You've seen it in the locker room. A shredded oak tree of a bodybuilder two lockers down pulls off his shirt, and, out of the corner of your eye, you see that he's got breasts. What's happening there is called gynecomastia—male breasts. And it's most common to bodybuilders, elderly men, and teenage boys.
According to Plastic and Reconstructive Surgery, the medical journal of the American Society of Plastic Surgeons (ASPS), gynecomastia, a condition caused by an imbalance of testosterone and estrogen, negatively effects self-esteem and other areas of emotional health. While not clinically dangerous, gynecomastia affects body image and socialization.
Guys with gyno may avoid beaches, pools, and may find it difficult to date. Any situation that may require the removal of one's shirt can feel acutely stressful to a man with gynecomastia. Bodybuilders with gyno will experience an impact to competition. Bodybuilders who supplement with anabolic steroids are at high risk of developing gynecomastia.
To learn more about this condition we interviewed Dr Mordcai Blau, a board certified plastic surgeon specializing in gynecomastia treatment. Dr Blau is the inventor of the "Natural Gland Technique," and a lecturer to plastic surgeons internationally, most recently at the American Aesthetic Society of Plastic Surgeons, and at Harvard University. Dr. Blau has over 5000 surgeries to his credit; and more than 2000 on bodybuilders.
Good afternoon Dr. Blau, thanks for speaking with us. Can you tell us a bit about your history in the medical field and how you came to specialize in Gynecomastia?
Before focusing on gynecomastia, I worked in plastic and reconstructive surgery. I did reconstructive surgery for 15 years after I finished my training at Albert Einstein. After that, it was mostly aesthetic surgery. During that time, I was teaching anatomy at Einstein and New York Medical College. I taught dissection to medical students and young, would-be surgeons.
One of my students was a bright young man named Dave Polumbo, a last year student at New York Medical College, a professional bodybuilder. He had gynecomastia. Dave asked me to correct it.
It was my very first gynecomastia surgery. It was a great result! That was the beginning. Soon afterwards, my practice filled with gynecomastia patients. Eventually 95% of my patients were gynecomastia corrections.
Wow. Did you expect that?
I didn’t seek that out. The patients just started to come! Focusing on one procedure was never my goal. That path that found me. Back then, there weren’t many truly experienced plastic surgeons doing this surgery. So patients just came, from all over the world. It all started with Dave. And I’m very grateful for that.
What exactly causes gynecomastia? It's hormonal, right?
Many times, it’s hereditary. With bodybuilders, it’s steroids and the hormones they are taking. Non-steroidal gynecomastia develops “generally” in 3 periods of a man’s life: during infancy, adolescent, or when they are around 50. These times of major hormonal changes in the body. At the later age, it appears in men once the testosterone starts to decline.
Does it go away?
It can. Sometimes. In adolescents, for example: A moderate case may dissipate. If it does, obviously you don’t need a surgery. But a severe case is always permanent. If gynecomastia persists for more than two years, just remove it. With young boys, it's best to remove gynecomastia as young as possible. This saves them from many emotional problems.
What are the "emotional" or social effects of this condition on people who live with it?
Emasculation. Men feel unattractive. They avoid the beach, the locker room, any situation where they might need to take off their shirt. Imagine how stressful that can be? For adolescents, they may not play sports or socialize like other children. I wrote about this in my book Masculinity Defined, Gynecomastia and the Search for the Perfect Pecs. In the book there's a story about a young boy at a soccer game. Shirts and skins. He was elected to the skins team. He wouldn't, so he couldn't play. He felt terrible. Children can be so very cruel, andyoung boys may feel a great feeling of shame, and the need to hide their body. This leads to shyness, poor body posture, and they separate from their peers; especially if their breasts are larger than the young females. My advice? Get the surgery. This will save them years of suffering.
If you do get the surgery, what are the biggest hurdles?
Expectation is everything. Being realistic about your results is key to having a great surgery. Body builders and athletes, for example, they really know their body. They make great patients. Experience of the surgeon is also important. I'm one of the most experience surgeons in this field, so a lot of difficult and extreme cases seek me out, after being turned down by other doctors. I can definitely make a huge difference in the lives of many who suffer extreme gynecomastia. And many patients, perhaps 95% of patients are very realistic. Some are not.
Specifically, people who have lost hundreds of pounds, who have severe cases of gynecomastia, sometimes may not be realistic. It’s very important that the patient expects. Patients know their result will be great, but when the surgeon expresses what is "realistic," the patient may not want to contradict the surgeon. They believe their results with be "perfect." This is not the case. There is no such thing as perfect, perfectly symmetrical with a perfect size and shape of the breast, areola, areola height etc. This procedure is like a nose job. Try too hard to make pecs “perfect,” you risk making it look unnatural. The most important thing is that it must look natural. Nobody should ever know that you had a surgery. You need to work with your body, solve the problem, and allow the body to heal itself.
What if you are a bodybuilder and have just developed gynecomastia? Is there something you can do to correct it before it becomes permanent?
Unfortunately, there's no good research into this that I'm aware of. Obviously, I'd recommend to stop taking steroids. We know one thing: If you've had gynecomastia as a man for more than 6 months, it will not go away. No treatment that I know of will help. There are many “solutions” sold on the internet. Don’t purchase these. You need a surgery.
You recently spoke at the 50th anniversary Aesthetic Meeting for the American Society of Aesthetic Plastic Surgery (ASAPS) as an expert in male body contouring, and recently was a speaker at Harvard University, correct?
Yes. It was a great experience. Additionally, I've also lectured on gynecomastia at the American Society of Plastic Surgery and the International Society of Plastic Surgery. I believe I'm the only surgeon focusing on gynecomastia who has spoken for all three of these organizations. It's a great pleasure and an honor for me to share my experience with doctors from around the world, and to advance this work for the patients.
Out of over 5000 patients, is there one that really stands out and gives you pride, maybe a feeling of "I changed this persons life for the better?"
There were many. It’s very hard to say. You know, men who have very large breasts they are so sensitive. And even children, that change is very dramatic. It helps the parents, as their child experiences an ability to socialize. One patient in my book, I didn’t identify him personally, he was 14. I remember the mother was very eloquent and spoke about her son and how antisocial he was. After the surgery, they went to Spain on vacation. He took his shirt off and he was having a lovely time, lying on the beach with his shirt off. He found a girlfriend. His entire life changed.
Also, there was a university professor. He told me his children, his wife, and his grandchildren never saw his chest. He hid his entire life. He never took his shirt off in front of his family. His wife couldn't even touch his chest. Imagine that? It was too sensitive for him psychologically. Three months after his surgery, he started to take his shirt off at his pool. What a difference. A dramatic impact.
And, finally. What should someone who is experiencing gynecomastia do? Who should they speak to for advice or consultation?
Research is important. Find an experienced surgeon. Read reviews, educate yourself, and go to consultations. The surgeon you pick should match you personally. I can not offer free consultations because our practice is so busy, but, we are happy to include the consultation in the price of your procedure. And we are happy to help. You can contact us at (914) 428-4700