As many as 70 per cent of men over 50 have enlarged breasts — gynaecomastia — according to some estimates.
Typically, this results from an imbalance in levels of the hormones testosterone and oestrogen, which can result in excess firm glandular breast tissue.
Oestrogen is often thought of as a ‘female’ hormone, but, in fact, men produce it, too. It stimulates the growth of breast tissue but, in men, high levels of testosterone usually keep this in check.
However, testosterone levels drop with age. Older men also tend to have more body fat: this produces oestrogen, which leads to a rise in levels of the hormone.
This double effect encourages growth of both glandular breast tissue and fat. Younger men can develop pseudogynaecomastia — bigger breasts due to being overweight. The excess fat stores can stimulate oestrogen production, creating more breast tissue.
In 2017, a study of British men over 40 found that those taking finasteride or dutasteride (for an enlarged prostate) were three times more likely to develop gynaecomastia, possibly because the drugs reduce testosterone production.
If bigger breasts are clearly caused by a hormonal imbalance (for example, the patient is otherwise slim), drugs can be prescribed to stabilise hormone levels.
Another option is breast reduction surgery. Not offered on the NHS, it can cost around £5,000 privately. It involves surgical removal of the firm glandular breast tissue, not just excess fat.
Treatments such as Coolsculpting are only recommended for pseudogynaecomastia, as they target fat, not excess breast tissue.
The treatment freezes fat cells to the point where they die (below minus 5c). These cells are then flushed out through the kidneys. One treatment is fairly usual, but it depends on the size of the area.
Ash Mosahebi, a professor of plastic surgery at University College London, who has a private Harley Street clinic, says Coolsculpting causes less collateral damage, such as ‘burning’ of the skin, than other freezing therapies which aim to treat bigger, less targeted areas.
‘I have used it on some of my private patients,’ says Professor Mosahebi. ‘But I think that most people with pseudogynaecomastia could probably solve the problem simply by losing weight.’
And the treatment is not without its drawbacks, he adds.
‘It can be quite painful and it feels like your flesh is frozen for up to an hour afterwards. Some patients also have swelling, bruising, stinging and tenderness around the area, but this usually settles down after a couple of weeks.’