Dad, If I Have Manboobs, Do I Have to Wear a Man Bra?

Talking to ‘tweens and teenagers can be a tough job in primary care.  Of course, certain topics are like inviting them to hold your hand crossing the street.  Can we talk about your zits? (eek!)  How often do you get your period? (OMG!) And for a larger number of boys than you might think, nothing tops questions about the finding of gynecomastia (aka manboobs): Have you noticed that plumpness on one of your breasts? (Aw, dude…um, yeah).  It is, quite literally, a tender question.

Fortunately, we can offer most boys a boatload of reassurance.

Fact is, this may or may not be the first time having enlarged breast tissue for many pubescent boys. Most babies (estimates are range up to 70%) of both genders develop transient breast enlargement at birth. Over several weeks, maternal hormones leave the infant’s body, and these pads of tissue often resolve spontaneously. (and, when it doesn’t, we talk)  During newborn exams, I’ll often point this out and explain this to parents.  The sighs of relief can often be heard a few doors down.

Fast forward then, to the life of a young male entering puberty. No doubt, many ask “Why do men have nipples at all?” This is a reasonable question, but is beyond the scope of this post. Testosterone and estradiol are on the rise, and changing levels can affect sensitive areas, such as the glandular tissue of the breast.  Sweet biological irony! Just as kids are carving out their sense of self identity, nature can throw a curveball to about two thirds of boys, with some bout of single- or double-sided gynecomastia. It is most common in early male puberty, around age 10-12 and rarely occurs in boys over 17. What’s more, these pads of fatty tissue behind the nipples can be very tender and sore, which often compounds the boy’s concern.

Just about none of these young bucks are happy about their ‘situation’. Some even, are quite freaked and miserable. Rightly so. I’ve met some kids who never take off their T shirts at the beach on hot summer days out of embarrassment. Others have been teased so mercilessly they cannot talk about it without tearing up. Locker room changing time becomes a circle of hell (more than it might already be). In the world of middle school or high school, this can be agony and we need take it seriously.

When gynecomastia is suspected, the young men and I take a deep breath together, and I’ll attempt to reassure them as much as possible.  I find it best to go right to the bottom line:  that breast enlargement happens to a lot of healthy, young males, that it almost always goes away (within 18 months usually), and that they are not the only guy to whom this happens. It is not cancer. The sighs of relief can often be heard a few doors down.

Of note, other conditions can foster, or mimic gynecomastia. These possibilities have to be considered by the examining health care provider. Obese young men can have deposits of breast fat that may be a result of being overweight, versus a true response to hormonal changes. Other heavy adolescents have both extra breast fatty tissue and breast buds responding to their adipose (fatty) deposits enhancing of the the effect of their body’s naturally occuring estradiol.  Focusing on nutrition and weight loss may be key.

Other factors may be at cause, such as diets rich in soy (those pesky phytoestrogens),  medications and drug use (marijuana, even!), and a longer list of rarer medical conditions may also be associated with gynecomastia.  A boy’s age, pubertal stage, and overall health help guide us to the diagnosis that is a transient, benign process in the majority of cases (from a physiological point of view, anyway).

A tincture of time is what works to resolve this issue for most boys. That may be only some consolation for a boy in the throes of embarrassment and self-consciousness. While waiting the weeks or months for the breast enlargement to disappear, I counsel parents to remain supportive, to help the adolescent avoid most difficult situations when possible, and categorically to avoid even lighthearted or vaguely teasing remarks.  On the plus side, many kids don’t notice, or care. Others, though, as in so many things ‘tween and teen, feel their self-consciousness keenly. It is the distinct minority of cases where these problems arise from something more complicated, or need a medical or surgical treatment. Still, if concerned or if not getting better, I urge families to check back in if needed.

Until then, I’ll keep busy making other 10-18 year olds squirm in their seats asking about their boogers, their bowel movements, and if they hold their parents hand crossing the street. If folks have ideas on how they dealt with it—well or otherwise—I invite you to share.

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