How It Happens and What You Can Do About It. "Doctor, I have bitch tits. Am I f***ed?" These are the words that a young bodybuilder used to introduce himself. He went on to describe how he followed a cycle of anabolic steroids and then afterward noticed a swelling of his chest that he thought was the muscle growing. It soon became tender and progressed to a sizable mass of tissue, to the point where he was embarrassed to take off his shirt and show the physique he'd worked so hard to build. Dieting and building up his pecs only made the problem worse. He couldn't even hug his girlfriend without discomfort. Gynecomastia, or "bitch tits," as it's called, is a benign enlargement of the male breast tissue. The term comes from the Greek words gyne meaning "woman" and mastos meaning "breast." It can occur naturally or as the result of certain substances being in the system. Historical writings and artifacts show that Gynecomastia is an ancient problem, as evidenced by statues of Pharaoh Seti I that have enlarged breasts. Aristotle reported encountering the problem, and the earliest description of the surgical removal of Gynecomastia is found in the writings of Paulus of Aegineta, who lived from 635 to 690 A.D. The incidence of naturally occurring Gynecomastia is somewhere between 32 and 65 percent of reported cases. It may be familial, and in that case it usually occurs at puberty due to hormonal shifts. While several drugs have been linked to this condition, including marijuana, anabolic steroids have been found to be the leading cause. These synthetic derivatives of testosterone trigger a variety of other side effects as well. Gynecomastia occurs in steroid users because the male hormones they take undergo a process called aromatization, which occurs in varying degrees in different substances-Anadrol and testosterone being the most aromatized. This process changes the configuration of the male steroid molecule to that of estradiol, a feminizing hormone. Those who have tissue sensitivity for this condition will begin to develop breasts. Fortunately, Gynecomastia is correctable with surgery, but be aware that so-called blocking agents like Nolvadex will not reverse it once it has occurred. Being a competitive bodybuilder as well as a plastic surgeon, I have developed corrective techniques that leave small, unnoticeable scars and allow the patient to quickly return to training. The chest looks normal at rest and when the athlete is posing. It's not necessary to have large, noticeable scars, indentations or deformities. The procedure can be done on an outpatient basis. A small incision is made at the border of the nipple complex, and the glandular tissue is carefully removed. Liposuction is then used to contour the chest and increase muscle definition. The patient wears an elastic vest for several weeks to control healing, and modified exercise routines are possible after two weeks, with a full return to training in four to six weeks. The entire procedure may be covered by your health insurance. I've treated athletes from around the globe and recently presented my work at an international teaching conference. Those of my patients who are competitive bodybuilders return to competition with confidence. I want all of my patients to be able to take their shirts off without feeling self-conscious.