"My last resort is to fucking chop the thing[s] off." It was late last year when an anonymous user writing under the name "Spiderman" confessed his plan to surgically remove his own breasts. Like the other young men on the gynecomastia forum, he felt that his body had betrayed him. This wasn't the first time Spiderman had written about his condition online, but it was an extreme post in comparison to his others. "People won't take my problem seriously," he said.
In his 2015 book, Masculinity Defined: Gynecomastia and the Search for Perfect Pecs, plastic surgeon and gynecomastia specialist Dr. Mordcai Blau explains, "Gynecomastia is an excess growth of glandular tissue." The cause of breast development in men varies. It often develops due to natural variation in hormones during puberty; contrary to popular opinion, both boys and girls produce estrogen, some more than others. During puberty hormone levels can fluctuate sharply.
"Because gynecomastia is an overgrowth of the mammary gland, not fat, working out doesn't get rid of it," Dr. Blau writes. However, while fat tissue is different than breast tissue, being overweight can actually cause gynecomastia in some men. According to Dr. Blau, "Obesity can develop into gynecomastia because excess fat stimulates estrogen production," which is why some overweight men who shed weight retain it in their chests.
The mental anguish that Spiderman reported as a result of gynecomastia had become so severe that he said he was willing to risk his life to remove his breasts. "I realize this is reckless," he wrote, adding that he'll never know who he can be in this life until his chest is flat. "I'd rather be deformed, or die from a failed attempt, than keep living this pathetic, depressing life with it." Spiderman's post ended with a sad, morbid moral: If his self-performed surgery did kill him, his death could serve to raise awareness for the reality that young men with gynecomastia endure.
I'd rather be deformed, or die from a failed attempt, than keep living this pathetic, depressing life with [gynecomastia].
As much as is possible online, other users came to his aid. They tried to knock some sense into him: "No dude, what the fuck," wrote one. "Jesus Christ," typed another, "I know how you must be feeling because I had the same shit, a lot of us did, or do. But this will fuck you up way worse than the gyn[ecomastia], believe me. DON'T." I wrote to Spiderman and didn't hear back. But after posting in the forum, I was contacted by other men who've lived with this condition.
Sam is in his late twenties. He can't relate to the extreme depression that Spiderman and some other men with gynecomastia report, but for ten years he did live with unwanted breasts. Recently, he shed them via surgery. "When i was 14, my mother noticed I had puffy nipples," Sam told Broadly in an email, adding that she took him to a doctor to have his chest examined. "The doctor at the time explained that it's completely normal for adolescent boys to experience growth in the chest and it will level out later in puberty. In my case it never did." For the next few years Sam was able to ignore his chest, though in hindsight he thinks gynecomastia caused him to keep to himself, to be a quiet person. In his late teens he became aware of how greatly the condition had impacted his confidence and self-esteem: Sam said he had become cripplingly insecure.
He devoted time each day to research his condition and also worked out habitually. The excessive exercise was an attempt to lose the weight on his chest, but no matter how many iron disks he shouldered, or calisthenic movements he repeated, the growths on his chest remained. "An ultrasound later proved that I had breast tissue behind the nipples, meaning no matter how many weights I lift or [how much] fat I lose, my chest will always look somewhat like it did." According to Sam, it was at this moment that he became obsessed with the fact he had breasts.
If a boy has minimal breast development early in puberty it is possible for it to reverse, Dr. Blau explains in his book. But if the tissue has significantly developed, it requires surgical excision. Sam explored surgery, but at $10,000 the procedure to correct his gynecomastia was prohibitively expensive.
According to Dr. Blau, "Gynecomastia doesn't always start in adolescence." Steroids are the most common non-pubertal cause, but other drugs, "such as certain antidepressants, pharmaceutical treatments for male pattern baldness, and valium can cause gynecomastia, too." Even recreational drugs like marijuana, heroin, or large amounts of alcohol, can lead to the development of breasts in men, Dr. Blau notes.
Linda Blum is an Associate Professor of Sociology at Northeastern University and the author of Generation Rx: Mothering Kids with Invisible Disabilities in an Age of Inequality. "I studied mothers raising kids diagnosed with the burgeoning labels of ADHD, of high-functioning autism spectrum disorders, as well as other mood, learning, and behavioral disorders," Blum said in an interview with Broadly.
"Vulnerable boys diagnosed with such disorders as ADHD, ASD, and other emotional-social-learning disorders are increasingly treated with low doses of antipsychotic medications." These medications, Blum explained, are part of a group known as "atypical antipsychotics," which are used to stabilize mood and quell anger. "[They] influence blood sugar metabolism and have a common side-effect of weight gain, often leading in boys to breast growth," Blum said. "This is a cruel effect in young men already likely to be bullied by peers—and mothers I spoke with were terribly concerned and conveyed stories of boys ashamed by their bodies."
I hated basic activities like clothes shopping. I would get angry looking at myself in those awful mirrors every time.
"My self-esteem dropped to next to non-existent," Sam said. His dissociation and discomfort with his body became the focal point of his life. "I hated basic activities like clothes shopping. I would get angry looking at myself in those awful mirrors every time." In some ways, his life was structured around his condition. Sam despised t shirts, as they accentuated his chest, and so he wore button-up shirts religiously. If he found a garment that flattered him, he'd wear it until it tattered. Between the age of twenty and twenty three, he gained approximately 50 pounds.
In our interview, Sam repeatedly told me that he'd become obsessed with his chest. "Every time I looked in a mirror that's what I looked at. Every reflective surface I walked past in the street I would check to see how noticeable it was. This went on for about five years," he explained. "I remember being about 24, out in a club and having lost some weight and feeling about as confident as I ever had. I walked past a mirror and saw my side profile, where there was a distinct line on my chest that outlined my gynecomastia. My mood, confidence and desire to be out completely diminished in an instant."
Sam tried to fix the problem by taking steroids, hoping that increasing his muscle size would counteract what he saw as the feminine aspects of his chest. Ironically, steroids are known to cause the condition he was trying to treat. In his book, Dr. Blau writes that the word gynecomastia is Greek, adding that "in many ways the Greeks were the original body-conscious society. From the Olympic Games to nude sculptures, they were some of the first to codify what the 'ideal' male body should look like."
Society puts pressure on men to live up to a muscular ideal.
"The practice of building 'hyper-masculine' bodies has grown," Blum said. "At the same time, we have lost vast numbers of decent 'manly' provider jobs in this country." She sees the hyper-masculinization of the male body as a reaction to the displacement of male supremacy: the so-called "feminization of the labor market," or even "the end of men." As more women have and are entering the workforce and men are increasingly taking on less traditionally masculine roles, the idea that men are being feminized—or that they're coming to an end—is not uncommon, Blum explained. But, she said, the end of men really refers to the end "of their economic and social privilege." This could explain why some men feel a need to hyper-masculinize their bodies. The social expectation for men to meet ideal standards of masculinity remain intact, but the social structures and norms that were once in place to help clearly define masculinity, and the difference between men and women, have diminished.
"Society puts pressure on men to live up to a muscular ideal—pick up any issue of Men's Health," Dr. Blau writes. And yet, he does not attribute his clients' need to self-actualize to the the pressure of cultural ideals: "Most of my patients are internally motivated." In other words, they are getting surgery to correct their gynecomastia because they want to change what they see in the mirror, not because someone else is telling them they need to.
There is another group of men who live, and often suffer, with breasts. Unlike gynecomastia patients, these men are transgender. Assigned female at birth, they identify as, transition to, and live as their true male gender. It is common for transgender men to report dissociative feelings toward their chest. Many trans men develop personalized terminology to re-gender their body parts; it's common for trans guys to think of their chest exclusively as their chest, without using the word "breasts" to describe that part of their body.
Some non-transgender men who have gynecomastia also manipulate gendered language to describe their gender nonconforming bodies. Specifically, these guys use acutely masculine terms to talk about their breasts. One user on a popular gynecomastia forum underwent surgery to have his breasts removed. He wrote about the experience with sports terms, stating, "I had two liters of fat removed from each breast, and a hockey puck of estrogen, or whatever." Another described his breasts as if fast food: "The amount of tissue for each breast was about the size of a quarter pounder burger from McDonalds."
I had two liters of fat removed from each breast, and a hockey puck of estrogen, or whatever.
None of the men that I spoke with felt like their gynecomastia was a gender issue. "I feel the need to say [that] I've never had any complex with my gender. My case with gynecomastia was no different to the mindset of someone who wants to remove an ugly scar, birthmark, or lump," Sam told me.
Brian is also in his twenties, and he lived with gynecomastia for many years before having it surgically removed. "Gender was never really something I contemplated in any sense of the word I guess," he told Broadly in an email. "When I developed gynecomastia, I was embarrassed by it and sometimes made fun of for it, but I never felt like 'less of a man.'" He said that he never felt the need to be manly. But he and Sam both felt a need to correct a part of their body that they had come to see as abnormal, something that caused them some degree of mental anguish. Though they don't feel aware of the way that gender relates to their experiences, it is arguably intrinsic. "Gender didn't become more important after puberty," Brian said. "I never really paid attention to the idea. It just was."
"Feminists and critical race theorists have long argued that this is how privilege works," Blum said. "Just as most whites don't experience themselves as having a race, [cisgender] men seldom experience themselves as having a gender." The sense of anxiety, insecurity, or disconnect that men with gynecomastia experience toward their chests can resemble the way that transgender men experience gender dysphoria. Both groups deserve to live without that anguish, and to have healthcare that recognizes the difference between cosmetic and medically necessary plastic surgery—but they also deserve to live in a society where their bodies are not deemed abnormal.
Men with breasts undermine deeply held beliefs about the gendered body, or binary sex. Blum told me that puberty-induced gynecomastia could be considered a normal variation of human sex, "just as those born intersex disrupt the idea that a strict sex binary at birth is normal." In these cases, it becomes increasingly difficult to strictly define the differences between male and female bodies, because they overlap. As Dr. Blau writes about his patients, an internal motivation drives many who seek to modify their bodies. But the fact remains that normal variation is often deemed abnormal because of subjective and shifting cultural values.
Blum affirmed that we sometimes medicalize or pathologize aspects of the human body or mind that could just as easily be considered natural, healthy, and normal forms of human variation. "It has occurred to some extent with men's body types. But feminist scholars know this also has occurred with women's bodies—in past centuries the pert Barbie breasts valued as ideal and unchanged by pregnancy, birth, or breastfeeding would have been seen as undesirable, but now such breasts that sag and jiggle are medicalized and treated by cosmetic surgery." Social ideals about normality and abnormality have an enormous impact on youth, particularly boys. Those tagged as "abnormal" are "far more likely to be bullied and harassed by their peers," which may affect their self image.
Imagine the terror that everything you believe about yourself could be wrong.
"Imagine the terror that everything you believe about yourself could be wrong," Dr. Blau writes, drafting a psychological portrait of his patients. "The fear that the outside world might view you as somehow less, and that, just maybe, the outside world could be right."
Spiderman later claimed to have gone through with his self-administered gynecomastia surgery, a feat that few surgeons in the world have mastered. Other users doubted his story, but he virtually shrugged, claimed he'd done it at home before being rushed to a nearby hospital where his wound was allegedly closed. He said that he'd upload a video to prove it, but never did.
On Spiderman's original post—the one where he confessed his desperate plan and gave up on life in his breast-ridden body—one anonymous user begged him to reconsider. "We're completely different humans you and I, but my advice is [to] convert that frustration and sadness that your body has brought you [and] turn it into fury at life for giving you this.
"Use that fury as a fuel," he continued. "Let it propel you forward, rip your obstacles apart, and make a flat chest your end goal. Don't set a date for it, just power forward until you get there, it won't be easy–I'll never tell you that it will be, but I can promise you that it's possible.
"I'm four years down the road from that night, and now my surgery is in seven days."