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Puzzling Development 

Ask Dr. Matt: Boys and breasts

I would like to discuss an issue that has led many a terrified lad to my office in great distress. They usually set up the appointment to have me look at their throat or something common like that, but at the end of the appointment they ask to speak with me about something else — something private. They stutter and stammer and say, "Is it normal for me to be developing breasts?"

What I like to ask these teenage boys: "Have you been thinking a lot about breasts?"

Before they have a chance to pass out from all the blood rushing to their flushed cheeks — I reassure, "I'm kidding, I'm kidding! It is not because of anything you have done or not done."

They then look very relieved, and I share with them the real explanation. Gynecomastia is very common in humans, even boys. Most all babies have some degree of "baby boobies," whether male or female, from maternal transfer of the female hormone estrogen. These lumps almost always resolve by 18 months of age. It is, of course, normal for females to develop breast buds during the phase of puberty known as thelarche (Greek for "nipple-beginning"). What is not widely known is that as many as 70 percent of normal males develop some firm tissue beneath one or both nipples during puberty. The best theories suggest it has to do with the relative ratio of estrogen and testosterone during the rising tide of sex hormones during puberty, with breast tissue being stimulated more robustly by estrogen than it is suppressed by testosterone.

Changes can be noticed as early as age 10, peaking by 13 or 14. The breasts can be sore, which ibuprofen can reduce. There should not be any discharge. The lump should be right under the nipple, and the nipple should not have any changes in texture. Universally, the young men are relieved to hear that 90 percent of cases resolve themselves within three years of onset.

For those with persistence, there may be other associated abnormalities of hormone balance that should be investigated; for some, the tissue simply doesn't go away, and they can seek surgical care to remove it.

It is important to note a difference between pubertal gynecomastia and pseudogynecomastia, which is the result of fat deposits in the chest of individuals who are obese — the mainstay of treatment for that condition is diet and exercise.

So you can reassure your adolescent boys that it is normal to develop some breast tissue during puberty, that it almost always goes away, and that while they may feel self-conscious about it, most of their peers are likely to have some as well, so not to worry. ♦

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