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Blanche was fascinated by a recent documentary Men with breasts, which recently aired on the cable network TLC. The subject was gynecomastia, a medical condition in which men have breasts like those of women. (The documentary had previously aired in England with the more alliterative Boys with breasts.) There doesn't seem to be a widely known (or polite) colloquial way of talking about gynecomastia, though sometimes the condition is called bitch tits.

Gynecomastia is not particularly uncommon, and frequently starts in adolescence. We think of it as not unusual for heavy guys to have large tits. But it can be particularly noticeable in slimmer men, who sometimes have slim waists and arms, accompanied by a pronounced bustline.

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The exact reasons that some men develop unusually large breasts aren't well understood, but the underlying anatomy is fairly simple. Men's breasts aren't really all that different in basic anatomy from women's breasts-- it's just a matter of size. Estrogen triggers breast enlargement in most girls at the time of puberty. But men have estrogen in their bodies as well, and if the balance of testosterone to estrogen shifts sufficiently towards estrogen, the breasts will get bigger. Even if the estrogen levels subsequently fall back in the usual range for men, the breasts have already grown and often do not shrink. Guys also have more of a tendency to develop breasts as they get older and testosterone levels start to fall.

The ability of men to grow breasts is especially obvious in the case of male-to-female transsexuals. Taking the right hormone supplements will reliably cause any man's breasts to grow. But in some men, estrogen levels can be naturally high enough at some levels in development that the breasts will enlarge, sometimes to sizes even larger than those of most women. The documentary followed several men as they talked about their-- generally traumatic-- experiences of not fitting into the generally accepted image of what a man's body should look like.

Curious readers may wish to have a look at some images in the gallery at www.gynecomastia.org to get a clearer idea of what this condition can look like. In the documentary Men with Breasts, one of the men was filmed shopping for bras with his girlfriend, and explained that he wore a size 56 double-D cup, much larger than the average woman.

In a society like ours, where both men's and women's bodies are constantly under scrutiny and subject to criticism, gynecomastia can be devastating. Guys with this condition face special torment in situations like high-school locker rooms or games of "shirts vs. skins."

What can be done? The Men with Breasts documentary followed several men who had undergone breast reduction surgery, with mixed success.

One poor fellow had undergone surgery that left him severely scarred and with a chest that looked, if anything, worse. There is good news and bad news on the surgical front. Good news is that the surgery seems to be getting better, as more surgeons are learning the right techniques. Bad news is that the breast tissue may grow back after surgery and that most insurance companies won't pay for the treatment.

Perhaps most fascinating to Miss Poubelle are the men who've decided to accept their breasts and live with them. Most of the men who've taken this path seem to be straight. Their female partners at least could empathize with the experience of having sore breasts or the difficulty of finding the right brassiere.

For gay men, there's some ambivalence about the acceptance of bitch tits. On the one hand, there are lots of gay men who are attracted to fat men and bears, who frequently have big breasts. Lots of guys also get off on large nipples or muscular chests. But Miss Poubelle doesn't see much evidence for the current popularity of average-size guys with womanly tits.

Still, gay guys with tits are going to be a growing demographic as the population ages. Using an economic analogy, the solution to the problem of oversupply might be stimulating demand. Will we someday have Mantit magazine next to Mandate on the shelf at our local porno shops? Maybe we'll know that manboobs have arrived when an aging Brad Pitt exposes his rack on the cover of Vanity Fair.