How’s your summer body coming along? Have you been spending any time on any chest presses as of late to get ready for shirtless season? Or are your winter moobs just too damn stubborn? If that’s the case, you might be interested to hear that not only are more men getting male breast reduction surgery these days, but that one’s inability to shed those pectoral pounds might actually be caused by a hormonal imbalance. Either way, thanks to a growing openness among men to talk about plastic surgery, more men are now taking a knife to the chest. (Doesn’t that just sound super masculine?)

Most men assume that when we have man boobs, or “moobs,” it’s because we’re unhealthy and overweight. That’s not always the case. Some men have a condition known as gynaecomastia, which cosmetic surgeon Dr. Navid Jallali describes as “men with excess or swelling of the breast tissue.“ Gynaecomastia is based on an imbalance of hormones—namely, testosterone and oestrogen. “Too much oestrogen causes breast tissue to grow,” Jallali explains. Because men have become more comfortable with the concept of cosmetic surgery, Jallali has seen an increase in breast reduction procedures among men.

According to The American Society for Aesthetic Plastic Surgery, breast reduction surgery ranks within the five most popular surgeries men seek. On top of that, 1.2 million men had cosmetic procedures done in 2015. When compared to the 286,790 men who had surgery in 1997, it’s safe to assume that men are coming around to the notion that plastic surgery won’t make them any less of a man. Good, because the concept of masculinity shouldn’t fit into a neat little box. But this growing trend does suggest that men may be a lot more insecure than they lead on.

Jallali estimates he has as many as four times the number of male breast reduction patients than he did five years ago. “We’re seeing more and more patients with gynaecomastia [specifically],” Jallali says. “Not necessarily because more men are developing the condition, but because more are now willing to talk openly about it. And that’s a positive step.”

Based on his patients’ collective testimony, Jallali believes patients with gynaecomastia aren’t taken seriously by corporate or governmental health professionals due to the perceived cause that man boobs are only caused by inactivity. But while it may be the case for some men, for others, a lax diet and relatively flaccid lifestyle will never fix portruding mammories.

Obviously, if you think this disease might be affecting your efforts to bulk like Hugh Jackman, talk to your doctor—or a plastic surgeon. Just make sure you’re doing it for the right reasons.