Gynecomastia in adolescents or teenage boys occurs during puberty, although symptoms can start as early as age 10. However, on average, initial symptoms of gynecomastia start around age 13 to 14. The appearance of man boobs (or moobs) can be extremely distressing and affect confidence and social interaction. Often, gynecomastia symptoms in teenagers will result in avoiding activities that involve showing their chest, such as swimming. Changing clothes at school or college for sports can also be difficult.
By age 17, gynecomastia symptoms will normally have resolved. For teenagers with persistent gynecomastia, treatment or surgery may be required. Before considering any type of gynecomastia treatment, it is vital to visit a doctor for a gynecomastia physical evaluation. Teenagers may then be referred to a specialist in hormone-related conditions and disorders, called an endocrinologist. Various diagnostic blood tests to determine the cause of gynecomastia symptoms are usually carried out. When there are elevated rates of estrogen levels, treatment with medication may be an option. Three types of medication may be recommended to treat gynecomastia in teenagers caused by a hormone imbalance.
Gynecomastia Symptoms in Teenagers and Boys
The initial symptoms of gynecomastia in teenagers and boys can vary. Usually, they will consist of slight soreness or tenderness in the chest area, increased nipple sensation, and a small lump underneath either one or both nipples. Increased growth of breast tissue may also occur, resulting in a more feminine appearance of the chest area. Gynecomastia has been classified into four grades, with grade 1 being the least severe and grade 4 the most severe.
What Is Hormonal Gynecomastia in Teenagers?
Estrogen and androgen receptors determine the degree that breast glandular tissue grows in boys. Estrogen is responsible for breast tissue growth, and androgen receptors in boys are responsible for inhibiting the formation of excess glandular tissue. Gynecomastia symptoms in boys are thought to result from a rise in estrogen and an imbalance between estrogen levels and androgen receptors.
During puberty, this causes the appearance of male breasts or man boobs. By the age of around 17, the balance corrects itself, and gynecomastia symptoms regress. This is why treatment with medication for gynecomastia in boys and younger teenagers is not usually offered. Psychological therapy is normally considered a more appropriate way of helping boys and teenagers affected by gynecomastia symptoms.
By age 18, if gynecomastia symptoms persist, various medications have been shown to cause a regression of gynecomastia symptoms. The success of medications varies, and research has shown differing results in regression of gynecomastia symptoms following treatment with “gynecomastia” medication.
Medication for the Treatment of Gynecomastia Symptoms in Teenagers
Currently, medication for gynecomastia is not FDA approved. The medications have been FDA approved for the treatment of other conditions, and when used for gynecomastia treatment, this is called “off-label” use. However, when a hormonal imbalance is diagnosed following blood tests, medications are often the first step for teenagers with persistent gynecomastia symptoms. There are three categories of medication that treat the estrogen/androgen imbalance, and they work in different ways.
Medications for Gynecomastia to Block Estrogen Receptors
Medications designed to block estrogen receptors are collectively called selective estrogen receptor modulators (SERMS). This type of medication is usually used to treat painful gynecomastia symptoms. The body continues to produce estrogen, but the effect on the breast cells is blocked. This category of medication was initially used to treat or reduce the risk of breast cancer in females.
Anastrozole (Brand name: Arimidex) — a type of estrogen inhibitor that works by stopping the production of estrogen.
Gynecomastia Medications Side Effects
All gynecomastia medications come with associated side effects, which are often the reason for discontinuing use. Research has shown that in some cases, when gynecomastia medication is stopped, gynecomastia symptoms can return.
Gynecomastia medication side effects include:
Testicular atrophy (reduction in size of the testicles)
Sperm count decline
Reduction in bone density
Nausea and vomiting
Skin rash and irritation.
Gynecomastia Surgery for Teenagers and Adolescents
Gynecomastia surgery is considered the most reliable solution to get rid of gynecomastia symptoms. It is the only permanent treatment for gynecomastia symptoms that does not come with the side effects that can be caused by gynecomastia medication. These side effects are one of the main reasons many male adolescents decide to have gynecomastia surgery.
When choosing whether to try gynecomastia medication, it is important to consider how the side effect may impact you psychologically. This is especially relevant for teenage boys who already have psychological difficulties due to their gynecomastia symptoms. Gynecomastia surgery also has associated risks and complications, although they are rare or normally easily rectified with appropriate treatment. When gynecomastia surgery is performed by an experienced plastic surgeon, the patient satisfaction rate is high and incidence of complications relatively low.
Types of Gynecomastia Surgery
Various procedures can correct gynecomastia symptoms and get rid of man boobs for good. The procedure option will be determined by the gynecomastia symptoms, and severe gynecomastia symptoms will require more extensive surgery to remove excess skin. When considering gynecomastia surgery, one of the main concerns is scars.
Grade 1 and 2 gynecomastia incisions are normally located around the bottom edge of the areola. The resulting scars are usually difficult to detect due to the difference in color between the areola and the surrounding chest skin. Scars continue to fade and normally become difficult to detect within six months to a year.
Gynecomastia Surgery for Grade 1 and Grade 2 Gynecomastia
The “Pull Through” technique is a relatively new technique developed to treat grade 1 and some grade 2 cases of gynecomastia symptoms. The advantage with this technique is the absence of visible scars due to the small incision required. Liposuction may also be needed to even out the contours of the chest. The disadvantage is that this technique can often produce uneven results when not performed correctly. This is one of the reasons gynecomastia revision surgery is generally requested following this procedure.
The “Standard” technique is usually used for grade 2 gynecomastia cases and involves a slightly longer incision around the bottom half of the areola. The breast glands are then excised along with fatty tissue, and liposuction is also often performed to smooth out the chest contours. The patient satisfaction rate following this procedure is high, and the scars, when healed, tend to be hard to see unless looking very closely.
A two-stage procedure is sometimes required for grade 2 and may be recommended for grade 3 gynecomastia symptoms. The first stage is the standard technique, followed by a periareolar lift around four to six months later. The periareolar lift is performed to remove excess skin and improve the contour of the chest. The advantage of the two-stage procedure is that incisions are only made around the edge of the areola.
Gynecomastia Surgery for Grade 3 and 4 Gynecomastia
Grade 3 and 4 gynecomastia symptoms are rare in teenagers. When they do occur, incisions in the breast crease are required to remove excess skin. In some cases, the skin crease will extend to a roll that will continue to the back. When this happens, the incisions will need to be extended, and the resulting scars will inevitably be longer and more noticeable.
A double incision mastectomy is the most effective gynecomastia surgery for most grade 3 and all grade 4 gynecomastia symptoms. The procedure involves an incision made in the breast crease, which may extend to the back. The breast glandular and fatty tissue is excised, and liposuction is performed for even contours. Although scars will be visible, once faded, they tend not to be an issue, and most patients report being very happy with the results of this procedure.
For personalized information about gynecomastia plastic surgery procedures, please complete Dr. Delgado’s inquiry form.
What is gynecomastia is a question frequently asked. The condition called gynecomastia causes men and boys to develop enlarged breast tissue. This may occur if two hormones in your body are thrown out of balance. In the case of enlarged breasts caused by fat deposits, you have a different condition known as pseudogynecomastia. In contrast to women, men do not develop breast tissue the way they do, all boys are born with a small amount of breast glandular tissue.
During puberty, testosterone is the main hormone produced by a boy’s body, which controls his sexual development. Additionally, males also produce some estrogen, which is the hormone responsible for promoting sexual growth in females.
In puberty or when the body of an older man produces less testosterone, the balance between these two hormones changes.
This can lead to male breast tissue swelling when a higher percentage of estrogen is present. The prevalence of this condition varies from half of the adolescent boys to two-thirds of men over the age of 50.
Symptoms of Gynecomastia
Gynecomastia can first be detected by a lump of breast tissue under the breasts. There might be tenderness or soreness in this lump. This may affect one or both breasts and can be established by a medical history and physical exam.
If you are experiencing these symptoms you may wonder whether you have breast cancer, which does occur in some men. In general, gynecomastia is not indicative of cancer, but your doctor may run some tests to confirm that it is not the result of cancer.
Breast enlargement may occur unevenly, with one breast growth larger than the other. Additionally, you may experience tenderness in your breasts.
If you notice swelling, burning, or tenderness in your enlarged breasts, or if you notice a discharge from the breast nipple, see your physician.
It is difficult to pinpoint the exact cause of the hormonal imbalance that leads to the growth of male breasts, and often the exact trigger is unknown.
Aside from normal body changes such as puberty and aging, gynecomastia can be caused by a number of factors such as:
Injuries or diseases that affect the testicles and result in testosterone production
Thyroid problems. since hormones from that gland control growth and sexual development
Obesity increases estrogen levels
A wide range of illegal drugs, including anabolic steroids, marijuana, and heroin
Kidney disease or kidney failure (when your blood cannot be cleaned and filtered)
Diseases of the liver
Pituitary gland tumors
Infant boys may briefly experience gynecomastia when they are still receiving hormones from their mothers.
Certain drugs can result in gynecomastia, including:
Anti-androgens medications. These drugs are used for the treatment of prostate enlargement and prostate cancer
Synthetic anabolic steroids and androgens. In order to enhance their athletic performance, athletes may use these drugs illicitly. Some of the drugs are also used to treat legitimate medical conditions.
Anti-HIV drugs. In some cases, gynecomastia may be a side effect of HIV treatment, also known as highly active antiretroviral therapy.
Anti-anxiety medications. Medicines such as diazepam (Valium ) can sometimes cause gynecomastia.
Medicines for the heart. In some cases, drugs such as digoxin (Lanoxin) or calcium channel blockers can cause gynecomastia.
Medications are used to eliminate the contents of the stomach. Metoclopramide (Reglan ) may cause gynecomastia as a side effect.
Medications for ulcers. Some medicines that you buy over the counter for ulcers can lead to gynecomastia, such as cimetidine (Tagamet). Antibiotics may also result in gynecomastia. Additionally, some cancer treatments and tricyclic antidepressants may have these effects.
Treatment of Gynecomastia
The majority of cases resolve on their own without treatment.
You might be referred to a specialist known as an endocrinologist when you suffer from gynecomastia. Endocrinologists treat problems relating to hormones and how they affect your body.
The gynecomastia treatment you receive will depend largely on your age, your health, the length of time your condition may last, and your response to certain medications.
The majority of cases of gynecomastia occur during puberty, and they usually disappear on their own. The process may take anywhere between six months and three years.
In the event that your hormonal balance is out of whack due to another health issue, you should treat that condition. Blood tests may be required to establish gynecomastia diagnosis.
You may be prescribed medication to treat the hormonal imbalance that is causing your breast tissue to grow.
In some cases, surgery may be necessary. The following techniques may be prescribed by your physician:
Liposuction (removing excess fat from the breast) Mastectomy ( removing the breast gland tissue). Plastic surgeons perform these procedures.
Guidelines for Preventing Gynecomastia
The likelihood of developing gynecomastia can be reduced by taking certain steps. The list includes items such as:
Please refrain from using drugs such as steroids, androgens, amphetamines, marijuana, and heroin, as they are illicit and recreational.
Drink alcohol in moderation or not at all.
Your doctor should review the list of your medications. When taking medications that may cause gynecomastia, ask your physician if alternative therapies are available.
The complications of gynecomastia
You may experience mental health consequences if you suffer from gynecomastia. This could result in feelings of embarrassment, anxiety, or depression. To manage these feelings, you can take several steps.
Discuss your feelings regarding gynecomastia with your doctor. Any mental health problems you may develop can be managed by a mental health professional.
According to statistics collected by the National Institutes of Health (NIH), between 50% and 60% of adolescent males experience gynecomastia. Gynecomastia often manifests in young individuals due to more male estrogen levels than is normally produced by the body during puberty. Around the time a man enters his 20s, the chest contour tends to naturally flatten out, but this may not always be the case.
Men with gynecomastia
Gynecomastia is even more prevalent among adult men. The same NIH study found that approximately 65% of men aged 27 to 92 years had some degree of gynecomastia. While the symptoms of gynecomastia in adolescents and adults may be similar, the causes of the condition are very different. Additionally to hormonal imbalances that occur over time, certain health conditions can also contribute to male breast enlargements, such as thyroid disorders and cancers of the pituitary gland. Consumption of alcohol and recreational drugs, such as marijuana, can also lead to gynecomastia.
What causes gynecomastia in puberty?
Gynecomastia is an increase in the size of the breast (guy-nuh-kah-MAS-tuh) as a result of the imbalance of the levels of the hormone estrogen and testosterone. Gynecomastia may affect one or both breasts, sometimes unevenly.
Gynecomastia before and After Puffy Nipples Eliminated
Gynecomastia, often referred to derisively as ‘man-boobs’, is endemic in the United States. While gynecomastia can be associated with excess body mass and obesity, many males I see for gynecomastia reduction surgery are not overweight, but simply have experienced the spontaneous proliferation of fibrous breast tissue on one or both sides of their chest, for reasons that medical science currently cannot fully explain. This causes many young men to ask, Why Do I Have Gynecomastia? For young men and teens with gynecomastia, the problem can create a vicious cycle of self-consciousness and social withdrawal. With breast area enlargement, a boy gradually becomes insecure about his appearance without a shirt on or even in workout clothing. They begin to avoid social situations in which their chest appearance is obvious (the gym, the pool, pickup games), and sometimes come to avoid sporting activity of any kind. This can potentially damage their psychosocial development and has a profoundly negative effect on their sense of well-being and quality of life. It certainly is possible that some gynecomastia may improve without surgical intervention after a few years, particularly in very young teens. However, if my own sons had gynecomastia that persisted beyond two years, particularly if they are fifteen or over, I would certainly support their decision to go forward with Surgical Treatment for Gynecomastia
Gynecomastia will not go away with diet or exercise, although I have seen young men injure themselves due to excessive workouts, and others put their health at risk by minimizing calories. Glandular tissue cannot be dieted away. if you are a parent with a son who is concerned about gynecomastia, assure him that it is not his fault and support him in any way you can.
Gynecomastia, often referred to derisively as ‘man-boobs’, is endemic in the United States. While gynecomastia can be associated with excess body mass and obesity, many males I see for gynecomastia reduction surgery are not overweight, but simply have experienced the spontaneous proliferation of fibrous breast tissue on one or both sides of their chest, for reasons that medical science currently cannot fully explain. Some males have fullness of the overall breast area, while others have exclusively enlarged glands or puffy nipples.
For young men and teens with gynecomastia, the problem can create a vicious cycle of self-consciousness and social withdrawal. With breast area enlargement, a boy gradually becomes insecure about his appearance without a shirt on or even in workout clothing. They begin to avoid social situations in which their chest appearance is obvious (the gym, the pool, pickup games), and sometimes come to avoid sporting activity of any kind. This can potentially damage their psychosocial development and has a profoundly negative effect on their sense of well-being and quality of life. Many young men will wonder, Why Do I Have Gynecomastia?
It certainly is possible that some gynecomastia may improve without surgical intervention after a few years, particularly in very young teens. However, if my own sons had gynecomastia that persisted beyond two years, particularly if they are fifteen or over, I would certainly support their decision to go forward with this surgery.
Gynecomastia correction surgery is the only surgery I perform on teens. I hear stories of young men who wear as many as four shirts during the heat of summer to camouflage fullness in their chest that makes them feel self-conscious. One parent shared with me that her son was selecting colleges based on the school colors. He only wanted to attend a college where the school colors included black, navy or dark green.
I have seen young men work out too hard and injure themselves, hoping that building muscle will be a distraction from gynecomastia. Others reduce calories so much that they risk a health problem. There is no diet, workout program or pill to eliminate gynecomastia. if gynecomastia persists for a year or more, it may be time to consider Surgical Treatment for Gynecomastia Some parents want the best for their sons’ but they do not realize that gynecomastia is not fat and that the only proven way to eliminate gynecomastia is with surgical correction.
The solution: Even though gynecomastia is common during puberty, older men can develop the ‘man boob’ too as a side effect from taking certain medication. The swollen breast gland tissue is what causes gynecomastia.
While you can always go on your regular exercise regimens, that doesn’t mean our bodies can always keep up as we age. Sometimes we need to rely on medicine and science to achieve that ideal body and figure.
When you look good, you feel good; the best thing about embarking on this journey is that you get the health benefits and looking younger than your age.
Even if it is not for the boost in confidence, each of these treatments contributes to your wellbeing and health. You’ll find yourself walking with a skip in your step everyday.
Up to 65% of young men will develop breasts by the age of 14. As boys go through puberty, they will have an imbalance of sex hormones. This is a normal condition but can be very frightening as they see their body going through changes
Unfortunately, if boys do not understand what is happening they will probably try to hide their chest with loose fitting shirts, avoid swimming, or any activities that require removing their shirt. Most boys are too embarrassed to confide in their parents.
With the prevalence of bullying in school, boys with gynecomastia are easy targets. Cruel nicknames can cause isolation and self-hatred.
Thankfully, 90% to 95% of young men will find the condition will resolve itself in a few weeks up to 2 years without any treatment. However, when you are young, 2 years can feel like an eternity! Receiving emotional support from parents or other family members can make a big difference.
Hopefully, young men and their parents will find this website. In addition to all the information posted here, there are many forums available (at no charge) where members can ask questions of each other and of gynecomastia specialist.
There are many personal stories posted on this site, one in particular is “A Mother’s Story.” She encourages boys to let their parents know how much they are suffering, and that they may be surprised at how supportive they are.
If any young men are reading this blog but feel it is impossible to talk to their parents, you might try sending an email with a link to the Mother’s story and also to this site. It is surprising how many people are unaware of gynecomastia. It is a tragedy for boys to suffer when help is available. The pictures below are of a 12 year old boy, he did not have any skin excision due to good elasticity.
In some cases of severe gynecomastia or severe depression, surgery may be an option and can be a life-changing event. Parents are urged to seek a consultation with a Board Certified Plastic Surgeon who specializes in gynecomastia.