There is a simple superficial answer and there is a complex answer that explains the root cause and process that results in pseudogynecomastia. The simple answer is that there is an excess intake of fat into the body and it stores the excess fat behind and around the areola (nipple). This gets built up over time since the chest is one of the least kinetic part of our body.
The root cause of pseudogynecomastia is a little complex and the main factors that come into play are high estrogen levels, low testosterone levels and low metabolism . Whenever there is a concentration of body fat in the chest among men, there is the inseparable aspect of high levels of estrogen. It is commonly agreed in the medical world that there is a direct correlation between body fat and estrogen in men . When you have high levels of estrogen in your body, it predisposes the body to retain more fat in the chest. This is because estrogen being the female hormone signals the body to retain more fat and store it in the chest [10,11].
The stored chest fat also produces an enzyme called aromatase and it converts even more testosterone to estrogen . The process of conversion of male hormone testosterone to female hormone estrogen is called aromatization . By producing the enzyme aromatase, chest and abdominal fat also acts as a secondary gland that produces estrogen. When you have excess estrogen, it also leads to even less production of testosterone and low metabolism. All of this becomes a negative feedback loop creating even more estrogen and this estrogen dominance signals the body to develop feminine features like breast tissue and fatty deposits in the chest.
The classification of breast enlargement into gynecomastia and pseudogynecomastia are primarily theoretical and for the sake of clarity. In majority of cases, breast enlargement is caused by a combination of chest fat and breast tissue . This happens because of the negative feedback loop between high estrogen and fat . High estrogen causes the body to retain excess fat in the chest and this excess fat then produces the enzyme aromatase that converts testosterone to estrogen . This excessive production of the female hormone estrogen then causes development of feminine features and one of which is breast tissue . This is why majority cases of breast enlargement in men is a mix of breast tissue and chest fat .
Coolsculpting is a new and emerging procedure for burning fat by means of controlled cooling [27,28]. According to its inventors, coolsculpting is effective in even burning off the stubborn fat that have stayed even after diet changes and rigorous workouts . It is not currently cleared for pectoral fat but is something that holds immense potential for those with pseudogynecomastia once it is cleared by the FDA for pectoral fat.
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