OMG!...I have Bitch Tits!

By Frank Monaco

Bitch-Tits, (aka Gyno, Man Boobs, Moobs or the more appropriately called gynecomastia) is a subject often discussed among athletes in the bodybuilding and fitness communities. For the rest of us, “gyno” is an issue that causes insecurity and discomfort and is, therefore, a closely kept secret. Most men aren’t aware of how prevalent an issue  gynecomastia is. You might be surprised to learn that one in four men have some degree of gynecomastia. Men can feel insecure or ashamed of their bodies due to this enlargement of breast tissue that causes their chest to have a feminine appearance. If this describes you or someone you may know, there’s a procedure that can remedy this affliction. 

Dr. Frank Stile, an accomplished cosmetic plastic surgeon in Las Vegas, NV, is one of the most experienced gynecomastia surgeons in the country.  His patients include professional athletes, UFC fighters, boxers, Mr. Olympia competitors and regular guys.

What is Gynecomastia?

Gynecomastia is commonly referred to as “gyno” or “bitch-tits.”  It is the result of enlarged or swollen breast tissue (gland) in men, commonly caused by an imbalance in the male hormone testosterone and the female hormone estrogen.  Gynecomastia isn’t typically dangerous, but it can cause mild pain and discomfort.  Disproportionately increased fat localized to the chest can also cause the appearance of gynecomastia or worsen the appearance of gynecomastia resulting from an enlarged gland. 

Regardless of the cause, affected men universally complain, “it just doesn’t look good.” The most common issue for men/boys with gynecomastia is lowered self-esteem resulting from this enlarged breast tissue. In many cases, patients may be so sensitive about their appearance that they refrain from events or situations in which they have to remove their shirt. These feelings of insecurity are heightened in gym locker-rooms, public pools, the beach when wearing form-fitting shirts and even in intimate encounters.

Gynecomastia surgery is on the rise.

There is an increased awareness of gynecomastia in both the general public and plastic surgery community. This has made it less of a taboo subject for discussion and more “main stream.” In 2011, 19,766 cases of gynecomastia corrective procedures were performed as reported by the American Society of Plastic Surgeons (ASPS)— an 8% rise from 2010.  

In 2015, The ASPS showed that men accounted for more than 40% of breast reduction surgeries performed in the U.S. A total of 27,456 breast reduction surgeries (gynecomastia corrective procedures) were performed on men, representing a 5 percent increase over the previous year and a 35 percent increase since 2000.



A before and after of one of Dr. Stile’s actual gynecomastia patients - click here to see more


What Causes Gynecomastia?

Gynecomastia is caused by an altered ratio of androgens to estrogens resulting in increased estrogen levels. Estrogen acts to increase the size of male breast tissue and is made to appear worse by excess fatty tissue in the breast. The cause of gynecomastia is unknown in the majority of cases, but drug use (pharmaceutical and illicit) are estimated to be the main contributor and cause up to 25% of cases of gynecomastia.

Certain health problems in men such as malnutrition, liver disease, kidney failure or low testosterone production can cause breast growth in men. Drugs and liver disease are the most common causes in adults.

Some of the common medications that are known to cause gynecomastia include:  

Ketoconazole, cimetidine, gonadotropin-releasing hormone analogues, human  growth hormone (HGH), human chorionic gonadotropin (hCG), finasteride, estrogens, and antiandrogens, flutamide, and spironolactone, calcium channel blockers such as verapamil, amlodipine, and nifedipine; risperidone, anabolic steroids, alcohol, marijuana, opioids, and omeprazole— just to name a few.

Anabolic steroid (androgen) use is a very common cause of gyno in the fitness and bodybuilding community.  When patients take anabolic steroids, their body temporarily ceases production of testosterone. This is sometimes called suppression.  When patients abruptly stop using these androgens, it takes a while for their body to produce normal levels of testosterone again.  This lag-time creates an imbalance with more estrogen being produced. The higher levels of estrogen can cause the breast gland to grow, resulting in gynecomastia.


A before and after of one of Dr. Stile’s actual gynecomastia patients - click here to see more



How does Dr. Stile Treat Gynecomastia?

Picking the right surgeon to correct your gynecomastia is extremely important. Incorrectly performed procedures can leave patients with noticeable deformities. Many of Dr. Stile’s patients are professional athletes who regularly appear on TV. These athletes can have their reputations adversely affected by the negative associations made between gynecomastia with performance enhancing drug (PED) use. These often incorrect assumptions can be career ending.

Treatment of gynecomastia begins with a thorough history and physical examination of the patient. Important aspects of the physical examination include evaluation of the male breast tissue to evaluate the cause of gynecomastia being fat vs. gland or both.

This is followed by a genital exam and evaluation of testicular development  and an assessment for masses that may raise suspicion for testicular cancer. Younger patients are assessed for proper development of secondary sexual characteristics, such as the amount and distribution of pubic and underarm hair. Gynecomastia usually involves both breasts but may occur unilaterally (one side) as well. 

A careful review of the medications or illegal substances patients take may reveal the root cause of gynecomastia.  In addition, blood work is also performed to find the underlying cause of gynecomastia. Lab tests include liver function tests, renal (kidney) function tests and thyroid levels. 

Sex hormones such as Serum beta-human chorionic gonadotropin (B-Hcg), Serum testosterone levels (free and total), estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) may also be evaluated to determine if hypogonadism (under-developed testes) may be the cause of gynecomastia. 

Just like many other conditions, there are different ways in which gynecomastia can be present in males.  True gynecomastia is generally characterized by enlarged glandular tissue whereas pseudo-gynecomastia presents with excess adipose (fatty) tissue.  Most cases are a combination of both. There may also be varying amounts of excess skin present that may need to be addressed during corrective surgery.

The severity of Gynecomastia is graded as follows:

•  Grade I: Minor enlargement, no skin excess

•  Grade II: Moderate enlargement, no skin excess

•  Grade III: Moderate enlargement, skin excess

•  Grade IV: Marked enlargement, skin excess

The choice of a specific treatment to correct this disorder depending on the severity of gynecomastia.

Dr. Stile, a world-renowned board certified cosmetic plastic surgeon, uses an excision of the breast gland in the case of enlarged glandular tissue and liposuction for cases with excess fatty tissue.  Some patients require both gland excision with liposuction contouring to achieve the best result. 

Most commonly the incision is in the lower part of the areola, and each incision is usually no bigger than two centimeters for most patients.  For extreme cases, Dr. Stile will use a male breast lift technique, removing excess skin to achieve optimum, most masculine results for his patients. Most procedures take approximately 90 minutes, but some extreme cases can require three hours of surgery time. Discomfort following this procedure is minimal. Most patients can return to full normal activity at about two weeks after surgery, including exercise.

Where is this surgery performed?

Dr. Stile is the only cosmetic plastic surgeon in Las Vegas who will perform your surgery in his private surgery center.  His facility, Premium Surgical Services Center, is the only dual state and federal certified ambulatory surgical services center in Southern Nevada. This center was designed with only one goal: to provide the highest quality care, comfort, and privacy for all of Dr. Stile’s patients. 

Want to learn more on how you can overcome this disorder?

If you’re interested in scheduling a complimentary gynecomastia consultation, either in-person or via e-mail and phone, contact us via (725) 222-8644 or visit us on the web at 




by dr. John j. pierce, do acoep, abaarm



It is truly an exciting time in history, as scientists get closer to the ever-elusive concept of the “fountain of youth.”  And, as oftentimes it occurs during a search for one remedy, other promising possibilities are found.  This may hold true with the drug, Metformin, the first-line treatment for Type 2 Diabetes.  

While Metformin is the most widely prescribed anti-diabetic drug in the world, scientists have found possibilities in its use as an anti-aging pill.

Currently, two studies testing Metformin and its possible protection against multiple diseases of aging are in process:  

TAME ‘‘Targeting Aging with Metformin’’

The TAME study will use Metformin to study biological aging, which may hopefully lead to the discovery of even better drugs to prevent aging-related diseases, which include cardiovascular disease, type II diabetes, osteoarthritis, osteoporosis, cancer, Alzheimer’s disease and other dementias.

MILES “Metformin in Longevity”

This study has already been completed at the Institute for Aging Research at Albert Einstein College of Medicine, and the health industry is excited to learn of its results, which have not been published as of yet.  Metformin was investigated as to its possibilities as a treatment to genetically restore the blood sugar levels of older adults with elevated blood sugar (impaired glucose tolerance – IGT) to that of younger subjects with healthy blood sugar levels.  

If data shows Metformin to actually alter the biology of aging in tissues to a younger profile, scientists may have tapped into one of the world’s first concepts of the fountain of youth, with a possible widespread use of the drug as an anti-aging treatment.

As fad diets deceptively promise to restore you to your teenage weight, drugs can often be mistakenly seen as a panacea.  And it can’t be emphasized enough that a lifetime of unhealthy lifestyle and abuse to your body cannot so easily be remedied with just one pill.  Nothing can ever replace the most beneficial methods to truly live a long, vital life:  regular exercise and healthy nutrition.

Dr. John J. Pierce, D.O. • Ageless Forever Anti-Aging and Longevity Clinic located at

6020 S. Rainbow Blvd. Suite C  Las Vegas, NV 89118 • 702-838-1994 •



HEPATITIS C WITH ONLY 4-WEEK TREATMENTJust two injections of RG-101, in combination with a four-week course of direct-acting antiviral (DAA) therapy, has been shown to clear Hepatitis C in patients at both 12 and 24 weeks after treatment in the majority of patients, according to research presented recently at The Liver Meeting.  

Hepatitis C (HCV) is a liver disease commonly spread through blood.  RG-101 is a newly developed therapy, delivered through injection that specifically targets the microNRA in the liver that is essential for HCV to continue to replicate (or stay active) in a person’s body. 


Here are the symptoms:

1. Intrusive thoughts, such as repeated, involuntary memories;  distressing dreams;  or flashbacks of the traumatic event.

2. Avoiding people, places, activities, objects and situations that bring on distressing memories.  Avoiding talking about what happened or how you feel about it.

3. Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad” “No one can be trusted”);  ongoing fear, horror, anger, guilt or shame;  much less interest in activities previously enjoyed;  or feeling detached or estranged from others.

4. Arousal and reactive symptoms may include being irritable and having angry outbursts;  behaving recklessly or in a self-destructive way;  being easily startled;  or having problems concentrating or sleeping.



The Vote is In. No: 4,553,833 (53.94%)  Yes: 3,888,895 (46.06%)

The adult film industry got their word out loud and clear in California on November 8th.  Most adult films are produced in Los Angeles’ San Fernando Valley, along with a great deal starting to be produced in Las Vegas.  In November 2012, Los Angeles approved Measure B, which required pornography actors to wear condoms on set.  (Cal/OSHA) requires condom use during sex in pornographic films, but it is not really enforced, as this requirement is in response to complaints, which there usually are none.  

Proposition 60 would have required adult film producers to provide condoms and make sure that performers use them during scenes in which actors engage in vaginal or anal sex.  This is where things getting sticky.  Almost all performers in today’s market are producers as well, as they produce their own content for websites, clip stores, trade, etc.  While condoms would have not been needed to be visible in films distributed to consumers, producers would have needed to prove that condoms were used.  The bill also contained language that would allow anyone watching a film that the performers were not having protected sex to sue the producer of the film, and access the legal names and addresses of the performers.  This essentially would open up all performers/producers to potential lawsuits, fines and loss of privacy.  The costs of performers’ workplace-related medical examinations, sexually-transmitted infections (STI) tests, and STI vaccines would have been covered by film producers under the measure, where they are now the responsibility of the performer.  

The AIDS Healthcare Foundation run by Michael Weinstein, who built a job for himself into the proposal, contributed approximately $5 million dollars to the proposal, while their opponents, organized as the Coalition Against Worker Harassment, received $545,719.  The California DNC, GOP, Green Party and Libertarian Party all opposed the measure.

Dr. Pierce asks: "What's in your Male Enhancement Supplement?"


By Dr. John J. Pierce, DO ACOEP, ABAARM



It feels great to be the Don Juan of lovers—but many men may not be aware that many sexual enhancement supplements contain ingredients that could pose a risk to their health.  

Men should take caution and be vigilant to choose a SAFE and HEALTHY product that fits their needs, by learning which added ingredients to avoid, so as to not put their health at risk.

The FDA has been actively pursuing investigations on the male enhancement products for years and warns consumers against using certain OTC supplements, which contain the following undeclared drugs:

Sildenafil: The active ingredient found in Viagra (a drug prescribed for erectile dysfunction).  
! This drug can cause symptoms like headache and flushing, and can interact with medications containing nitrates such as nitroglycerine, resulting in dangerously low blood pressure.  Men with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. Sulfoaildenafil, Thiosildenafil, Desmethyl carbodenafil and Hydroxythiohomosildenafil are all similar to Sildenafil and its ! Caution.

Tadalafil: The active ingredient found in Cialis (a drug prescribed for erectile dysfunction).
! This drug can cause symptoms like headache and flushing, and can interact with medications containing nitrates such as nitroglycerine, resulting in dangerously low blood pressure.  Men with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates.

Dapoxetine: A selective serotonin reuptake inhibitor (SSRI) (a drug to treat depression). 
! Dapoxetine has not been approved by the FDA. SSRI drugs are associated with serious side effects including suicidal thinking, abnormal bleeding, and seizures, and can interact with other common medications such as aspirin and ibuprofen, which can cause ventricular arrhythmia or sudden death.

FDA’s National Health Fraud Coordinator, Gary Coody, R. Ph., warns men of the many sexual enhancement products which have been found to contain undeclared drugs or other potentially harmful ingredients such as prescription antidepressants, diuretics and other drugs. All Public Warnings and Recalls of these supplements are available at Consumers who have purchased any of the recalled supplements and/or those with issued warnings should discontinue use immediately and contact their healthcare provider if they have experienced any adverse side effects. Both healthcare providers and consumers are encouraged to report any adverse reactions to dietary supplements to the FDA’s “MedWatch Adverse Event Reporting Program”. For continued monitoring of all supplemental products visit: 

I help many patients find natural alternatives to pharmaceutical drugs at my Ageless Forever clinic, through careful analysis of each patient’s bloodwork. 

Dr. John J. Pierce, D.O. • Ageless Forever Anti-Aging and Longevity Clinic located at 6020 S. Rainbow Blvd. Suite C Las Vegas, NV 89118 • 702-838-1994 •

ANABOLIC STEROIDS - You've Amped Up, Now What?


By Dr. John J. Pierce, D.O.



In order to boost physical performance, many athletes have used anabolic steroids over the years. But with today’s definition of “perfectly fit”—it is the non-athletes who make up an even larger portion of those who have been self-prescribing hormones to improve their physique and appearance. An estimated 2.9 to 4.0 million Americans (age 13-50) have used anabolic steroids, and most without physician supervision, using underground black market resources and products. This is not only medically ill-advised as potentially dangerous, but the purity of the product is greatly questionable, adding extra risk to one’s health.  

Other added dangers are increased by a common method of “stacking” (using two or more anabolic steroids—often androgens) in progressively increasing doses in intermittent cycles. This practice makes it hard to predict the cumulative potential health consequences—not to mention that anabolic steroids are not natural to the body, as they are synthetic man-made compounds. Testosterone is the opposite—it is produced naturally by the body, and is necessary physiologically for health and wellbeing. Anabolic steroids are not, and they can come with negative side effects including damaging both the heart and liver, causing high blood pressure, depression, shrinking of the testicles, erectile and sexual dysfunction and infertility, enlarged breasts (aka “bitch tits”), and negatively affecting cholesterol and blood fat levels.

The practice of “cycling” is based on the notion that drug holidays (intermittent use of anabolic steroids followed by taking a break) may prevent desensitization to large doses of androgen (even though this concept remains to be proven scientifically). Yet after a cycle of anabolic steroid use, testosterone levels may fall to unnaturally low levels (even within a female range), known as anabolic steroid-induced hypogonadism, and it can cause loss of sexual desire and sexual function, depression and even hot flushes, all of which can last sometimes up to four years. These symptoms of withdrawal can be so difficult to tolerate that many men go back on another cycle of anabolic steroids, causing a vicious cycle known as “hooked-on-hormones” syndrome.

Post Cycle Therapy helps to restore natural hormonal function for those who have self-administered anabolic steroids, in order to prevent hypogonadism-induced health consequences, such as loss of muscle and bone mineral mass, sexual and reproductive dysfunction, and depression, as well as to promote healthy aging. Treatment involves various dosages of medications in order to achieve balance once again, as there is no “one-size-fits-all” post-cycle therapy. Therefore it is of utmost importance to find a doctor who is well-versed in andrology (the science of man) and endocrine regulation, as well as the side effects of anabolic steroids. Yet, most physicians tend to be uncomfortable and are hesitant to treat patients who have used anabolic steroids.  

Dr. Pierce at Ageless Forever Anti-Aging Clinic in Las Vegas, Nev., understands the importance of listening to patients so that they feel open to discuss their cycles, stacks and motives, in order to properly diagnose and treat them to bring them back to a balanced and healthy state once again. As a former athlete himself, Dr. Pierce understands the mentality of anabolic steroid users and has educated himself in not only the underground lingo, but also in the newest medical research on the subject, to better provide the best possible individualized care for his patients.

Dr. John J. Pierce, D.O. • Ageless Forever Anti-Aging and Longevity Clinic located at
6020 S. Rainbow Blvd. Suite C Las Vegas, NV 89118 • 702-838-1994 •




One of the most popular training techniques to build muscle is PHA Training (Peripheral Heart Action). This method works as an all-in-one training program that burns fat, boosts cardio and builds muscle all at the same time.

To PHA train, choose five-to-six low intensity exercises that include both upper and lower workouts. Alternate between the upper and lower by completing 15 reps of each maneuver before moving onto the next (but without any breaks—at all!). Implement PHA and you will surprisingly gain more muscle.

The University of São Paulo performed a study that showed PHA as effective in growing bigger biceps and a rock solid core. Former Mr. Universe, Bob Galda swore by PHA Training—and he beat out Schwarzenegger!

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