There are a number of theories about why some pubescent boys develop breast tissue, but doctors aren’t sure why it occurs. Parents may be reassured to learn that this condition, known as gynecomastia, doesn’t mean there’s anything physically wrong with their sons, but boys who experience it often suffer agonizing embarrassment and may fear they have breast cancer.
“I remember not wanting to be on the ‘skins’ team, when we played basketball in gym class” recalls James, who today is an adult with no sign of breasts. James was about 13 when he developed breast tissue, which he says was gone in a year.
Who gets gynecomastia
Boys who develop gynecomastia are often too embarrassed to discuss the condition with friends or parents. But they are far from alone. “I’d say that up to three-quarters of boys develop gynecomastia, usually around the normal timing of puberty,” says Jennifer Abuzzahab, MD, a pediatric endocrinologist with Children’s Hospitals and Clinics of Minnesota. “Heavier boys are more likely to have gynecomastia than thinner boys are.”
In mild cases, a boy may not even be aware of the slight swelling (average is one to two centimeters in area) below one or both nipples. Dr. Abuzzahab describes the typical appearance as “A rubbery, firm nodule under the nipple that may feel tender.” In some extreme cases, the boy may even have lactation (a milky substance discharging from his breast).
Probable causes
“[The cause] is still a little up for debate,” Abuzzahab says. “One theory is that it may be caused by a higher level of estrogen; and if a boy is making a lot of testosterone, it can convert to estrogen.” Other causes can be a hormone imbalance; steroid use; or the habitual use or abuse of psychotropic drugs, which can include hallucinogens (marijuana is the most common), narcotics, stimulants, and depressants.
“Generally, it’s gone in about a year,” says Abuzzahab. “If it’s not resolved in two years, it’s probably not going to go away on its own.” According to Pediatrics, the journal of the American Academy of Pediatrics, even stubborn gynecomastia should be gone by the time a young man is out of his teens. The notable exception is among those who are obese.
It’s wise to talk to your pediatrician about the possibility of a referral to an endocrinologist if your son is prepubescent, if the condition doesn’t clear up on its own after a year or so, if the swelling appears to increase, or if there is notable pain. One possible solution is surgical intervention. “I would say that if the condition doesn’t resolve in two years, reductive mammography [breast-reduction surgery] may be in order,” said Abuzzahab.
How to help
James, who had gynecomastia as a boy, thinks it’s best to tread lightly. He now has two sons and noticed the swellings on his older son’s chest when the boy was 12. “All of a sudden Nick didn’t want to take off his shirt when we were out in the summer, and I noticed his shirts fit differently. Because I remember what it was like, I tried to talk to him about it. At first he was so embarrassed that he just turned red and walked away. I wrote him a note saying that I’d had the same thing when I was his age and would be here if he wanted to talk. He came back a couple of weeks later, and it was hard for him to start talking, but he was really relieved when I told him it was normal and would probably go away, like it did with me.
“Sure enough, it did. I’m glad we talked about it. Now I’m prepared if it happens to my younger boy.”
Michele St. Martin is a St. Paul writer.
