form of plastic surgery, which is offered by various private clinics. According to Tillo, who often performs these procedures, costs can range from £2,000 up to £10,000 depending on the complexity of the individual case.
“The simplest option is liposuction to get rid of the fatty part of the gland and reduce the volume,” he says. “But in very extreme cases, it can be like doing a mastectomy on women. You have to cut the whole skin of the chest to remove the tissue, leaving a long scar. That requires general anaesthetic and it’s a big surgery.”
The only way you can find out if your moobs are a health threat is by seeing a GP, especially if the area is very painful or there’s an obvious lump. As moobs can sometimes be linked to serious conditions, it’s worth getting yours checked.
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