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The Vigilant Hypochondriac

The Vigilant Hypochondriac: Okay, so you've got man boobs; now what?

A man who obsessed over female breasts when he was young may start to obsess about his own when he gets older. As his testosterone declines with age, allowing the estrogen in his blood to assert itself, he may find the female hormone stimulating the growth of genuine breast tissue, the kind that inspired Kramer, in a memorable episode of Seinfeld, to invent the Bro, or Manzierre: a bra for men.

This condition, known as gynecomastia, may develop in pubescent boys and in weightlifters who take supplements that affect their hormones, but older men are particularly vulnerable, especially if they've packed on a few pounds. The extra fat not only amplifies the size of their breasts, it also encourages the production of more estrogen.

Some men find this very upsetting, according to Merle Yost, an Oakland, Calif., psychotherapist and author of Demystifying Gynecomastia: Men With Breasts.

"How they deal with it has everything to do with their sense of self-esteem and their relationships," said Yost, who developed pronounced breasts during puberty and endured ruthless mockery from classmates. "If a man has a good body image, and feels comfortable with aging, he probably won't think twice about it, especially if his partner is supportive, but if he is single and is relying on his body to be his calling card, it may cause significant psychological distress."

If gynecomastia is just starting, it may be possible to slow or even stop its development by losing excess fat, exercising, minimizing alcohol intake and the use of medications that contribute to the disorder. (Unfortunately, antidepressants known as SSRIs fall into that category, according to Yost.)

"Basically, anything that impairs the liver — alcoholism, hepatitis — can contribute to the problem," Yost says.

Once the breasts have enlarged, however, only surgery can reverse the condition.

Yost first had breast reduction surgery 15 years ago, when he was 33, and he was dissatisfied with the results.

"But the procedure has improved," said Yost, who had the surgery redone three years ago. "There have been big advances — different types of liposuction, different techniques for removing tissue and reducing the amount of scarring. Just go to a surgeon with a lot of experience."

The surgery usually involves a combination of liposuction and the removal of breast tissue, according to Dr. Jeremy Benedetti, a St. Petersburg plastic surgeon.

"Also, a breast-lift procedure," he says. "Any surgeon can remove breast tissue and do liposuction, but doing a breast lift in a man — that's where the art of gynecomastia surgery comes in."

The length of the surgery and the cost vary depending on the patient, according to Benedetti.

"Just removing breast tissue takes about an hour," he says. "Liposuction adds about an hour, and a breast lift adds another hour."

And the fee ranges from about $3,000 to $5,000.

Insurance seldom covers a male breast reduction, which is considered cosmetic, but Yost has heard of men who argued that the surgery was necessary to treat the breast tenderness that often accompanies gynecomastia.

"If you come at it from a pain angle — you have pain in your breasts and the only way it will go away is through surgery — insurance might cover it," he says.

You can reach Tom Valeo in care of LifeTimes, St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731, or at

about the feature

The Vigilant Hypochondriac explains what happens to the body as it ages and what can be done to preserve good health.

The Vigilant Hypochondriac: Okay, so you've got man boobs; now what? 07/27/09 [Last modified: Monday, July 27, 2009 4:30am]
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