With his shaved head, lean torso, and broad shoulders, strength and conditioning specialist Kevin Larrabee looks like a lot of fitness professionals. In the weights room, the 30-year-old fits right in with the crowd.
But back when he was a teenager, Larrabee stood out for the wrong reasons. For one thing, he was overweight at 90kg. And he had another problem: man boobs.
“I just thought I had the chest of a fat kid,” says Larrabee. So at age 15, he decided to lose the excess poundage.
He ditched the junk food and embraced a healthier, lower-kilojoule diet. He exercised “a ridiculous amount.”
In three months he dropped to 80kg. But somehow he still had those womanly breasts.
What Larrabee didn’t know was that his condition, gynecomastia – known colloquially as man boobs, mannary glands or, if you’re especially unkind, chesticles – was caused by breast tissue, an artifact of the hormonal big bang that hits all boys at puberty.
He also didn’t know that 50 per cent of his peers had developed gynecomastia as well but that in most of them it later receded to unnoticeable levels.
“I knew it wasn’t right, but there wasn’t anything I could do about it other than try to lose more weight,” he remembers. “I was as far as I could get with the knowledge I had.”
Your body is not always a perfect regulator of your hormones, says Dr Adrian Lo, a plastic surgeon who specialises in gynecomastia.
In fact, out-of-whack hormones are what cause the formation of excess tissue in the first place: your testicles produce both estrogen and testosterone, but in early puberty you may not have enough free testosterone (the hormone that builds muscle) to counteract the estrogen. That imbalance allows glandular tissue to form.
“In puberty, many boys have ‘breast buds,’” Lo explains. “Usually that tissue shrinks to nothing as they grow out of puberty.” For a few, however, it remains. And men can grow breasts in other ways; in fact, as many as 60 per cent develop them at some point in their lives.
Some are guys with pubescent gynecomastia that never went away, while others develop man boobs because of medications. Up to 25 per cent of gynecomastia cases are caused by meds, according to the journal American Family Physician.
Some examples: antidepressants, antipsycholics, cholestoeral drugs, hair-loss treatments, heartburn remedies, ulcer drugs, ACE inhibitors and anabolic steroids.
Then there are the men carrying excess body fat that enlarges their breast tissue, creating the dreaded condition.
A guy with a bosom born of chest fat instead of tissue has a condition known as pseudogynecomastia. This is the type often seen in overweight men, whose moobs can resemble anything from the perky proto-breasts of your first girlfriend to those deflated National Geographic specimens.
Working out or losing weight may help those disappear.
With true gynecomastia, however, no exercise will work. The only option: surgery.
Lo performs four or five such procedures a week. “The men I see are usually pretty fit,” he says. “But most men with gynecomastia qualify for surgery even if they’re not an ideal weight.”
A sliver of breast tissue the size of a dollar can be enough to make the areola soft and puffy. Then the man needs to decide whether it bothers him enough to do something about it.
Larrabee was bothered. All through his teen years, he would try to cover up his chest with creatively layered T-shirts and sports jerseys.
Earnings from his part-time jobs were spent on spot-reducing creams and sprays. “I wasted hundreds of dollars on that stuff,” he says.
In the gym, he built his workouts around chest exercises. He avoided any situation where he might be expected to take off his shirt. But despite his best efforts, people noticed.
Finally, in college, Larrabee googled “fat chest” and learned that surgery was his only option. After pleading with his parents to help pay for it, he had the operation in 2007.
The first time he saw his new chest was an emotional moment. He compares the experience to looking in the mirror and seeing a different face staring back. “It was unbelievable,” he says. “I had a flat chest! I couldn’t wait for summer.”
“At the end of the day,” he says, “it was a miracle that worked.”