PHILADELPHIA -- As legalized medical marijuana gains acceptance across the country, a long-smoldering question burns a little hotter.
In the vernacular, stoners ask, "Do doobies make boobies?" Plastic surgeons phrase it more scientifically. "Does marijuana cause gynecomastia?"
Speculation that men who smoke pot are prone to develop abnormal breast tissue or "man boobs" has been around for decades. The first scientific paper examining the clinical impact of the drug's active ingredient, THC, on hormonal systems was published in 1972 in the New England Journal of Medicine.
This was about the same time Brewer & Shipley stoked Spiro Agnew's ire with the hit single "One Toke Over the Line." The drug's ability to stoke controversy has not abated. The 1972 study found that the drug has "widespread effects on multiple hormonal systems, including gonadal, adrenal, prolactin, growth hormone, and thyroid hormone regulation." When the drug throws off the normal balance of hormones, estrogen levels rise and stimulate breast tissue growth.
Subsequent studies have been few and their findings conflicting. As a result, marijuana's advocates call the association a myth, asserting that there is no solid scientific proof.
They have a point, says Adrian Lo, a plastic surgeon at Pennsylvania Hospital who specializes in breast reduction for men. Because marijuana is illegal in most states, he explains, it's hard to conduct research. But this does not make the link a myth.
"What we're left with are doctors, endocrinologists, and surgeons with clinical acumen saying we notice a trend," he says. Of the 100 or so patients who come to him for breast reduction surgeries each year, more than one-third report regular marijuana use.
"Some men are more susceptible to gynecomastia than others," he says. Smoking pot can lower testosterone levels for 24 hours, he says. After just one joint, patients have reported feeling swelling and puffiness around the nipple, while regular users may have no reaction, at least in their breast tissue.
"We can't predict who it's going to happen to," Lo says.
"I wouldn't say I was smoking seven days a week, but it was close," says a 23-year-old patient who recently underwent breast reduction. Worried about the legal ramifications and his job security as an actuary, he agreed to speak identified only by his middle name, Michael.
He first developed enlarged breasts when he was going through puberty, a few years before he started smoking. His mother took him to the pediatrician, who said the condition was normal and temporary. But Michael was among the small percentage who did not grow out of it.
For years, he would avoid baring his chest. "In games where the choice was shirts vs. skins, you never wanted to be skins," he says.
Once he started having relationships with women, he worried about how they judged his body. At 5-foot-11 and 190 pounds, he was not overweight, and worked out three or four times a week at the gym. "I benched and lifted," he says. "Underneath, I had pecs." But no amount of exercise made his breasts turn to muscle.
He had heard that pot could cause man boobs. "When I was high, they felt a little more noticeable," Michael says. "But I don't know if it was my state of mind at the time." Since he had had them for so long, he did not think quitting would make a difference.