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Teen Gynecomastia Study: A Little of Everything

Teen Gynecomastia Study: A Little of Everything

It pleased us, perplexed us and perturbed us all at once. We’re talking about a study of teens with man boobs published last month in the Journal of Clinical Endocrinology & Metabolism. We are not endocrinologists, but we have worked with our share of adolescents with gynecomastia in New York for more than 30 years. Therefore, we found our reactions to the new study spanning a spectrum.

Confirming What We Suspect

The study, performed by pediatric endocrinologists in Germany, included 86 boys with gynecomastia and 38 with “pseudogynecomastia” (mainly fatty tissue—more on that later). The researchers found that the subjects with gynecomastia had a significantly higher ratio of the hormone estradiol (estrogen) to testosterone when compared to youngsters with pseudogynecomastia and to controls without enlarged breasts. Levels of other sex hormones did not differ among the populations.

Along with other gynecomastia specialists who treat adolescents, we have suspected for years that persistent gynecomastia in New York teens is sometimes due to hormones that are “out of whack.” It’s important to note that this isn’t always the case, however. We treated one young man whose father, an endocrinologist, tested the son’s hormones and found them to be perfectly normal. And several years ago, a team of doctors at the Mayo Clinic found that sex hormone levels were not statistically different among teens with man boobs and teens without.

There are other gynecomastia triggers for teens. Young men who have certain genetic conditions or who use steroids or street drugs can develop breasts. For some adolescents, there’s no known reason breast growth occurs. We encourage our New York teens with man boobs not to worry too much about the cause. There are just too many unknowns.

No News About the Unknown

We are always happy to see new gynecomastia research come out, and we were glad to read this new study suggesting that hormone swings can trigger breast growth in teens. What’s frustrating for both doctors and patients is that no one can explain exactly how hormones and man boobs are related. A doctor writing for American Family Physician several years ago stated that up to 50% of adolescent males experience some breast growth. Since every teen experiences hormone swings at some point, why do some boys grow breasts and some don’t?

Researchers at the Mayo Clinic found that about 10% of pubertal gynecomastia cases persist after age 17. Why? As puberty starts to settle down in the later teen years, why do some guys continue to have enlarged breasts while most don’t? In our experience, sometimes there’s a family connection. We have treated teens with gynecomastia in New York whose fathers and grandfathers have also had the condition. But a genealogical explanation doesn’t work for the majority of our patients.

Perpetuating Misconceptions

Finally, we are somewhat dismayed by the medical community’s insistence on distinguishing cases of gynecomastia from cases of pseudogynecomastia—read an article on this topic here. The recent German study continues this trend.

It’s not that teens who are overweight don’t have breasts made up of fatty tissue—they do. What many doctors don’t realize is that fat creates its own local environment including elevated estrogen levels; consequently nearly 100% of overweight boys with breasts have extra gland tissue mixed in with the fat.

All too often young men are told that losing weight is the solution. Those who do drop extra pounds find that their breasts are still enlarged, and sometimes the extra gland tissue is even more noticeable without fat to disguise it. Even the rare young man whose breasts may be almost entirely made up of fat will not be able to make them disappear entirely—pockets of fat persist like saddlebags in women and love handles in men. Once adolescents have man boobs for two years or longer they require surgery, no matter the ratio of fat to breast gland.

There are other reasons we don’t like to see the term “pseudogynecomastia” bandied about. One is that it can lead to ineffective treatment—namely liposuction only. A plastic surgeon needs to be skilled with both cannulas and sharp instruments to treat almost all cases of man boobs. And maybe worst of all, the term carries an air of dismissiveness, as if moobs are not worth treating if they are comprised of fat. Take our word for it, what’s under the skin doesn’t have much to do with how terrible a patient can feel about his physique.

We’re delighted that gynecomastia research continues, and we look forward to the day we know more about the causes than we do today. When we understand the condition better, we may discover additional treatments that really work. Until then, we’re here in New York for teens with man boobs and men too. Contact us to find out more.

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