Gilbert's syndrome

Big breasts are a nice place to visit, but you wouldn't want to live with them.

Not personally, that is.

Gynecomastia, which translates literally as "woman's breast," is the benign enlargement of male breast tissue. It's an age-old problem. Aristotle wrote about it, and accounts of surgery to correct gynecomastia date back to the early Christian era.

Then and now, it's the leading breast disorder in men. Natural or drug-induced hormonal imbalances cause a flat pad of glandular tissue to grow for a short time beneath the nipple, resulting in swollen and sensitive breasts (or breast; the condition can be one-sided).

NATURAL FORMATIONS

About half of all reported cases of gynecomastia occur naturally and sometimes temporarily, explains Mark Solomon, M.D., a plastic surgeon in the Philadelphia area. Familial cases usually occur at birth, at puberty due to hormonal shifts, or in older men as part of the aging process. Some men with fat deposits on their chests are mistaken for having the condition, but such examples of "pseudogynecomastia" are merely symptoms of obesity.

In rare cases, gynecomastia may be a side effect of medications, and it's been tenuously linked to marijuana abuse. It may also be the result of HIV disease, chronic liver disease, or certain genetic disorders such as Klinefelter's syndrome or Gilbert's syndrome.

ANABOLICS AND BITCH TITS

Most of the time, though, nonfamilial gynecomastia--or "bitch tits," as it's called in gymspeak--is a response to the use of anabolic steroids, which are synthetic derivatives of testosterone.

Legitimate medical uses for anabolic-androgenic steroids include treatment for androgen deficiency, chronic wasting diseases, conditions such as anemia and cachexia, and even certain musculoskeletal injuries. But steroids are frequently used informally--and illegally--to enhance athletic performance and muscle gain.

When anabolic steroids are introduced, your body attempts to counter the additional testosterone with a process called aromatization, which changes the configuration of male steroid molecules to that of feminizing hormones, principally estrogen. The higher estrogen levels will, sooner or later, cause even the most masculine among us to grow breasts.

"The higher the dosage and the longer the steroid cycle," says Solomon, "the better your chances for getting gynecomastia."

DON'T QUIT COLD TURKEY

Solomon advises against quitting steroids abruptly, because this method can backfire. Steroid use causes your testicles to shrink, hindering normal testosterone production. Stopping gradually allows the testicles to begin to heal and resume their normal function, but doing it cold turkey lets estrogen continue to dominate the system, resulting in breast growth.

Other side effects of anabolic-androgenic steroid abuse include severe acne, insulin resistance, hair loss, cholesterol elevation, testicular atrophy, and increased risk of prostate cancer. If substances are injected with shared needles, add the potential of hepatitis and HIV infection.

"Most male AAS users exhibit [at the very least] some combination of acne and gynecomastia," says Perry Koziris, Ph.D., an assistant professor of kinesiology and health promotion at the University of North Texas in Denton. "The paradoxical aspect of AAS abuse is that many abusers are otherwise health-conscious."

BLOCKING ESTROGEN

AAS users can also be well-informed. Juiceheads avoid gynecomastia by taking anti-estrogens such as Nolvadex or Proviron, or by exclusively using steroids that can't be converted to estrogen.

"Instead of stacking a second steroid during a cycle, I usually take an estrogen blocker," says Christopher, a 31-year-old New York City commercial painter and bodybuilder. "It doesn't prevent bitch tits, but--for me, anyway--my gains are bigger during that cycle. That's because the blocker is keeping the estrogen from curbing the effects of my testosterone production."

Although blocking agents won't reverse gynecomastia once it occurs, the condition is correctable with surgery. When properly done, the outpatient procedure leaves small, barely noticeable scars. An incision is made along the border of the nipple, from which the swollen glandular tissue is removed. Liposuction usually follows, returning a natural contour to the chest and increasing muscle definition. An elastic vest designed to aid in healing is worn for several weeks after the surgery, and most patients are able to return to training in about a month.

The cost starts at about $3,000, can easily double with ancillary charges, and usually isn't covered by health insurance.

"I know plenty of guys who think it's worth it to bulk up quickly, get the size, and then get their chest-reduction surgery after," acknowledges Christopher. "Ultimately, you have to decide whether you're going to risk your health by bringing on a bout of gynecomastia. Ask yourself, `Do I want a big man's body topped off with a woman's chest?'"

RELATED ARTICLE: Is it cancer?

Men who develop gynecomastia often fear that they are at higher risk for breast cancer. There is no confirmed statistical association between the two conditions, except when the gynecomastia is associated with cirrhosis or a chromosomal disorder called Klinefelter's syndrome. Genetics, high levels of estrogen (which can lead to gynecomastia), and radiation exposure are more established links to breast cancer. Some male breast-cancer patients have a history of testicular infection or injury. Breast tumors may also be the result of metastasis from primary prostate cancer.

In the United States, 1 percent or less of all breast cancer is found in men. For women and men, a hard, irregular, painless lump found by the patient is by far the most common symptom. Skin thickening, inflammation and ulceration of the nipple and areola are signs of malignancy.

Typically, lumps in the male breast can be felt, yet men with breast cancer are often diagnosed at a stage late enough to compromise treatment and recovery. This may be due to a general reluctance among men to consult a physician, especially for what is considered a "woman's disease." Where cancer is suspected, any delay can be dangerous. See a doctor if you find any changes in your breasts.

COPYRIGHT 2002 Weider Publications
COPYRIGHT 2002 Gale Group