Gynaecomastia is usually caused by a "hormonal imbalance with a alteration in the ration of testosterone to oestrogen in the body," according to Dr Rick Silverman, a plastic surgeon in Boston, USA. The imbalance is that "the oestrogen is high, thereby stimulating receptors in the breast tissue in individuals with susceptibility to this," he says. "Hormonal therapy may prevent the condition in cases where an inciting cause can be identified early," Silverman explains, "but generally, the diagnosis is made after the fact. By then it's too late for hormonal therapy to have any impact."

In London, Dr Chris Inglefield mostly agrees with that assessment. He says, "the cause is oestrogen stimulation resulting in breast development. This occurs naturally in puberty but can occur as a result of drugs (side effects) and tumours."

Gynaecomastia - A major adolescent problem?

Typical emotional traumas faced by adolescent boys are caused by everything from spotty faces, to bodies with more fat than muscle, and not least by their opinion of the size of their genitals in compared with those of their mates. Such problems are potentially devastating and can carry over throughout their adult lives, seriously affecting their physical and emotional well being, and even their intimate relationships as this author knows only too well.

Back when I was a teenager, we had no idea. We had no internet to use to find out what our boobs were all about. All I knew was that our housekeeper told me at age 10 or 11, "you have boobs just like a girl". Now that's something a kid doesn't talk to dad about.

Fortunately this was the mid-1950s and women, including my mum, were wearing stretchy, wide elastic belts with their skirts. I stole one from my mother and 'bound' my boobs with it. Of course I still had to wear loose fitting shirts to hide the bulges caused by the belt, above and below it, but at least those slight bulges looked nothing like 'boobs'.

"Most men are unaware of what is 'wrong' with them and are unaware of how easily surgery can correct the problem," explains Dr Robert Hamas, a cosmetic surgery specialist from Texas, USA. "The internet has opened the doors for many men who now are happy to learn all about what has caused them such emotional pain for so long."

Gynaecomastia education is important

Inglefield expands on this theme, noting, "Education and support are very important. In puberty, boys need support and reassurance that they are not strange or freaks and in many cases Gynaecomastia will resolve by the end of puberty. In adults it is important that these individuals have an examination to rule out the possibility of breast development being caused by drugs or tumours."

"Regrettably," Silverman finds, "many young men are not aware of what their condition is, and they feel embarrassment or get teased in a way that they feel responsible for it. Because 95% of patients who get Gynaecomastia will resolve on their own, many paediatricians advise against early intervention, believing that it may go away." He thinks this a reasonable approach but that it "doesn't compensate for the psychological issues at a time when young men are particularly vulnerable to sexual insult and teasing by peers."

Rather than just ignoring the condition, he suggests doctors should "perhaps [advise] teens specifically that they have a common condition that almost always resolves within two to three years, and that they should consider surgical intervention if it doesn't resolve thereby setting a time line they might handle the problem better, and parents could better support them through it."

Silverman says such advice isn't more frequently provided because, "many paediatricians don't assign much significance to this 'cosmetic' disease, and insurers (at least in the US) are willing to pay for fewer and fewer procedures."

Hiding the problem?

So how do sufferers handle the condition? According to Inglefield, many teens and older men put on weight in order to disguise the condition as one of being fat. "I do not believe that this condition can be hidden away by fat," he says. "Most men have been through this cycle of weight gain and loss to change their breast but with no effect."

Hamas says, "men usually hide the breast prominence under baggy clothing... If it can't be hidden well, they tend to avoid social situations where it would cause embarrassment, such as swimming pools and locker rooms."

And true to form, I did all those.

But I got stick from the other boys anyway because no method of trying to hide the "lumps" is truly successful. And I thought I noticed a few girls looking at me "funny" and so became shy around them.

And so, as in Hamas' example, I avoided PE classes as often as possible; I stalled getting into the shower till the other kids were gone. I avoided the beach and I never went without a shirt or at least a t-shirt.

Asked why the range of estimated numbers of men suffering from gynaecomastia is so broad, Silverman says it's "because the definition [of gynaecomastia] varies and the method of surveying varies." "Defining gynaecomastia as any mass or lump is different from saying that the breast must actually look 'female' in nature," he continued. "Some surveys might look at the absolute number of individuals who develop any symptom (lump, pain, fullness) versus full-blown condition. The higher numbers will come from the more inclusive surveys."

Gynaecomastia benefits?

So is there a positive to men "suffering" from Gynaecomastia?

Well in my own experience, I find, or rather my wives and lovers have found, my breasts to be very erotically sensitive. However, Inglefield says there is "no evidence that the breasts are more sensitive than normal."

And Silverman agrees, noting that he is not aware of evidence of such increased sensitivity. "In general, because women are not very attentive to men's breasts during sexual activity, most heterosexual men are not terribly attuned to nipple sensitivity. In my practice, a few men have expressed concern over nipple sensitivity, and these have generally been gay men, where 'nipple play' is a more significant part of the sexual repertoire."

Gay or not, that's one benefit I wouldn't want to lose.