There are several subgroups of gynecomastia patients such as puberty, hormone use in fitness, obesity and medications. Little has been written regarding a not uncommon category of patients who are over fifty years old. I have struggled to give it a name. OMG or "old man gynecomastia"? Senior gynecomastia? Gynecomastia of advanced age? None of these terms make me feel good as a gynecomastia surgeon and patient who has a few miles on him.
The cause of gynecomastia in men of advancing years is the imbalance of the sex hormones estrogen and testosterone. Less testosterone made results in relatively higher levels of estrogen which acts on the tissue of the male chest to stimulate the development of gynecomastia tissue. It's usually not something that happens overnight so the development of the appearance of gynecomastia occurs over years. A formally normal looking chest looks a bit fuller with saggy skin. It often looks worse in shirts than bare chest.
The treatment of gynecomastia in men over fifty is different in that I have to take into consideration the laxity of skin that normally occurs with age. There is a loss of elasticity (think rubber bands) that makes skin retraction less predictable. A 20-year-old with the same gynecomastia is no worry. I have to prep these patients differently. Their expectations must be in line with the reality of the situation. Although I am well trained and very experienced, I am not the Messiah. It is not uncommon for them to have some skin folds or creases and they will have to work their recovery very carefully and intently in order to ensure the very best result. If the measure of success is looking good in a shirt. This is easy. If you want to look good and feel confident without a shirt you will have to do your best to manage your recovery. This means good posture, use of the compression garments for weeks or even months and the manipulation of your chest skin so it is smooth and flat. This isn't a spectator sport—you will need to engage and manage the healing process.
Does this mean that I don't recommend treatment for gynecomastia in men over 50? Absolutely not! I had mine treated when I was in my early sixties, and it has been a game changer for me personally. It's just that you need to have realistic expectations regarding results, and you have to commit to working your recovery. At my age I was willing to manage some degree of imperfection because it is unrealistic for me to believe I will get the same result as a 20-year-old. As I have said many times before, your result won't be perfect, but it will be perfectly amazing!
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