BREAST ENLARGEMENT IN BOYS AT PUBERTY (pubertal gynaecomastia)
Some breast enlargement is remarkably common in boys in early puberty,
indeed it can be considered normal as nearly half of all boys are affected.
Nonetheless, it is often a cause of unnecessary distress.
Cause.
The key event at puberty is the secretion of sex hormones. Hormones
are chemicals secreted into the blood by endocrine glands. The main sex
hormone in boys is testosterone, secreted by the testes, and in girls is
oestrogen, secreted by the ovaries. However, both hormones are in fact
secreted in both sexes. There is some production of oestrogen from the
testes and some production of testosterone from the ovaries. It is the
balance between these two hormones that determines the pattern of development
as male or female. In boys there is also another potential source of oestrogen
because testosterone can be converted to oestrogen in fatty tissue. Breast
tissue is sensitive to oestrogen in boys as it is in girls and exposure
even to the small amounts of oestrogen secreted in boys can cause some
breast development.
Symptoms.
Most commonly, soon after the boy starts to show signs of puberty, small,
firm plaques of breast tissue develop right under the nipples. These can
be quite tender. In some boys there is also fatty development around the
nipple, this is more likely to occur and more prominent in boys who are
overweight. Although such breast development is completely harmless, it
may be a matter of real concern. Boys are naturally sensitive about their
male development at this age and some who find they have breast development
suffer agonies of worry without mentioning their concern to anyone. In
some boys one breast is more affected than the other and sometimes the
development can be entirely one sided; this has no special significance.
If the breast development becomes at all obvious most boys find it embarrassing
and take to wearing loose clothes and avoiding exposure in showers and
swimming pools. Obviously this can greatly inhibit their activities.
Outlook.
Fortunately, pubertal breast development nearly always proves a transient
problem and gradually resolves as puberty progresses. It usually improves
within one year and is seldom a concern after two years. Puberty progresses
normally in all other respects. Very rarely, the problem is more severe
and persistent. There are several extremely unusual disorders in which
breast development can occur in boys of this age. It can also occasionally
run through several generations in some families. Underlying disorders
can generally be excluded by physical examination and a blood test. If
the breast development is particularly troublesome, therefore, it is worth
consulting a doctor with experience in these matters.
Treatment.
When there is fatty breast development it is obviously helpful to lose
some weight. Boys should also be allowed some privacy if they wish. Most
schools are helpful about this. Many different medications which affect
hormone release or action have been tried but none are both effective and
safe. The only really effective treatment is plastic surgery. Total removal
of the breast tissue requires quite a long operation and is inevitably
sore afterwards but it usually gives an excellent result with only slight,
and often nearly invisible, scarring along the border of the nipple. Liposuction
has been tried but is less effective. Fortunately, only very few boys require
such radical treatment. In the very great majority all that is needed is
explanation and reassurance possibly backed up with some weight loss. |
