Adolescent Gynecomastia

What is it?

Adolescent gynecomastia (sometimes referred to as “Puffy Nipples”) is swelling of the breast tissue in young males and is caused by an imbalance of the hormones testosterone and estrogen.

These hormones control the growth and maintenance of sex characteristics in both men and women. Testosterone controls male traits, such as body hair and muscle mass. Estrogen controls female traits, such as the growth of breasts.

Estrogen is commonly thought to be restricted to females, but men also produce this hormone, though in small quantities.

Breast development occurs naturally in many newborn infants of both sexes due to effects of the mother’s estrogen, in adolescent boys due to hormone changes, and in older men. This is referred to as physiologic gynecomastia.   

What causes adolescent gynecomastia?

A decrease in the amount of testosterone compared with estrogen can trigger gynecomastia. The cause of this decrease may be related to conditions that block the effects of or reduce testosterone, or a condition that increases estrogen levels.

diagram - production testosterone and estrogen

This diagram illustrates the production of both testosterone and estrogen in the testis and adrenal gland. It also shows how an overproduction of estrogen in the breast results in male breast development.

Signs and symptoms of adolescent gynecomastia

During puberty, it’s common for hormones to fluctuate, resulting in a state of elevated estrogen. In fact, research has shown that this occurs in up to 65 percent of adolescent boys. In most cases, gynecomastia will go away within two years of its development.

However, in approximately five percent of males, the adolescent male breast tissue remains. This is known as persistent pubertal gynecomastia or adolescent gynecomastia. In such cases, the tissue becomes firm and fibrous in nature. The chest may have varying ratios of fat to breast content. While the fat content can be increased or decreased by weight gain or loss, the breast volume remains the same. The breast tissue can also be stimulated by drugs, such as steroids, and can become significantly large and even painful. 

symptoms of adolescent gynecomastia - figure

What is the best approach to treating gynecomastia?

In most adolescent patients, surgical correction usually leads to immediate cosmetic improvement and is considered the best approach.

A surgical treatment known as gynecomastia gland excision with liposuction is a highly effective procedure for adolescent boys. The young, elastic and pliable skin easily contracts back to the muscle after the gland is removed. However, this ability decreases with age, which is why it is important to correct this condition as early as possible. For the best outcome, it is advisable to wait two years after breast development.

adolescent male before and after breast gland excision

A 12-year old adolescent male before and after breast gland excision and liposuction surgery. You can read this young man’s story here. This case is courtesy of Miguel Delgado M.D. 

before and after male breast reduction surgery - Puffy Nipples

Puffy Nipples” before and after male breast reduction surgery

Investigative and other treatments

Medical treatment of adolescent gynaecomastia is currently under investigation. As of 2015, there are no drugs approved by the Food and Drug Administration (FDA) for the treatment of gynecomastia. Drugs under investigation include:

  • Tamoxifen, which blocks the actions of estrogen
  • Danazol, a synthetic form of testosterone that blocks lowered estrogen production and increases androgen (male sex hormone) levels
  • Dihydrotestosterone (DHT), an androgen hormone that is the active form of testosterone

Herbal or natural treatments, exercises, and off-label drugs are easily available on the internet. However, these approaches fail to produce the desired results. To see what surgeons and patients are saying about these “cures,” visit the Gynecomasia Forum.