It's not always just about being fat – and slimming can make them WORSE: Are female hormones to blame for the rise of 'man boobs'
00:16 GMT, 14 August 2012
00:16 GMT, 14 August 2012
Despite all the effort comedian Ricky Gervais has put in to losing weight over the past few years, there’s one — or, indeed, two — obvious fatty areas that just won’t budge: his man boobs, or moobs.
The Office star is not alone.
Only last week Simon Cowell was pictured exposing his male breasts on a yacht in St Tropez, while Aerosmith rocker Steve Tyler swanned around with his on show in Hawaii.
Ricky Gervais has lost weight over the past few years, but there's one – or, indeed two – obvious fatty areas that just won't budge: his man boobs, or moobs
Even Jonathan Ross’s breasts have been splashed all over the papers.
It’s enough to put many women off their breakfast.
In fact, moobs are a growing problem — and no laughing matter, as they can have serious emotional and physical implications.
Excessive development of male breasts — also known as gynaecomastia — is thought to affect 40 per cent of men and it seems the proportion is rising.
Some men are genetically predisposed to moobs, says Professor Kefah Mokbel, a breast surgery specialist at St George’s and the Princess Grace Hospitals, London.
‘Why one man’s breasts will go on to develop more than another man’s is genetically determined in the same way that some women will have bigger breasts than others.’
But the trigger may well be lifestyle, he says. The condition occurs when men have excess levels of the female hormone oestrogen.
All men produce oestrogen and it plays a vital role in protecting the bones, among other functions.
However, some men are more likely to have higher levels probably because of lifestyle, says Professor Mokbel.
Last week Simon Cowell was pictured exposing his male breasts on a yacht in St Tropez. Moobs are a growing problem
‘The rise in obesity and alcohol consumption, for instance, may be a factor.
'Obesity, particularly around the abdomen, increases levels of oestrogen because of the enzyme aromatose,’ says Pierre-Marc Bouloux, professor of endocrinology at the Royal Free Hampstead NHS Trust.
The high sugar content in alcohol is a contributory factor, by increasing weight gain.
Additionally, alcohol can cause liver disease, which goes on to impair the body’s ability to break down oestrogen.
‘Man boobs can also be caused by medication, such as drugs for heart disease — spironolactone blocks the action of testosterone, while digoxin resembles oestrogen structurally and so imitates it,’ says Professor Bouloux.
‘Male breasts are a recognised side-effect of hormone treatments for prostate cancer, which reduce the amount of testosterone in the body.’
Another factor is puberty.
‘During this time a boy’s hormones are in a state of flux,’ says Jonathan Staiano, plastic surgeon at City Hospital, Birmingham, and BMI Priory Hospital, Edgbaston.
‘Along with testosterone, boys have oestrogen in the body too (about a fifth to a tenth of the amount in women).
This is needed for bone and muscle growth and also the development of the testes and prostate.
‘As a result, fluctuating levels can result in a temporary state in which oestrogen concentration is relatively high, leading to the development of female glandular tissue and larger breasts.’
This affects half of all teenage boys.
By the age of 18, about 90 per cent of these problems are resolved.
But whatever the cause, gynecomastia can have serious psychological repercussions.
‘The problem with this condition, and the mockery that is made of it, is that many suffer in silence for years.
'It can cause immense stress, with sufferers becoming depressed, insecure and lacking in confidence, but the condition is treatable,’ says Mr Staiano.
One of those affected is James Giffen, 25, who became aware of his male breasts when he was 17.
‘I suppose I’d had them for a while but my puppy fat meant they weren’t overly obvious, so luckily I wasn’t bullied,’ says James, an airline steward from Crawley, West Sussex.
‘However, when I was 17, I became more aware of how I looked. I was 5ft 6in but a stone or so overweight and so I made an effort to go to the gym.’
The pounds started to drop and James’s physique improved — but the slimmer he got the more obvious his breasts became.
‘Despite all my efforts, they wouldn’t budge and from I became increasingly self-conscious.
‘I spent all my time trying to disguise my chest. I refused to go swimming — something I’d loved.
'And every time I passed a mirror or a shop window I’d instantly cross my arms across my chest.
‘I come from a close family and mentioned it to my parents, but they were adamant I didn’t have a problem.
'I suppose that’s the case with many physical abnormalities — it’s far more of an issue to the person concerned than others.
‘But this made the whole thing even more isolating. This really is a condition that affects everything you do, and my confidence took a real pounding.’
When he was 19, he went to see his GP, who put a name to his condition, gynecomastia.
‘Diagnosis is straightforward — usually made by a physical examination,’ says Professor Mokbel.
‘A blood test may also be taken. This will check the hormone levels to see if there are any underlying causes, such as a thyroid problem or low levels of testosterone.
‘In rare cases it could be a sign of cancer, so further tests may be required.
'But it’s important to stress that for it to be breast cancer, usually just one breast would be enlarged.
'In rare cases there may also be discharge from a nipple.
'When all underlying conditions are ruled out, treatment generally involves surgery.
‘Losing excess weight may help, but the breasts are made up of fat and breast tissue — and if you have more breast tissue, that’s far more difficult to budge.’
Mr Staiano says: ‘The operation can involve liposuction to remove fatty tissue, using a small incision under the armpit.
'But if the breast is predominantly tissue, you may need to make an incision around the nipple to remove the dense tissue.
‘These procedures are extremely straightforward and usually take less than two hours. Scars fade over the months until they are barely visible.’
In 2003, 22 men underwent this surgery. By 2010 the figure was 740, according to the British Association of Aesthetic Plastic Surgeons, with male breast operations the second most common cosmetic procedure among men, behind rhinoplasty or nose jobs.
And while the surgery is available on the NHS, only a few receive it.
‘The rules for treating gynecomastia on the NHS are extremely strict,’ says Mr Staiano.
‘As the operation is deemed cosmetic surgery, the main criteria is that the problem has to be significant, affecting your life considerably.’
James did not qualify for NHS treatment, so started saving up to pay for the treatment privately.
In December 2009, when he was 23, James had saved the 4,000 required to have surgery with the Harley Medical Group.
‘I was nervous about the operation, but by then I’d lived with the condition for years and just wanted to get it sorted out.
‘I know it wasn’t doing me any harm medically, but psychologically it was having a serious effect — I was introverted and always self-conscious about the way I looked and that’s not the way to live your life.
‘When I woke up I didn’t feel a thing — the joys of strong medication.
'But as the pain relief wore off I was sore and found it difficult to sleep for several nights.
'I also had to wear a tight vest for a week to keep down the swelling, which wasn’t comfortable either.
‘However, a week afterwards, when the nurse removed the vest, I was lost for words.
‘For the first time in years, instead of staring at female breasts, I had a flat chest.
'Yes it was a bit bruised, but I looked completely and utterly normal.
‘After a couple of weeks I went on a shopping spree.
'Instead of buying baggy T-shirts and tops, I could buy fitted T-shirts to show off the physique I’d worked so hard on.
‘Just a month or so later I was happily going topless on the beach — the freedom it gave me was fantastic.
‘Two years on, the scars have completely faded and you wouldn’t even know I’d had it done.
‘Yes, it was a lot of money, but I think it was one of the best decisions I’ve ever made.’