Minor breast development common in boys during early teens
Thirteen years old and showing signs of early breast development. Was my teenage patient pleased to reach this stage of maturity? Actually, I have to say that the athletic boy was more than a little mortified by this new and unwelcome body change.
I could see that the young man was envisioning a future as the only member of his high school football team requiring a support bra, so I quickly assured him that quite a number of perfectly normal boys develop a small amount of breast tissue during puberty. The teen seemed relieved to hear that his breast budding was temporary, and that, in time, he was sure to see the return of his manly flat-chested physique.
In their 2007 review of breast development, University of Miami endocrinologists Drs. Stavros Diamantopoulos and Yong Bao explain that about 60 percent of adolescent boys experience this self-limited period of male breast enlargement or gynecomastia.
Gynecomastia usually begins in early to mid-puberty, typically peaking in 13- to 14-year-old boys - the mid-pubertal age group - and fading away within two years of starting. The authors note that gynecomastia occurs more often and tends to last longer in obese males than in their more slender peers.
Most cases of breast enlargement in young males fall under this category of normal or physiological gynecomastia, and can therefore be followed by simple observation. Diamantopoulos and Bao recommend further medical work-up for boys who don't fit the usual clinical picture in terms of timing of the breast development or size of the resulting breast tissue.
Many infant boys have a small amount of breast tissue that persists for the first few months of life, accompanied in some cases by an early milky nipple discharge or galactorrhea. This neonatal breast enlargement is considered a classic example of physiological gynecomastia.
The Miami endocrinologists suspect abnormal or pathological gynecomastia in young males who show the first sign of developing breast tissue beyond this newborn period. That is, anytime after three months of age, but before the onset of puberty.
Young male patients with features of rapidly expanding breast size, breast diameter larger than four centimeters, or nipple discharge occurring outside of the neonatal age group, also require medical investigation and referral to an endocrinologist.
Hormone-secreting tumors, liver and thyroid disease, and chromosomal abnormalities are among the recognized causes of abnormal male breast development. Use of certain prescription medications, anabolic steroids, several drugs of abuse - alcohol, marijuana, amphetamines and heroin - as well as some estrogen-containing cosmetics is also associated with the development of pathologic gynecomastia.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.