Having enlarged breasts, when you're a man, is an embarrassing physical flaw the majority of males would like nothing more than to get rid of.
Gynaecomastia - better known as "man boobs" - is just one of the effects that can happen when a man has heightened levels of the female hormone oestrogen.
And while some men can achieve rippling pecs and rock hard chests reminiscent of Sonny Bill Williams or Daniel Craig, others are stuck with a less desirable upper half due to unlucky genetics, with many paying between $10,000 and $12,000 for a breast reduction.
For the past month, the Herald has run a Men's Health series highlighting conditions that affect Kiwi men.
The series has covered Type 2 diabetes, adrenal fatigue / stress and prostate health. Today's instalment, and the last in the series, will look at how having too much oestrogen in the body can affect men.
Both sexes have levels of the female hormone, and the male hormone testosterone. But sometimes levels of oestrogen will be higher in some males and vice versa.
Auckland cosmetic and reconstructive plastic surgeon Dr Martin Rees has seen dozens of men seeking to get a breast reduction over the years.
Although a higher level of oestrogen was not always the cause for larger breasts in men, he acknowledged that oestrogen, through medication, often played a big part.
"One of the treatments for prostate cancer is to give [patients] oestrogens, as some of the cancer can be suppressed with oestrogen. But, of course, the side-effects of that [are] that they then start growing man boobs," Dr Rees said.
"So you often see guys in their 60s and 80s plus - they may be overweight or fat but they're growing man boobs. Some of them don't take their shirts off, but others won't worry."
The causes of a hormone imbalance can be a range of things, including being overweight or obese, drinking too much alcohol and eating foods with high levels of oestrogen, such as yams.
Among the patients he and fellow plastic surgeon Dr Tristan de Chalain have seen in their private practice over the years are elderly men, middle-aged men, adolescents and even young boys.
Patients often arrived with gynaecomastia in both breasts, but sometimes had the condition in only one of them, with the breasts growing to a B-cup or sometimes larger.
"The bulk of them don't have any obvious cause. It's probably just a genetic thing that they genetically have more breast tissue than the average male. They don't have high oestrogen levels or they've just got breast tissue that's super sensitive to the oestrogen."
Dr de Chalain said he had seen about half a dozen gynaecomastia cases per year and most were young men below the age of 30.
Having too much oestrogen in the body, for men, can affect not only prostate health but also cause blood clots, lead to increased belly fat, and reduce sex drive.
3 Tips from fitness guru Lee-Anne Wann
1 Limit your exposure to toxins
This is such a challenging thing because it's what I call a soft issue. We don't see what we are absorbing or digesting and we cannot always see or feel the damage it can cause until it's too late. As with aiding in prostate health, limiting your exposure to chemicals from personal care products, paper receipts and air freshener can go a long way to helping reduce the overall oestrogen in the body.
2 Gain muscle
Muscle is not just about looking great. The truth is that the more muscle you have, the better you will be able to process and eliminate excess oestrogen in the body.
Aim for weight sessions in your exercise routine at least three times a week to help combat oestrogen dominance.
3 Cut sugar and minimise processed carbs
Nutrition plays a big role in our hormone balance and eating too much sugar can actually turn off the genes that regulate testosterone and oestrogen. Avoid any obvious sugar and minimise processed food because this is where hidden sugars can be substantial. Choose lots of vegetables as your carbohydrate options as this will increase fibre, which is critical for managing oestrogen.
Too much oestrogen
• Causes include being overweight or obese, genetic inheritance or eating foods with high levels of oestrogen, such as yams.
• Can lead to a low sex drive, belly fat, prostate health issues and development of man boobs.