• Gynecomastia is common in newborn boys, affecting 60-90% of them. This happens because they are exposed to their mother’s hormones during pregnancy.
• This breast enlargement is usually temporary and resolves on its own within 4-8 weeks after birth, though in some cases, it can last up to 12 months.
• The breast development may be uneven, and about 5% of newborns might even produce some milk (a condition known as galactorrhea).

• During early to mid-puberty, up to 70% of boys experience some degree of breast tissue growth under the nipple.
• It’s most common around age 14, especially during Tanner stages 3-4 of puberty when testicles grow to a certain size.
• The condition can affect one or both breasts, and it’s not unusual for them to grow at different rates. The breasts might be tender, but this usually goes away.
• Most cases of pubertal gynecomastia resolve on their own within a few months to two years.
• This condition can cause significant stress, especially in boys who are overweight or have larger breasts.

Causes: 

• The exact cause is believed to be a temporary imbalance between estrogen and testosterone in the breast tissue. 
• Some boys may also have a slight sensitivity to estrogen or mild resistance to androgens (male hormones).

• Rare Genetic Causes: 
  • In very rare cases, gynecomastia can run in families due to genetic mutations.
  • These cases are often inherited and can lead to an increased conversion of male hormones to estrogen.
• Exposure to Estrogens: 
  • Gynecomastia can also be caused by exposure to external sources of estrogen, such as certain medications, hormonal treatments, or even substances like lavender oil, tea tree oil, or soy.
• Medication-Related Gynecomastia: 
  • Certain medications can cause gynecomastia by lowering androgen levels, increasing estrogen levels, or interfering with how androgens work in the body.
  • Drugs like spironolactone, anabolic steroids, and some cancer treatments are common culprits.
• Associated Conditions:
  • Klinefelter Syndrome: 
    • A genetic condition affecting males, where about 50% of adolescents with this syndrome develop gynecomastia.
  • Other Hormonal Disorders: 
    • Conditions like partial androgen insensitivity, thyroid problems, and certain adrenal or testicular tumors can also cause gynecomastia.
  • Nutritional Issues: 
    • Gynecomastia can occur in malnourished individuals when they start eating normally again (refeeding syndrome), likely due to changes in liver function or hormonal balance.

Diagnosing gynecomastia typically involves a physical exam and a review of the patient’s medical history.

• History and Physical Exam: 
  • In most pubertal cases, a detailed medical history and a physical exam are enough to rule out rare, more serious causes. A family history especially in male relatives is enquired. 
  • history of liver or kidney disease.
  • medications, drugs, or herbal products that the child may be using, as these could contribute to gynecomastia.
  • Cosmetic Products: Be aware of exposure to products that may contain plant-based estrogens (phytoestrogens), such as certain herbal or cosmetic products.
  • Breast Examination: 
    • The doctor will carefully examine the breasts, looking for any skin changes, lumps that feel stuck in place, swollen lymph nodes, or any nipple discharge.
  • Testicular Exam: 
    • A testicular exam will also be performed to check for any abnormalities.

• Recommended Tests
  • In typical pubertal gynecomastia without any other concerning signs, no lab tests are usually necessary.
  • For prepubertal boys or pubertal boys with unusual or worrisome symptoms, further testing is needed.
    • Thyroid Function Tests: To rule out hyperthyroidism, which can cause gynecomastia.
    • Hormone Levels: Tests for testosterone, estradiol (a form of estrogen), human chorionic gonadotropin (HCG), luteinizing hormone (LH), and prolactin levels may be conducted.
    • Prolactin Levels: High prolactin levels are often associated with milk production (galactorrhea), but sometimes it can cause gynecomastia without this symptom.

• Additional Tests: When Necessary
  • Karyotype Test: This may be done if hormone levels suggest Klinefelter syndrome, a genetic condition that can cause gynecomastia.

• Other Tests: In some cases, the doctor may also check levels of dehydroepiandrosterone sulfate (DHEA-S), and liver and kidney function tests may be ordered to rule out other causes.

The treatment for gynecomastia depends on the underlying cause, the severity of the symptoms, and how much it is affecting the child. Here’s an overview of the treatment options:

• Observation and Reassurance:
  •  In many cases, especially when gynecomastia occurs during puberty, no treatment is necessary. The condition often resolves on its own within a few months to a couple of years. Reassurance and regular monitoring by a healthcare professional are usually all that’s needed.

• Medical Treatment Options
  • Treatment is more effective in the early stages (less than 12 months), but it’s often not necessary since most cases resolve on their own.

• Surgical Options: 
  • Surgery might be recommended if:
    • The breast enlargement is significant
    • It causes significant psychological distress.
    • It doesn’t improve after 18-24 months.
    • The boy has completed or nearly completed puberty.

At Gertrude’s Children’s Hospital, we are committed to providing the best possible care for children with Gynecomastia. Here’s why families trust us:

If you’re concerned about your child’s development or if they’re showing signs of gynecomastia, our team at Gertrude’s Children’s Hospital is here to help. We provide compassionate, expert care tailored to your child’s needs.

Don’t wait—schedule a consultation with one of our specialists today to ensure your child receives the best possible care. We’re here to answer your questions and guide you every step of the way.