When a man or boy discovers gynecomastia, it often has a major psychological impact on their emotional being and sense of self. We are highly cultured to believe that breasts are on women. Anything looking like breasts means female. While there is a subset of men that find having female like characteristics exciting or pleasurable, the majority of males find it antithetical to being male.
For adolescent onset, gynecomastia happens at the worst possible moment. The boy is just starting to mature; the deepening of his voice, the increased hair growth and suddenly his chest is doing something strange, something unexpected and certainly unwanted. It confuses him. At first he wonders if he is sick or if there is something wrong with him. Until recently he was in a world of isolation. The Internet has provided possible answers and reduces isolation. But it is likely that is has too much shame to really talk to anyone about it.
For most boys and girls the changing body is deeply private. The more education that a parent provides the easier it is to move through this transition to physical adulthood. If they have an open relationship with his parents he can talk about what is happening. Unfortunately for most, gynecomastia is an unknown condition and parents maybe alarmed or dismissing or even humiliating. Fathers and sometimes mothers can reject a son that somehow does not match their internalized picture of what a boy/man should be or look like.
Because of this feared rejection many boys will suffer in silence. They will retreat from family, friends, social and athletic activities out of a fear of being discovered they are somehow less of a man. At the very time it would be useful to reach out for support from trusted people, it does not happen and this can begin a life long pattern of social isolation and distrust.
For most boys this fear of rejection or humiliation is not based on reality. Most parents want their kids to be happy. They will do what they can with whatever means that they can to resolve the issue. Because most parents have limited knowledge about gynecomastia they will defer to their doctor who may or may not have much more information than the parents.
From a psychological perspective it is important to take the feelings of these young men seriously. He is taking a huge risk and being incredibly vulnerable to expose something so personal. It is important that his risk be honored and dealt with in a serious way. Jokes, diminishing it as fantasy or some how not important is really damaging to a young mans self-esteem and body consciousness.
Adult onset is a very different experience for most men. They have had a long time to be familiar with their male bodies. Hopefully he has come to some terms with his masculinity and is emotionally secure. Thus the development of gynecomastia is just another change to be accepted or changed, but it is not a reflection or diminishing of his manhood. If a man is not secure it can be devastating and give another reason for self-loathing and criticism.
While surgery is a cure for the physical condition gynecomastia may bring to light some emotional concerns that need to be addressed. Boys and men can find an external feature that they can focus on that becomes the cause of their internal pain. There were studies showing that vets coming back from war with physical injuries did better than some that did not. If there is a physical wound then there is justification to acknowledge pain, if it is inside, then it cannot be acknowledged or justified.
Changing the body is an important part of healing for many men and boys but it is often not the only issue and there needs to be attention to the healing of the mind as well.
Merle Yost, LMFT