Life is funny, and sometimes you don’t see something for a while and then you see a ton of it. Recently I have seen young men come in with gynecomastia. Being a teenage boy is hard enough. Having to cover your chest because you are self conscious and feel like you have breasts? No one needs that.
First, what is gynecomastia? “gyne” = female, “mastia” = breasts.
What causes it? True gynecomastia is actual breast tissue. It is thought to be due to the ratio of estrogen to androgens. During puberty, which starts around 10-12 years old, there are some cases of temporary gynecomastia, where there is breast enlargement for up to 18 months. This can autocorrect as testosterone increases later in puberty.
Other potential causes of true gynecomastia:
- tumors (can increase prolactin level in blood, decrease hormone production.)
- klinefelter syndrome (hypogondaism, gynecomastia, higher breast cancer risk)
- brain issue, where there is decreased production of lueteinizing hormone, which leads to decreased hormone production
- medications, which can increase estrogen levels, mimic estrogen, or decrease testosterone
To diagnose: You need to show there is breast tissue. To do this you need a good physical exam to evaluate whether it is fat, breast tissue, or both. You should be at your ideal body weight. They will look at development of the boy body parts (penis, testes, pubic and underarm hair). Mammogram can be done as well. Ultrasound can be done to look for other issues like adrenal gland or testes issues.
Labwork: Tests for aspartate transaminase and alanine transaminase (liver disease), creatinine (kidney disease), thyroid stimulating hormone (to look for thyroid disease), and other tests such as estradiol, serum testosterone, leuteinizing hormone, and FSH.
To treat true gynecomastia, you need to cut out the breast tissue. You cannot do liposuction alone; liposuction is good for treating fat only. The usual surgery for this is to make a small cut at the areola, remove the breast tissue, and then do liposuction as well to smooth out the contours.
To see if insurance will cover the surgery, see my next blog on the subject. Insurance companies need proof there is breast tissue, and have other parameters which need to be met, such as proving there are no medicines or other issues causing the breast development.
What is not true gynecomastia? Fat. Many cases we see of breasts in boys and men are simply due to fat deposits in the area, and are not true breast tissue. To treat this, we simply need to do liposuction. This tends not to be covered by insurance.