✍️ Why is Gynecomastia Underestimated?

When someone talks about a breast, the common mental picture one comes up with is a feminine figure, voluptuous and in all its angelic beauty. Surely, that’s regarded as the most intricate and mystifying creation. But that same divinity probably despised this partiality amongst the two sexes and endowed many men with a similar bosom. And this is the divine oversight that leads many men to explore the possible treatment for the illegitimate part of a male body.

Jokes apart, Gynecomastia or male breast as it is commonly referred to, is a serious issue. Gynecomastia is generally defined clinically as an enlargement of male breast tissue. It is characterized by the presence of a rubbery or firm mass extending diffusely and concentrically under the nipple and areola.

Most men with gynecomastia feel the presence of a firm to hard mass under their nipples during the puberty. Most notice it under their school uniforms. Many of them are subjected to jokes or ridicule and some even suffer various psycho-social issues. Many students start wearing loose-fitting shirts in this period hoping the gynecomastia gets noticed less. Many others try working out. I have noticed many students in their high schools or early college working out endlessly in the gyms trying to burn the ‘fat’ under the nipples. They sometimes overwork enough to get disproportionately bulky chest muscles as compared to the rest of the body. Some extreme cases of steroid injections and unhealthy dietary supplement intake are not uncommon.

It’s a common complaint from such a student’s parent during the period that their son’s self-confidence and outlook have drastically dimmed as he entered high school or college. Many attribute it to the academic stress or mental changes at puberty. It is further complicated by the fact that many such boys don’t talk openly about the male breast with their parents which leaves parents guessing what suddenly went wrong with the kid. This can interfere with very important group social activities, including swimming, playing sports, and participating in the gym.

One parent in 2014 met me with their son who was studying in 11th. They were worried about the sudden drop in his grades and his low self-esteem. They had taken him to a psychiatrist too. The boy was on medication as he did not fully disclose the issue to the psychiatrist. Only later did he reveal gynecomastia to his father who in turn got him to meet me. The boy had in the last four years been under severe psychological impact apparently as his friends poked fun at him for his breasts. He started wearing loose-fitting shirts on top of a male bra. Yes, you read that right; a male bra.

The male bra is a compression vest that is used following surgical correction for a few weeks so that the surgical swelling reduces faster. Many misguided boys wear it under their shirts to compress the breasts hoping that it would not show up on top of clothes and also hope that wearing it long enough would make the gland disappear. Some others try bandaging, wherein they roll a tight and lengthy bandage or a cloth to compress the glands against their chest to hide it better. Some boys end up getting their skin damaged and even sustain rashes that have to be treated independently. The skin damage is due to tightness and subsequent skin irritation. The extent to which some men go to for correction of the breast is quite baffling; especially in these days where a simple google search reveals that surgery is the straightforward option.

In August 2018, a very important and systematic meta-analysis was published on the psychological impact of gynecomastia and surgery. Meta-analysis is like the analysis of many research projects under one umbrella. In such studies, various other research patterns and results are analyzed to give us a better and clearer understanding of the issue being researched. This study was published in the Gland Surgery journal by Martin Sollie from Denmark. They analyzed over 500 research papers on the topic. They too noted that gynecomastia impacts the general health, functional capacity, social aspects, vitality, and mental health of the individuals. And all these were significantly and objectively improved once it was corrected by surgery. This is a seminal piece of information on the often neglected psychological aspects of the male breasts. There are many more detailed and meticulous trials and studies that second this conclusion. 

Many studies have shown that the incidence of gynecomastia is highest during puberty. The percentages vary from 20-60%. Though this seems like a very high number, it does however give us an insight into the wide prevalence of male breasts. It’s not as rare as you think. There is also a wide difference in its occurrence among various races. Asians and Indians are perched right at the top of the pile, while Caucasians experience far lesser incidence of gynecomastia.

Now, it does seem strange that an issue that affects such a large populous is discussed so less among mainstream media and has so few books written on them. There is a visible lacuna and knowledge gap among the common men. They book endeavours to fill that gap as much as it can. As I go through, I would be discussing the various aspects of gynecomastia with special focus on the treatment. It goes without saying, if you have a gynecomastia, the least you can do is know what it is.