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Gynecomastia, or Man Boobs - Why Does This Happen?

Posted on by Rob Brown, MD

gynecomastiaAfter a recent workout, I entered the gym’s sauna which was more crowded than usual. It was one of the only times I had been in the sauna without hearing the whining of music coming through earbuds. People were actually talking to… each other! The banter was initially over sports and exercise routines. But then, it turned to guys talking about their experience getting older and gaining weight. The men were different races, and ranged in age from the mid 20s to the late 50s. “I’m 57.” One guy said. “Once you hit 50, the weight just creeps up on you.” “Man, that started happening to me at 40!” another added. My eyes were closed when I heard a crackle followed by a long wheeze. I opened my eyes and noticed that almost everyone in that room had a plastic water bottle. Wow! I thought… good for hydration, but drinking water from hot plastic? A younger guy sitting next to me told the group how he had gained 50 pounds in the last year after he had started to work out. He was chunky, but not obese. By his side sat an oversized, purple opaque plastic water bottle with a ribbed plastic straw. “You got man boobs to boot!” One guy teased, laughing. “Yeah, I got ’em too.” Another guy added. “I don’t know how or when that happened.” Should I say something? I held back. In this pack, I didn’t feel comfortable being a teacher. I left the room and took a shower, feeling as if I had missed an opportunity to help a few people. What are man boobs? Many people think that “man boobs” are merely excess fat. In other words, that when a man gains weight, he deposits fat in his breast. That’s not actually correct. Man boobs do contain fat, but they also contain breast tissue, a condition medically referred to as gynecomastia. As a radiologist, I see men with breast tissue ALL the time. CT scans clearly show this condition because they allow a view through the body separating out structures of differing density. Breast tissue is a higher density than fat. Twenty-five years ago, gynecomastia was something I saw once in awhile, perhaps 2 or 3 times a week. It was a condition often seen in patients with alcohol-related liver disease. Now, I see gynecomastia throughout the day, everyday! I see this condition in children as well as in middle-aged and older men. Why is this happening? Breast tissue develops in response to estrogen. It’s not normal for a man to produce excessive estrogen. So where is it coming from? Have you heard of estrogen mimicking compounds? They are in our plastics, synthetic fragrances, food additives, and personal care products. The literature is replete with articles describing the estrogenic effects of many of these compounds. Yet, there are almost no articles calling out these chemicals as causing disease. We know plastics contain these compounds and we know that the chemicals leach into the food and water held within plastic containers. We know that plastic water and soda bottles are and have been a source of long-term exposure to these chemicals that many of us have been exposed to, perhaps for decades. Excess estrogen can lead to many health concerns, including breast cancer, endometrial cancer, cervical cancer, obesity and gynecomastia. Are estrogen mimicking chemicals responsible for the dramatic increase in the incidence of breast cancer, which in the US, is now 1 in 8?! One recent article showed an association of PCB 138 with breast cancer and called for further environmental epidemiological study to assess the association of the other chemicals such as phthalates, BPA and other PCBs with the development of cancer. Even though it hasn’t been proven yet, I strongly suspect these chemicals cause appreciable hormonal effects, and yes, cancer. So when you read about estrogen mimicking chemicals within a product that you are going to eat from, drink from, put on or inhale, take the information seriously. Assume these chemicals ARE affecting your health and the health of your family. These chemicals are pretty much ubiquitous in our environment. But, it is possible to consciously lessen your exposure to them. Limit the frequency you drink from plastic bottles. Read up on your personal care products and try to eliminate those that contain these contaminants. A review of the Environmental Working Group (EWG) website is a great place to do some research. Back in the locker room, after showering and getting dressed, I saw the twenty-something-year-old guy and struck up a conversation. “I don’t mean to neb into your personal business, but I overheard you say that you gained a lot of weight this past year.” “Yeah, man,” he said. “I can’t figure it out.” I then told him about the chemicals in his plastic water bottle and suggested that he get a glass bottle or a stainless steel bottle instead. I could see a light turn on in his eye and he said… “You know, that makes a lot of sense.” He was appreciative and I went home feeling helpful.
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