These hormones control the growth characteristics 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 breast development. Hormonal fluctuation also occurs naturally in many newborn infants of both sexes due to the effects of the mother’s estrogen. It happens again in older men, usually around 60 years old, when the testosterone begins to drop naturally. The testosterone decline is referred to as low testosterone, more commonly referred to as “low T” or andropause, which is similar to menopause in women.
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What is Teenage Gynecomastia?
Adolescent gynecomastia is a type of physiological male breast enlargement. Adolescent gynecomastia is caused by an unbalance of the estrogen and testosterone ratio or an increase in the target organ’s sensitivity; in this case, the breast tissue. During puberty, it’s common for hormones to fluctuate, resulting in a state of elevated estrogen. The literature has shown that this hormone variation occurs in up to 65% of adolescent boys. In most cases, pubertal gynecomastia will go away within two years of its development. However, in approximately 5% of males, the juvenile male breast tissue remains. The stubborn tissue is known as persistent pubertal gynecomastia or adolescent gynecomastia. In such cases, the tissue becomes firm and fibrous, and the chest will 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.
Signs and Symptoms of Adolescent Gynecomastia
Adolescent gynecomastia is hallmarked by the apparent sign of abnormal breast development. The size can range from “puffy nipples” to a C or D cup. Also, the male chest could have an oversized nipple-areola complex, which can get quite large and distorted and display a feminine appearance. Some cases show stretch marks, and most have pale skin from lack of sun exposure due to the embarrassment the condition causes.
Adolescent gynecomastia can have symptoms of pain and discomfort, mainly as the tissue develops. If the breast mass becomes significant in size, it can become susceptible to or bumped during regular activity.
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, pliable skin quickly contracts back to the muscle after the gland is removed. However, this ability decreases with age, so it is wise to correct this condition as early as possible. For the best outcome, it is advisable to wait two years after breast development.
Male breast reduction surgery is the treatment of choice and the best cure for adolescent gynecomastia. Removing the target organ, or the breast tissue is a permanent solution unless the area is stimulated to grow again.
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.
Will my gynecomastia come back?
Adolescent gynecomastia rarely returns. If the surgery is performed correctly, the procedure usually results in a cure. The issue is that during and after puberty, hormones are still present, and the body is still in its growth phase.
When the target organ, or breast tissue, is aggressively removed, it has minimal effect on any remaining gland. However, if one were to take anabolic steroids, a recurrence could occur. Also, if a young man were to gain a significant amount of weight, it could increase in size due to fat. This fat accumulation is called pseudogynecomastia or “fake gynecomastia.”
When should I have surgery?
When should I have surgery is a frequently asked question, especially by parents. However, a straightforward answer does not satisfy all criteria. A parent will often notice a change in the young man’s behavior when his enlarged breasts start to become an issue. He may stop taking off his shirt; he doesn’t want to go to the pool or beach anymore; his clothing changes to more massive, more concealing garments that may be dark in color, and he may stop competing in sports.
In general, when the condition begins to affect a young man psychologically and socially in such a negative way, it is time for a discussion. In many cases of adolescent gynecomastia, the glandular tissue will resolve in about two years, so waiting for this period allows nature to take its course. If it doesn’t shrink in this period, then it usually becomes permanent. Young men who want to have surgery traditionally come out on the other side as almost a new person. They become happy, confident, and have a sense of freedom.
Young men with adolescent gynecomastia recover exceptionally well. The healing is fast, with good-quality incisions. The youthful skin contracts and shrinks very well to the new chest contour. Most young men can be back at school in a week. The hardest thing is no exercise for 4-6 weeks, which can be challenging for boys on sports teams or who are very active.
Investigative and other treatments
The medical treatment of adolescent gynecomastia is currently under investigation. As of 2020, the Food and Drug Administration (FDA) has not approved any drugs for gynecomastia. Drugs under investigation include:
- Tamoxifen, which blocks the actions of estrogen.
- Danazol, a synthetic form of testosterone that prevents 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 readily 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 Gynecomastia Forum.
Kinsella, Christopher Jr. M.D.; Landfair, Angela M.D.; Rottgers, S. Alex M.D.; Cray, James J. Ph.D.; Weidman, Carla Ph.D.; Deleyiannis, Frederic W.-B. M.D.; Grunwaldt, Lorelei M.D.; Losee, Joseph E. M.D.
Plastic and Reconstructive Surgery: January 2012 – Volume 129 – Issue 1 – p 1-7
CA Nordt, AD DiVasta – Current opinion in pediatrics, 2008 – journals.lww.com
CA Laituri, CL Garey, DJ Ostlie, SDS Peter… – Journal of pediatric …, 2010 – Elsevier
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