Keeping men healthy is a little like getting directions to an unfamiliar destination: If a guy gets lucky and finds his way easily, everything is fine. If not, well, there’s no rush to take action. Men are simply less likely to call the doctor when something is wrong, and when they do, it has to really be bothering them, like when they tear something on the playing field or stop performing in the bedroom.

The medical name is rarely heard, but countless men walk around with the visible results of this condition: embarrassingly enlarged breasts. Fortunately, there are treatments.

a common condition
“It is much more common than people think— up to a third of the male population. Most of it has to do with the increasing percentage of obese people,” says Dr. Samer Cabbabe of Plastic Surgery Consultants of St. Louis.

“In the general population the incidence of gynecomastia is estimated at 32 to 65 percent,” adds Dr. Michele Koo, who has a plastic surgery practice in Kirkwood. “The majority of causes are idiopathic, meaning there is no known explanation. Sometimes it can be caused by hormonal dysfunction, medications or due to a genetic syndrome. The most common cause is over-the-counter hormones, frequently sold in sports and general nutrition stores, or anabolic steroids.”

As male breast enlargement has become more common, so has acceptance of plastic surgery for men, Cabbabe says. “This is becoming an issue now, right before swimsuit season,” he says. “I probably do 30 to 40 of these operations a year.

hormones & imbalances
Gynecomastia results from an imbalance of estrogen and testosterone in men. In addition, other diseases or substance abuse can contribute to the problem, Cabbabe says. “It can be related to anything that affects the liver, including alcohol abuse or marijuana use,” he notes. “Another causative factor is steroid use. A percentage of my patients are body builders who have used steroids.”

The condition may be hereditary, Koo says. “On a rare occasion there is a strong family history of breast cancer, even amongst male relatives.” Obesity has created a new wave of male breast enlargement. Overweight men grow fat cells all over, which also leads to hormone imbalances. “When you are an obese male, that fat converts testosterone into estrogen,” Cabbabe explains.

“Surgery can be achieved safely at any time during or after adolescence after a clinical history and other developmental concerns have been ruled out,” Koo says. The surgery typically involves the excision of the breast bud that underlies the nipple and areola (the surrounding ring of pigmented tissue), she describes. “Oftentimes liposuction also is necessary to flatten and reshape the chest and the side of the chest area,” she says. “I often perform the procedure in the office under local anesthesia.”

The procedure has little in common with female breast reduction surgery, Koo says. “It is a much shorter and more simple procedure. The amount of tissue removed is typically much less.” As a result, recovery is relatively short. “A compression vest is worn day and night for the first two weeks. My patients typically return to office work in one to two days with the compression vest on under their clothes. They can return to a more strenuous manual occupation after one week.” The resulting scar is imperceptible, Cabbabe adds.

As a cosmetic procedure, male breast reduction surgery is rarely covered by medical insurance. The surgery may cost $3,000 to $6,000, Cabbabe says, higher if additional incisions must be made to remove excess skin. “This is a very safe and extremely helpful procedure for later adolescent males to improve body- and self-image,” Koo says. “Many men have considered it since their teenage years and pursue it when they are more financially capable.

erectile dysfunction
You’ve heard of this condition if you have turned on the TV in, oh, the last 5 minutes. The discovery of profitable medications has made erectile dysfunction one of the best-known maladies.

“Since the advent of Viagra 25 to 30 years ago, direct-to-consumer marketing definitely has brought a significant increase in awareness of erectile dysfunction, which I think is a good thing,” says Dr. Etai Goldenberg, a urologist at Urology Consultants Ltd. In the dark and distant past, men were less likely to discuss sexual inability. Now every commercial break of every game depicts another cool guy restored to manhood by a little pill.

“Because there is more information, more people are pursuing treatment,” says Dr. Bryan Warner of BodylogicMD of Saint Louis. A number of problems hamper erectile function, most related to a lack of blood circulation. “Some studies say that one in five guys over the age of 20 might have some degree of erectile dysfunction,” Goldenberg says. “It becomes more common with co-morbid medical conditions such as being overweight or having poor blood flow, usually due to diabetes, high blood pressure or high cholesterol.

age & other factors
In addition to blood circulation issues, “diabetes can affect the nerves that cause the penis to get erections,” Goldenberg says. “Having radiation treatment for prostate cancer can have effects, and so can some other pelvic surgeries.”

A common culprit is the decline in the body’s testosterone level, Warner explains. “In your 20s and 30s, high stress hormones will suppress your other hormones and normal functions.” And, of course, men’s natural testosterone levels decline with age. “After the age of 32, men lose 1 or 2 percent of their testosterone a year. By their mid-40s, men may have lost enough to feel the impacts of erectile dysfunction,” Warner says. “Testosterone has more than 300 functions in your body, so the effects can be reduced stamina, strength and confidence, muscle loss and feeling more tired in general.

how they work
The magic pills help, when you have stimulation, to get increased blood flow into the penis,” Goldenberg says. “Many men have good success with those medicines, but they are contraindicated for people taking certain other medicines.” The pills can have some short-term side effects, he adds. “Cialis has the risk of causing muscle aches. Viagra and Levitra tend to give some flushing and headaches, but there are no long-term effects that we know of.” Viagra and Levitra should be out of the system within six hours, and Cialis within 36 hours.

Warner’s practice specializes in hormone replacement therapy (HRT), but he also prescribes the pills for 30 to 40 percent of patients. “The normal range for hormone levels is pretty wide,” he says, “but just because you are within the normal range doesn’t mean your hormones are optimum.”

Testosterone therapy may be delivered through injections, gels or pellets inserted under the skin that dissolve over four to five months. Patients must be monitored for the potential side effects of testosterone replacement. “The more you keep your hormones restored, the less degeneration you will have as you get older,” Warner notes.

sports injuries
Ah, the sounds of spring: the crack of the bat, the pop of ball striking mitt, and the scream of a meniscus ripping as the over-eager runner tries to stretch that gapper into a double.

start slow!
“The most common injuries I see this season are knees, shoulders and ankles,” says Dr. Robert A. Sciortino of Jones and Sciortino Orthopedics in Chesterfield.

Tennis courts will contribute to the sports rites of spring, too, says Dr. Donald R. Bassman, whose practice moves May 1 to Motion Orthopaedics in Creve Coeur.
“There are a lot of overuse injuries this time of year, when people are just starting to play.” Why now? Why you? “It’s all from not stretching enough and going from not playing to playing more than you should be,” Bassman says.

Sciortino says the most common knee injury is to the meniscus (the cartilage that maintains stability in the knees). “A lot of times that comes from a twisting injury where something will pop,” he says. “Many of those won’t heal without surgery. Less common, but maybe more serious, are some of the ligament injuries (ligaments hold joints together) that occur when someone makes a sudden stop, acceleration or deceleration. Those sometimes require surgical reconstruction.” The major ligament in the knee is the ACL.

Amateur athletes may be more prone to injuries that Bassman calls ‘the itises’ and involve the tendons that connect muscle to bone. “As you get older your muscles become less elastic. You are pulling more on the tendon insertions and you get more of the itises—tendonitis, epicondylitis (tennis elbow) and things like that,” he says.

senior moments
When it comes to vigorous sports, the male body begins its decline relatively early. “When men hit 30 or 35, I start to see them and it increases from there,” Bassman says.

Sciortino explains it as a loss of flexibility. “A lot of injuries are caused by stiffness,” he says. “People also tend to lose muscle mass. After age 30, men and women start losing calcium from their bones, so it’s important to take calcium supplements.”

Despite the physiological inevitabilities, those wacky kids in the baby boom generation continue to push envelopes farther than their parents did. “We’re seeing people playing organized sports well into their 40s and 50s,” Sciortino says.

slow & steady
“We don’t want to discourage people from exercise or sports or tell them they shouldn’t do something,” says Sciortino. “Ideally, you should exercise all winter to keep up your strength and flexibility. Maintain yourself so you are not suddenly using muscles you haven’t used in months or have weakness in an ankle or knee.”

Bassman says amateur athletes should approach a new season as professionals do. “You ought to work up to it for weeks,” he says. “That is what the Cardinals do in spring training—they take a month to get back in shape.” And Sciortino warns against things like deciding the office picnic is a time to relive past glories on the softball field. “Sedentary people should not all of a sudden try to play like they are 20 again; it’s a recipe for disaster.”

Even the accomplished athlete may need to back off. “There is a time to find a sport that is not quite as active,” Bassman says. “You can play doubles tennis rather than singles, or pick up a sport like bicycling or hiking that doesn’t have the same risk of injury.”

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