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In the ongoing “Body Talk by Buford” interview series, board certified Plastic Surgeon Gregory A. Buford, MD, FACS, PCEO discusses gynecomastia, what underlying medical issues may be contributing to male breast enlargement, and what needs to be done to promote awareness and education in the politically-charged landscape of marijuana legalization.
We know from previous segments that hormone levels can contribute to gynecomastia and a host of other health issues. With the recent progress in marijuana legalization, you’ve had a few concerns. How can marijuana contribute to gynecomastia?
Dr. Buford: There have been a few studies that suggest marijuana use reduces testosterone. I have seen this in a few cases myself, where otherwise healthy male patients develop an estrogen dominance and, subsequently, increased breast tissue; a common factor was marijuana use, but I’m hesitant to make a definitive statement of fact without the subject being properly studied on a larger scale.
My biggest concern has less to do with gynecomastia and more to do with systemic changes. In other words, increased risk of heart disease, increased risk of stroke, emotional volatility. There are a number of things that happen when your testosterone levels go down, and gynecomastia could be the figurative canary in a coal mine.
With that being said, there needs to be more attention focused on some of the negative effects of marijuana use, in addition to all the great studies out there showing that it can be very effective for a number of things. My personal belief is that while there are some very positive medicinal uses for marijuana, we need to stop shying away from exploring potential negative side effects. Understanding and accepting both the good and bad of a substance does not mean you are condemning it.
What do you feel needs to happen now that more and more states have legalized or are pursuing legalization of marijuana?
Dr. Buford: The most pressing need is studying how marijuana affects our bodies. The few studies that have been conducted are mostly animal studies that don’t clearly document how testosterone is lowered by THC. Unfortunately, I think the problem is that there isn’t a huge incentive for anyone to perform larger studies. Regardless of how you feel about marijuana or questions of health implications, these studies need to be performed on humans.
These studies will have to happen at the academic level at large teaching institutions. We’re currently hampered by the financial and political implications of marijuana legalization, but we need to be studying the medicinal properties.
While I want to take a stand on the necessity of studies being conducted, I’m certainly not saying that marijuana is bad. Aspirin has a side effect in which a very small handful of the population will have anaphylaxis and die from taking it. That doesn’t mean you need to ban the use of aspirin or disavow its positive benefits, it just means it’s important to be aware of potential dangers. My feeling is that marijuana is very similar: we need to fully understand the Pandora’s box we may be opening.
What specifically would you be interested in learning from these studies?
Dr. Buford: People have been smoking or ingesting cannabis for years, but studies have focused primarily on addiction; there hasn’t been much about long-term effects. I want to see studies that look at it from a whole-body standpoint. How does it affect the brain? How does it affect the neurotransmitters? What is its effect on the hormones? In reality, everything is so intricately interwoven and interconnected that if you change one thing, you change another. Our bodies are elaborate, well-tuned engines, and if you change one setting on your engine, the way it runs is completely altered.
It’s naive to think that a single shift in our neurotransmitters or one change in our hormones is not going to have a ripple effect. We really need to understand what is happening internally with marijuana use before we have an epidemic of side effects in new users. Everyone responds differently, and while one person may not experience any change in their hormone levels, another may see profound effects.
We are already seeing increasingly low testosterone levels in men, which is very scary to begin with. There are a number of theories as to why it’s happening, but the bottom line is: if lower levels are the baseline, what is going to happen now that we are introducing a substance that may lower it even further? That could be a serious long-term national health problem.
Any final thoughts?
Dr. Buford: My hope is that marijuana legalization can be stripped of any religious, moral, or political implications, and that we simply look at it as what it is. It is a drug, just like alcohol or acetaminophen is a drug. I think we need to look at this in a very scientific manner and strip away our assumptions and preconceived notions. We need to look at both the positives and negatives from a purely scientific standpoint.
Marijuana has been shown to have an overwhelmingly positive effect on those who suffer from seizures, and also as an appetite stimulant for cancer patients. Stating that marijuana is purely good or bad is like saying alcohol or over-the-counter pain relief is definitively good or bad. How a substance behaves is fully determined by usage patterns, the individual taking it, other substances in the body, and the list goes on.
Like anything that has been popularized and widely accepted, marijuana now needs to be reinvestigated. Perhaps we even need to see how it can be manipulated on a chemical level to eradicate potentially negative side effects while retaining the positive medicinal benefits.
The bottom line is this: marijuana is here to stay. We need to stop playing the opinion game and start treating it like the controlled substance it is becoming. We need to understand all of the effects it has on the human body, and we need to determine how we are going to approach using marijuana safely, smartly, and effectively.
Read more of this interview series where Dr. Buford discusses gynecomastia and hormone replacement therapy.