Problem

Gynecomastia results in an increase in breast tissue in males that, when problematic, is readily detectable by other individuals. The increased tissue may be breast glandular tissue, adipose (fatty) in nature, or a combination of the two. This results in significant functional and psychological limitations. The physical deformation may also be exquisitely painful. As a general rule, the glandular tissue is significantly more painful than the fatty tissue. Situations like gym class may require children or adolescents to remove their shirts in the presence of other students. This can put a boy with gynecomastia in danger not only of embarrassment but also of physical harm.

Most patients have never heard of this condition until the family physician identifies it. The physician may be unaware of the possible causes of the condition and its psychological impact. After initial presentation, boys are frequently advised to ignore the gynecomastia and are told that it will go away. Fortunately, in most instances, cases of minimal subareolar pubertal-onset gynecomastia do regress as puberty progresses.

Individuals with no regression or even progression of the deformity often receive little or no understanding about the shame and humiliation they experience. Coaches, sergeants, physicians, parents, and peers (both boys and girls) can inflict damage out of ignorance, cruelty, or both. The author reports that a parent recently exclaimed during an initial evaluation, "I just don't understand why 'he' has to slouch around all the time." Postural and clothing modifications to mask the deformity are the norm in these patients from puberty through adulthood.

Awareness of gynecomastia needs to progress in order to inform the men and boys with gynecomastia and their physicians what can be done to improve the condition.

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