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Brief communication
Submitted: 2021-04-28
Accepted: 2021-07-16
Published online: 2021-07-28
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The causes and psychological impact of gynaecomastia in boys and adolescents

Zdravka P. Todorova1, Elissaveta M. Stefanova1, Ivilin P. Todorov2
DOI: 10.5603/EP.a2021.0070
·
Pubmed: 34378787
Affiliations
  1. Department of Endocrinology, Specialized Hospital for Active Treatment of Paediatric Diseases, Faculty of Medicine, Medical University — Sofia, Sofia, Bulgaria
  2. Department of Cardiothoracic Surgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria

open access

Ahead of print
Short communication
Submitted: 2021-04-28
Accepted: 2021-07-16
Published online: 2021-07-28

Abstract

Introduction: Gynaecomastia (GM) is benign unilateral or bilateral proliferation of the glandular tissue of the breast in males. Its development during adolescence is usually considered a physiological phenomenon and is expected to resolve within months. Sometimes, however, it is due to pathological conditions or diseases, and it is not uncommon for these not to be recognized promptly. The present study aims to investigate the causes of prepubertal and pathological pubertal GM, its association with obesity, the age of appearance, and whether GM has a psychological impact on boys and adolescents admitted to the endocrine department.

Material and methods: A total of 157 boys and adolescents with GM were included in a cross-sectional retrospective study in a single tertiary centre for endocrine diseases. Patients were evaluated by anthropometric measurements, serum hormonal levels, and a questionnaire.

Results: In the period 2009-2018 a total of 157 boys and adolescents were diagnosed with GM (76.43% obese, 3.18% — overweight). Twelve (7.64%, mean age of GM development 7.53 years) were prepubertal, 5.09% with primary or secondary testicular damage, 5.73% with hypogonadotropic hypogonadism, 11.48% with elevated prolactin level, and 110 boys (70.06%) with physiological pubertal GM. A statistically significant difference was found between the age of development of physiological GM — 11.85 years (9.35–16.92) and hypergonadotropic —13.57 years (10–16.25) (p = 0.006) and hypogonadotropic — 12.77 years (10.50–14.0) (p = 0.028) hypogonadism. Onset of pubertal GM in normal-weight boys was 13.13 years, and in obese/overweight it was 11.69 years (p < 0.001). Eighty-four patients (53.5%) expressed having a psychological burden of GM, 12.1% consulted because of its development, in 8.2% it led to cessation of sports, and 2.5 % changed their clothes.

Conclusions: Prepubertal and pubertal GM has a high association with obesity. Excess adipose tissue has an impact on the age of development in both groups. Nearly a quarter of pubertal cases are due to pathological conditions, and those are often diagnosed more than 18 months after the appearance of breasts. Hence, although a greater number of pubertal GMs are physiological, it may be reasonable for adolescents to be evaluated within the first 6 months of breast development so as not to delay the diagnosis of pathologic cases. Additionally, we found that GM has a complex influence on the psychological state of boys and adolescents.

Abstract

Introduction: Gynaecomastia (GM) is benign unilateral or bilateral proliferation of the glandular tissue of the breast in males. Its development during adolescence is usually considered a physiological phenomenon and is expected to resolve within months. Sometimes, however, it is due to pathological conditions or diseases, and it is not uncommon for these not to be recognized promptly. The present study aims to investigate the causes of prepubertal and pathological pubertal GM, its association with obesity, the age of appearance, and whether GM has a psychological impact on boys and adolescents admitted to the endocrine department.

Material and methods: A total of 157 boys and adolescents with GM were included in a cross-sectional retrospective study in a single tertiary centre for endocrine diseases. Patients were evaluated by anthropometric measurements, serum hormonal levels, and a questionnaire.

Results: In the period 2009-2018 a total of 157 boys and adolescents were diagnosed with GM (76.43% obese, 3.18% — overweight). Twelve (7.64%, mean age of GM development 7.53 years) were prepubertal, 5.09% with primary or secondary testicular damage, 5.73% with hypogonadotropic hypogonadism, 11.48% with elevated prolactin level, and 110 boys (70.06%) with physiological pubertal GM. A statistically significant difference was found between the age of development of physiological GM — 11.85 years (9.35–16.92) and hypergonadotropic —13.57 years (10–16.25) (p = 0.006) and hypogonadotropic — 12.77 years (10.50–14.0) (p = 0.028) hypogonadism. Onset of pubertal GM in normal-weight boys was 13.13 years, and in obese/overweight it was 11.69 years (p < 0.001). Eighty-four patients (53.5%) expressed having a psychological burden of GM, 12.1% consulted because of its development, in 8.2% it led to cessation of sports, and 2.5 % changed their clothes.

Conclusions: Prepubertal and pubertal GM has a high association with obesity. Excess adipose tissue has an impact on the age of development in both groups. Nearly a quarter of pubertal cases are due to pathological conditions, and those are often diagnosed more than 18 months after the appearance of breasts. Hence, although a greater number of pubertal GMs are physiological, it may be reasonable for adolescents to be evaluated within the first 6 months of breast development so as not to delay the diagnosis of pathologic cases. Additionally, we found that GM has a complex influence on the psychological state of boys and adolescents.

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Keywords

prepubertal gynaecomastia; adolescent gynaecomastia; pathological gynaecomastia; psychological influence of gynaecomastia

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About this article
Title

The causes and psychological impact of gynaecomastia in boys and adolescents

Journal

Endokrynologia Polska

Issue

Ahead of print

Article type

Brief communication

Published online

2021-07-28

DOI

10.5603/EP.a2021.0070

Pubmed

34378787

Keywords

prepubertal gynaecomastia
adolescent gynaecomastia
pathological gynaecomastia
psychological influence of gynaecomastia

Authors

Zdravka P. Todorova
Elissaveta M. Stefanova
Ivilin P. Todorov

References (4)
  1. Deepinder F, Braunstein GD. Gynecomastia: incidence, causes and treatment. Expert Rev Endocrinol Metab. 2011; 6(5): 723–730.
  2. Carlson HE. Approach to the patient with gynecomastia. J Clin Endocrinol Metab. 2011; 96(1): 15–21.
  3. Rahmani S, Turton P, Shaaban A, et al. Overview of gynecomastia in the modern era and the Leeds Gynaecomastia Investigation algorithm. Breast J. 2011; 17(3): 246–255.
  4. Rivera NF, Eisenstein E, Cardoso CB. [The relation between pubertal gynecomastia and body mass index in a sample of adolescents attended at the Outpatient Health Unit of a University Hospital]. Arq Bras Endocrinol Metabol. 2009; 53(4): 435–439.

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