Gynecomastia: What Bodybuilders Need to Know

Gynecomastia and weightlifting

  • Why gynecomastia occurs in bodybuilders
  • Surgery and how it can help bodybuilders specifically 

Weight lifters push their body to the max almost every day to maximize their gains.  It is a grind, requiring hours in the gym, with only one guarantee: your improvements will come at a snail’s pace.  The best part of this struggle is the results, the immediate pump and the long term improvement in strength and body composition. The worst part of this struggle for most is that it takes years to realize a real change.  Improving your strength and body composition by adding muscle is excruciatingly slow, even for the most genetically gifted.  To maintain maximum output during the building process, you need an extreme amount of dedication and focus that only a few people can maintain.  So, what do you do if you are not only competitive but you are also hell bent on maximizing your gains? How do you speed up this process?  Besides tweaking your routine, maximizing your nutrition and focusing on sleep and recovery, your options are limited.  This is why so many turn to supplementation.  They are searching for any advantage in this almost unwinnable challenge of maximizing anabolism.  But supplementation for weightlifters, as with any attempt to game a complex system, can have some unintended consequences.  One of the least desirable consequences is the development of male breast, aka gynecomastia.  In this blog article, we break down what is gynecomastia, why it occurs, how supplements can lead to this condition and what you can do about it medically and surgically.

What is gynecomastia?  By definition, gynecomastia is the development of breasts in men. Specifically, it is the enlargement of breast buds, or breast tissue, that is present in every man.  The degree of gynecomastia really depends on how much the breast tissue grows. The appearance of gynecomastia is also worsened by the presence of subcutaneous fat surrounding the chest.  This is why gynecomastia is a common finding in those who are obese.  Pseudogynecomastia refers to cases where the breast buds are not enlarged and the appearance of male breast are caused primarily by excess fat.

What causes gynecomastia?  The causes of gynecomastia are numerous.  From medication induced side effects, obesity, illicit drug use, puberty, hormone secreting tumors and exogenous hormone supplementation, the causes vary greatly.  But there is one common finding in all these scenarios: the testosterone and estrogen balance in a man is disrupted. Specifically, there is an increased estrogen effect on the breast tissue, aka mammary gland, that stimulates growth. 

How does supplementation with weightlifters cause gynecomastia?  Supplementation is a broad term and encompases many different products.  In the natty world,  supplementation includes things like creatine and BCAAs.  It is very unlikely that the more ‘natural’ supplements will have any effect on male breast growth.  Once you cross over into the ‘gear’ category, there are many examples of how supplements can disrupt the testosterone and estrogen balance.  From anabolic steroids to exogenous testosterone, all will have unintended consequences on hormonal balance.  Often, attempts are made to counteract these imbalances by taking estrogen blockers.  This can help, but if it is not monitored by a physician, suboptimal treatment may occur.  Overall, if gynecomastia does occur in a weightlifter who has chosen to supplement in the gear category, it is highly recommended that they quit anything that could affect the testosterone and estrogen balance before considering surgical treatment.

What can I do medically to treat gynecomastia?  Diet and exercise can drastically reduce the size of enlarged male breasts, especially in those of you who are obese. Discontinuing recreational drug use can also help.  You may also have hormonal imbalances that have led to this condition.  Therefore, in instances of potential hormone imbalances, a workup and treatment by a hormone specialist can sometimes avoid the need for corrective surgery.  Discontinuing exogenous hormone supplementation not being monitored by a physician is also must before proceeding with a medical workup.  Unfortunately, in most cases, this will not reverse gynecomastia and surgery will be necessary.

How do you surgically treat gynecomastia? Surgical correction of gynecomastia is fairly straightforward and is a low risk procedure.  It is often completed in the office, with you awake and with assistance of local anesthesia.  The surgery itself most often includes liposuction and removal of breast buds.  In a high majority of cases the incisions are made around the edge of the areola and are almost imperceptible once they heal.  Recovery takes up to 1 week to get back on your feet and return to non physical work duties, around 2 weeks to return to normal daily activities and 4-6 weeks to return to your normal workout schedule.  The results are long lasting, especially if your weight is maintained or ‘gear’ like supplementation is not restarted.

If you remove the breast buds with gynecomastia surgery, why can’t you restart supplements that can affect the testosterone and estrogen balance?  It is nearly impossible to remove all the breast tissue with this surgery without removing the areola completely.  Therefore, even if you have had your breast buds removed, there will be a residual amount of microscopic breast tissue left that could regrow if exogenously stimulated.

So, in summary, if you are a weightlifter, and you think you may have gynecomastia, go seek help from a specialist. If all medical issues are addressed and the gynecomastia still persist, surgical correction will solve this problem.  And for those of you who have supplement induced gynecomastia, it is best that you rethink and rework your approach to supplementation with training.  Click on the link below to listen to the episode our Podcast, Beauty and the Surgeon, that discusses gynecomastia and its treatment.