Sep 24, 2023
Aug 14, 2018
Man boobs or ‘moobs’ might sound like a joke or a made-up word even, but for many men, it is a real problem. So why do men get them? Let’s explore some possible causes.
Man boobs or 'moobs' might sound like a joke or a made-up word, but for many men, it is a real problem that's far from a laughing matter.
Man boobs can be either pseudogynecomastia or gynecomastia.
Gynecomastia is a medical condition that can also indicate underlying health problems.
Pseudogynecomastia, medically known as lipomastia, is a condition where fat builds up in the chest area, possibly due to a person being overweight or obese.
Everyone is born with breast glands, which are not usually noticeable in males. Gynecomastia results from enlarged breast tissue (glands and fat) rather than only fat. Unlike pseudogynecomastia, exercising or losing weight will not reduce or remove gynecomastia. The male breast tissue is overdeveloped and become enlarged, causing soreness, pain and discomfort for the affected individual.
The only effective solution to this medical condition is gynecomastia surgery .
Enlarged male breasts affect males of all ages, including newborns, during puberty, and older adults. In fact, according to a study :
Gynecomastia is a common male breast disorder that stems from an imbalance between the hormones androgen and estrogen.
With the increasing awareness of the importance of health, natural products are commonplace on supermarkets' food shelves, including the grooming section. While going au naturel when it comes to the latter is commendable – read the ingredients label. When applied topically in large amounts, products such as herbal supplements  and, lavender and tea tree oils  may lead to gynecomastia. These are commonly found in shampoos, lotions and soaps, and while the notion may seem far-fetched to the uninformed individual, it can happen.
Soy proteins, despite containing high levels of phytoestrogens (estrogen-like compounds derived from plants), no scientific proof has been that soy causes gynecomastia .
Obesity, as we know it, is the cause of many health problems, gynecomastia included. Obesity lowers testosterone levels, thus causing havoc to your muscle-to-fat and estrogen-to-androgen ratio . The male hormone androgen will convert into estrogen in the subcutaneous fat. Excessive fat in obese men may worsen the appearance of man boobs.
Arguably, two common bad habits among people are excessive drinking and cigarette smoking. Gynecomastia is more common in men who have drunk alcohol and smoked cigarettes before (67% and 43%) .
Smoking cigarettes is harmful to every part of your body. This smelly and unhealthy habit has been known to cause many diseases. Smoking cigarettes has also been known to decrease testosterone production, which will eventually cause hormone imbalance. A study published in the American Journal of Epidemiology found that smokers who smoke more than 36.5 packs a year "show a faster age-related decline in testosterone than non-smokers" .
Alcohol abuse affects the liver's ability to get rid of excess estrogen, and when it can't function effectively, it may also start converting androgens into estrogens. Smoking also causes hormone imbalance and, like excessive drinking, will eventually result in gynecomastia as it lowers your testosterone .
To achieve that close-to-perfect physique, a man would sometimes do just about anything. The common uses of anabolic steroids are for bulking up and performance enhancement. It has been reported that 1% to 5% of men abuse steroids in their lifetime .
While side effects such as roid rage seem to take centre stage most of the time, other equally pressing side effects such as gynecomastia should not be ignored. Anabolic steroid contains aromatase, an enzyme that converts androgens into estrogens . Note that this can also occur with legal steroids, so always remember that there are no shortcuts to success!
The direct relationship between cannabis abuse and gynecomastia has been successfully proven. Cannabis abuse encourages hyperprolactinemia and low serum testosterone levels . In Singapore, cannabis use, in any form, is illegal.
Systemic disorders are health conditions that impact the entire body when a single organ or more in the respiratory, neurological, circulatory, and digestive systems are affected.
Medications can cause hyperprolactinemia, a condition of elevated prolactin levels in blood . Prolactin is a hormone responsible for lactation and breast development, amongst others. While prolactin is not directly responsible for causing gynecomastia, it suppresses the hormone-releasing hormone that helps your sex glands mature and function. Prolactin receptors are also found in male breast tissue and may lead to gynecomastia .
Chronic renal failure is commonly associated with hyperprolactinemia. Renal disease can cause testosterone deficiency, which may cause enlarged male breast tissues .
1 in 40,000 men suffers from Kennedy's disease. It is a genetic motor neuron disease that can cause muscular weakness, muscle atrophy and muscle twitch, usually occurring after testosterone resistance between the ages of 40 and 50 .
Androgen insensitivity syndrome is when a person is born male but is resistant to male hormones. In this rare syndrome, gynecomastia develops during puberty and does not regress spontaneously .
Graves' disease is an autoimmune thyroid disorder, the most common cause of hyperthyroidism. Hyperthyroidism happens when the thyroid gland puts too much thyroid hormone into the bloodstream. Gynecomastia has been reported in about 40% of men with hyperthyroidism. .
Germ cell tumours are growths of cells from reproductive cells in the testicles or the ovaries. It stimulates testosterone production and increases the conversion from androgens into estrogens. Some germ cell tumours occur in other body parts such as the abdomen, brain and chest .
Gynecomastia is commonly found in patients with liver cirrhosis, which is the severe scarring of the liver [21, 22]. This liver disease and the side effects of its medication disrupt the hormonal levels, thus encouraging gynecomastia.
Andropause, also known as male menopause, can cause low sex drive, erectile dysfunction, low energy, depression and mood swings. This is due to the decreasing testosterone levels related to ageing. Men undergoing andropause with gynecomastia are primarily physiological. In the United States, it is estimated that there are about 2.4 million men from 40 to 69 years old who have lower levels of testosterone .
According to Mieritz et al., causes of testosterone deficiency  include:
Inflammation of one or both testicles
Most common in men between the ages of 20 and 40, the tumours could be malignant or cancerous
Using specific drugs to shrink or kill cancer cells.
Using radiation therapy with high-energy beams to kill cancer cells
Abnormal growth in the pituitary gland, found at the base of your brain and the top of your nose
Abuse of powerful pain-reducing medications can decrease testosterone level
A genetic and hormonal disorder that delays or prevents puberty and causes olfactory impairment
Klinefelter syndrome is one the most common genetic conditions, where a male is born with an extra X chromosome that affects about one in every 550 males.
Various medications have been associated with gynecomastia as they contain "estrogenic properties, metabolises testosterone, enhance estrogen production" . Medications for high cholesterol (statin), bacterial infections (amoxicillin) and gastrointestinal diseases (proton pump inhibitors) are at higher risk of developing gynecomastia .
Case reports in 2018 on "Statin Medications And The Risk Of Gynecomastia" by Skeldon et al. have suggested an increased risk of gynecomastia with statins, a class of drugs often prescribed to help reduce cholesterol levels in the blood .
Gynecomastia surgery has been the only effective solution to permanently remove the enlarged male breast tissue for decades. Suitable candidates include those whose condition does not resolve independently within a year.
Gynecomastia surgery is also known as a chest masculinisation surgery as it aims to remodel the contour of the chest - whether you have gynecomastia in one or both chests - and relieve pain and discomfort associated with the medical condition. If your condition causes protruding or prominent areolas, the surgery can rectify the issue.
We welcome you to call us and schedule a consultation with Dr Ivan Puah to understand how we can help you address your issue.
1. Prasetyono TOH, Andromeda I, Budhipramono AG. Approach to gynecomastia and pseudogynecomastia surgical techniques and its outcome: a systematic review. J Plast Reconstr Aesthet Surg. 2022 May;75(5):1704-1728. doi: 10.1016/j.bjps.2022.02.008. Epub 2022 Feb 20. PMID: 35304857.
2. Kanakis, G.A., Nordkap, L., Bang, A.K., Calogero, A.E., Bártfai, G., Corona, G., Forti, G., Toppari, J., Goulis, D.G. and Jørgensen, N., 2019. EAA clinical practice guidelines—gynecomastia evaluation and management. Andrology, 7(6), pp.778-793.
3. DiRaimondo, C. V., Roach, A. C., & Meador, C. K. (1980). Gynecomastia from exposure to vaginal estrogen cream. The New England journal of medicine, 302(19), 1089-1090.
4. Toorians AW, Bovee TF, De Rooy J, Stolker LA, Hoogenboom RL. Gynaecomastia linked to the intake of a herbal supplement fortified with diethylstilbestrol. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2010 Jul;27(7):917-25. doi: 10.1080/19440041003660869. PMID: 20432093.
5. Henley, D. V., Lipson, N., Korach, K. S., & Bloch, C. A. (2007). Prepubertal gynecomastia linked to lavender and tea tree oils. New England Journal of Medicine, 356(5), 479-485.
6. Giampietro, P. G., Bruno, G., Furcolo, G., Casati, A., Brunetti, E., Spadoni, G. L., & Galli, E. (2004). Soy protein formulas in children: no hormonal effects in long-term feeding. Journal of Pediatric Endocrinology and Metabolism, 17(2), 191-196.
7. Mathur R & Braunstein GD 1997 Gynecomastia: pathomechanisms and treatment strategies. Hormone Research 48 95-102.
8. O'Hanlon, D. M., Kent, P., Kerin, M. J., & Given, H. F. (1995). Unilateral breast masses in men over 40: a diagnostic dilemma. The American journal of surgery, 170(1), 24-26.
9. Svartberg J, Jorde R. Endogenous testosterone levels and smoking in men. The fifth Tromsø study. Int J Androl. 2007 Jun;30(3):137-43. doi: 10.1111/j.1365-2605.2006.00720.x. Epub 2006 Nov 27. PMID: 17163954.
10. Rachdaoui N, Sarkar DK. Effects of alcohol on the endocrine system. Endocrinol Metab Clin North Am. 2013 Sep;42(3):593-615. doi: 10.1016/j.ecl.2013.05.008. PMID: 24011889; PMCID: PMC3767933.
11. Anawalt BD. Diagnosis and Management of Anabolic Androgenic Steroid Use. J Clin Endocrinol Metab. 2019 Jul 01;104(7):2490-2500.
12. de Ronde W, de Jong FH. Aromatase inhibitors in men: effects and therapeutic options. Reprod Biol Endocrinol. 2011 June 21;9:93. doi: 10.1186/1477-7827-9-93. PMID: 21693046; PMCID: PMC3143915.
13. Duca Y, Aversa A, Condorelli RA, Calogero AE, La Vignera S. Substance Abuse and Male Hypogonadism. J Clin Med. 2019 May 22;8(5):732. doi: 10.3390/jcm8050732. PMID: 31121993; PMCID: PMC6571549.
14. Eckman, A., & Dobs, A. (2008). Drug-induced gynecomastia. Expert opinion on drug safety, 7(6), 691-702.
15. Ferreira M, Mesquita M, Quaresma M, André S. Prolactin receptor expression in gynaecomastia and male breast carcinoma. Histopathology. 2008 Jul;53(1):56-61. doi: 10.1111/j.1365-2559.2008.03059.x. PMID: 18613925.
16. Swerdloff, R. S., & Ng, J. C. (2023). Gynecomastia: etiology, diagnosis, and treatment. Endotext [Internet].
17. Finsterer, J. (2010). Perspectives of Kennedy's disease. Journal of the Neurological Sciences, 298(1-2), 1-10.
18. Hellmann, P., Christiansen, P., Johannsen, T. H., Main, K. M., Duno, M., & Juul, A. (2012). Male patients with partial androgen insensitivity syndrome: a longitudinal follow-up of growth, reproductive hormones and the development of gynaecomastia. Archives of disease in childhood, 97(5), 403-409.
19. Mohammadnia N, Simsek S, Stam F. Gynecomastia as a presenting symptom of Graves' disease in a 49-year-old man. Endocrinol Diabetes Metab Case Rep. 2021 Apr 1;2021:20-0181. doi: 10.1530/EDM-20-0181. Epub ahead of print. PMID: 33880994; PMCID: PMC8115411.
20. Daniels, I. R., & Layer, G. T. (2003). Testicular tumours presenting as gynaecomastia. European Journal of Surgical Oncology (EJSO), 29(5), 437-439.
21. Rupp, J., Cantarow, A., Rakoff, A. E., & Paschkis, K. E. (1951). Hormone excretion in liver disease and in gynecomastia. The Journal of Clinical Endocrinology, 11(7), 688-699.
22. Cavanaugh J, Niewoehner CB & Nuttall FQ. (1990) Gynecomastia and cirrhosis of the liver. Arch Intern Med 150, 563–565.
23. Mieritz, Mikkel G., Peter Christiansen, Martin Blomberg Jensen, Ulla N. Joensen, Loa Nordkap, Inge A. Olesen, A. Kirstine Bang, Anders Juul, and Niels Jørgensen. "Gynaecomastia in 786 adult men: clinical and biochemical findings." European journal of endocrinology 176, no. 5 (2017): 555-566.
24. He B, Carleton B, Etminan M. Risk of Gynecomastia with Users of Proton Pump Inhibitors. Pharmacotherapy. 2019 May;39(5):614-618. doi: 10.1002/phar.2245. Epub 2019 Apr 1. PMID: 30865318.
25. Skeldon SC, Carleton B, Brophy JM, Sodhi M, Etminan M. Statin medications and the risk of gynecomastia. Clin Endocrinol (Oxf). 2018 Oct;89(4):470-473. doi: 10.1111/cen.13794. Epub 2018 Jul 15. PMID: 29923212.