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Gynecomastia and Booby Traps

By introducing the idea of a "manssiere," an episode of Seinfeld shed light on breast enlargement in men (gynecomastia), a very real and worrisome condition characterized by an imbalance of hormones.

One of my favourite Seinfeld episodes is “The Bro.” On discovering that George’s father, Frank, has “man-boobs,” Kramer concocts a male version of a bra, that he calls “The Bro.” Frank, who prefers the name “Manssiere,” tries it on just as his wife Estelle and George make an appearance. Estelle’s expression as she exclaims “Oh my God” is priceless and makes for a hilarious scene.

However, “gynecomastia,” the proper term for breast enlargement in men, is not funny and can cause embarrassment and grief. It occurs when the balance of the male hormone testosterone and the female hormone estrogen is disturbed. Yes, males also produce estrogen! It is produced from testosterone with the aid of aromatase, an enzyme present in the adrenal glands, the brain, the testes and in fatty tissue.

A change in the relative amounts of circulating testosterone and estrogen can have many causes. The onset of puberty, as well as of old age can trigger changes. Testicular tumours, an overproduction of thyroxin by the thyroid gland, medications such as finasteride (Proscar, Propecia) or amphetamines (Adderall) can all play a role in disturbing the balance of testosterone and estrogen. Anabolic steroids, compounds that behave like testosterone, can also have an effect as the body tries to counter the increase in male hormones by producing more estrogen. Bodybuilders who abuse “roids” are destined to learn about gynecomastia first hand.

What can be done to counter gynecomastia? There are surgical options as well as prescription aromatase inhibitors or tamoxifen that can reduce circulating estrogen. Some marketers of “natural” remedies have gotten into the game. One product, SoliPac, is advertised as a “Gynecomastia Tightening Ginger Cream” and entices customers with seductive anecdotes and “before” and “after” pictures. Since there are no human trials published in the scientific literature, we are left to take the marketers’ word for the authenticity of the photos. I’m skeptical.

The possibility of a ginger-based cream having some effect cannot be dismissed out-of-hand since animal studies have shown that ginger can boost testosterone. In diabetic rats! This research was not aimed at gynecomastia, a condition not seen in rats. Rather the goal was to see if ginger, or compounds found in ginger, may play a role intreating low testosterone levels. That’s a potentially useful effect since insufficient levels of testosterone in men are linked with infertility, loss of libido, diabetes and osteoporosis.

While pharmaceutical testosterone can be prescribed, “natural” treatments seem more attractive to some. And the diet supplement industry is keen to capitalize on the demand. Hence the rat studies. They are interesting because ginger root has shown evidence for increasing testosterone, as well as for countering the effects of some reproductive toxins such as lead or aluminum chloride. Surprisingly, zingerone, geraniol or 6-gingerol, the main bioactive components of ginger root have shown no such effect when individually tested. And no study has demonstrated any reduction of breast size in men either by consuming ginger or by scoffing dietary supplements containing various ginger extracts. Neither is there any study demonstrating the benefits of rubbing ginger cream on the chest, a-la-SoliPac. Buyer beware!

At this point, any claim about ginger treating gynecomastia is highly suspect, but there is some evidence that ginger can treat nausea as brought on by pregnancy, motion sickness or chemotherapy. Perhaps it may also be able to treat nausea triggered by unsubstantiated claims like this one by SoliPac: “Ginger works for gynecomastia. Known to stabilize the body’s immune system and triggers the production of testosterone and androgen. Lowers estrogen production and dilutes the effect of the same. It can burn fats in your chest area and turn it into muscle.” Ginger doesn’t burn fats, and hasn’t been proven to work for gynecomastia. Sometimes just a word or a phrase can be a giveaway of untrustworthiness. “Testosterone and androgen” is an example. “Androgen” is not a compound. Androgens are male sex hormones of which testosterone is one.

As far as Kramer’s “manssier” is concerned, so far, it only exists in the classic Seinfeld episode (“The Doorman”). It remains for some ingenious vendor to gingerly introduce “The Bro” into the marketplace.


@JoeSchwarcz

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