Medical condition can devastate males

Justin's* idea of fun never involved going swimming with anyone else. Summer days were never spent shirtless in the sun. Instead, he wore double layers of clothing as camouflage for the medical condition haunting him. He's lived with the condition since puberty: gynecomastia, or the abnormal development of breasts in men.\nThe condition affects a wide variety of men with virtually no restrictions on age. Newborns might develop it from the surge of estrogen entering through the placenta. In preteens and teens, it can result from a temporary hormonal imbalance, or puberty. And in older men, it occurs as age affects the production of testosterone, letting the estrogen catch up.\n"Living in a society where perfection and beauty is celebrated, having breasts is tough to deal with and extremely damaging to one's self-esteem," said Justin, a 23-year-old from Portsmouth, N.H., who has struggled with gynecomastia ever since his teenage years, when his breasts were formed as a result of puberty.\nLike many men, Justin felt gynecomastia was an extremely tough subject to talk about and has spent his life living in silence about it. He said he always knew there was something wrong but didn't know what. His parents were out of the loop because he said they wouldn't understand. And his doctor said the symptoms were part of puberty and that they would go away -- but that wasn't the case.\n"Relationships became difficult since you yearn for someone to be with yet are scared of what they will think during intimacy," Justin said of his struggle with the condition.\nGynecomastia occurs when more estrogen surges through a man's body than testosterone. While obese men can have fatty tissue deposits, it isn't the actual forming of breast tissue by the body, as is the case with gynecomastia.\nJust like a woman, the size of breasts developed due to gynecomastia is unpredictable. A man can walk around with breasts the size of a quarter all the way up to a set that would rival Dolly Parton.\nGynecomastia in this sense is when actual breasts are formed because of rise in the body's estrogen levels.\nDr. Jonathan Stafford, a radiologist with a private practice in Bloomington, said many times the estrogen levels in the male body are out of control due to side effects from some prescription drugs. He gives out a sheet of paper naming many of the prescription drugs to his patients. The drugs include blood pressure pills, anti-depressants, cholesterol drugs and others.\nPrescribed drugs are processed by the liver -- and so is estrogen. When people take these kinds of medications for long periods of time, the liver has to devote so much energy to process those medications that it can't spend as much time breaking down the estrogen the body produces. Without the work of the liver, the estrogen isn't digested, the level rises, and breast tissue begins to form.\nMen notice gynecomastia in a number of ways, but Stafford said they usually detect it themselves because most family doctors just don't think to even check men for the problem. And since routine breast examination isn't part of a man's routine health exam, men probably aren't going to notice anything strange unless the breasts are noticeably larger or they feel a lump. Stafford said at that point, if and when a man goes to his doctor, the doctor usually sends him along for proper diagnosis by mammogram or ultrasound.\nStafford's practice at the Bloomington Breast Center sees anywhere from 3,500 to 4,000 patients each year, and of that number only about 500 are diagnostic exams. Of those 500, only 10 to 15 are men, and 100 percent of those men are diagnosed with gynecomastia.\nSo if gynecomastia simply means a man has grown some breast tissue and it was caused by factors altering his estrogen levels, how is it treated?\nIt isn't easy.\nDr. Richard Spark, an endocrinologist at Harvard University, said a plastic surgeon can use liposuction to remove the fatty breast tissue if it's a case of obesity-related gynecomastia. But this procedure often leaves quite a lot of loose tissue hanging from the chest. The only way to treat estrogen-caused gynecomastia and remove the excess breast tissue is to have it removed by a plastic surgeon. Spark said this procedure is considered cosmetic and is not typically covered by medical insurance. Uninsured, the surgery can cost upwards of $3,000.\nWhile gynecomastia seems simply a cosmetic flaw on the surface of the body, the flaws it can leave on someone's self-image are really more serious. Especially in Justin's case.\n"Changes in what you wear is one of the biggest things involved with the condition. You try to hide it as much as you can ... " Justin said. "Swimming and beach days I often skipped out on, saying I couldn't swim."\nStill, no man should ignore the possibility that he, too, could have to take a swim in Justin's suit someday.\n-- Contact staff writer Brandon S Morley at bmorley@indiana.edu.\n*Last name withheld to protect the source's privacy.