FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ENLARGED BREASTS COMMON IN TEENAGE BOYS GO AWAY ON THEIR OWN

Question: My 15-year-old son -- 5 feet 10 inches tall, 125 pounds -- wants treatment or surgery for his large breast buds. He is ashamed to take off his shirt in public. What type of physician specializes in concerns of this nature?
Answer: Breast development in males, called gynecomastia in doctor lingo, can be either a normal phenomenon or a signal of disease. It depends on the timing and what other symptoms may also be present.

Male breast development is due to an excess of the female hormone estrogen compared to male hormones, most noticeably testosterone. The normal ratio of testosterone to estrogens in the blood circulation of a male is about 300 to 1. If the relative amount of estrogen increases -- either as a result of too much estrogen or not enough testosterone -- gynecomastia can result.

There are three times in a male's development when we commonly see breast development. First is in the newborn. This is due to estrogen from the mother. This is seen in male and female newborns and may also be associated with milk discharge. The folk name for this is "witch's milk." It usually goes away a few weeks after birth.

The second time that a male may have enlarged breasts as part of his normal development is during puberty. This benign gynecomastia of adolescence is commonly seen in mid to late adolescence. Frequently, it is one-sided or unequal and is associated with breast tenderness. In one to two years this condition subsides and goes away on its own.

A man approaching his “senior years” is in the third time period where "normal" breast development can occur. Most common after age 65, gynecomastia at that time is usually due to the decreasing amount of males hormones that are being produced in the man’s testicles.

Male breast enlargement can run in families and is a genetic trait carried on the X chromosome. This “genetic form” of gynecomastia causes breast development during puberty in males and has no other known consequences.

Certain medications can also cause breast enlargement in men. This includes chemotherapy and some blood pressure medications. Illicit drugs such as marijuana, methadone, heroin and the anabolic steroids some unwisely use for body building can be at the root of male breast enlargement.

There are some medical conditions that can cause gynecomastia. These include hyperthyroidism, renal failure, some malignancies and hormone secreting tumors. While the odds are that none of these is what is wrong with your son, I’d recommend that you take him to your family physician just to make sure. If he or she finds that your son is developing as an otherwise healthy male, you’ll be reassured that there is nothing to be concerned about. In the rare event that your family doctor suspects something more is going on, your son will probably be referred to a pediatric endocrinologist.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.