Do you remember being in your teens? Stuck between a kid and an adult?

UGH, who wants to remember? Probably the most awkward time of life ever. I'm pretty sure I had orange and blue braces (the colors of my summer camp), my first haircut with "layers" (disaster two weeks later), a Dolphin toe ring (really), and many more awkward things I choose to pretend did not happen.

Now, imagine Seth's experience. Not only does he have a voice that cracks, but he unfortunately suffers from the condition of gynecomastia—Or in Seth's words, he's got boobs. As a thirteen-year-old guy. The fact that his father also had them as a kid does not prevent other teenage boys from hanging bras on Seth's locker. Or calling him "Man-boobs." Or "Double D."

No wonder he wants to start over in high school. Boob-less.

What is gynecomastia and why do some boys (and adult men) have it?

Gynecomastia is swelling of the breast tissue in boys or men, usually caused by an imbalance of the hormones estrogen and testosterone. It can occur in males of all ages—literally ranging from newborns to the elderly. Gynecomastia is not considered a serious or life-threatening health condition, but it may involve pain and most likely, distress or embarrassment.

In most cases, the individual cause of the enlarged breasts cannot be determined. But when the amount of testosterone decreases compared with estrogen, a hormone imbalance ensues. Factors that disrupt this balance include natural hormone changes, medications, and certain health conditions.

Many male infants are born with enlarged breasts due to the exposure of their mother's estrogen. Typically, the swollen tissue will return to normal size within two to three weeks after birth. During puberty, many boys experience hormone changes, leading to gynecomastia. Doctors advise waiting six months to two years to see if the enlarged breasts shrink before beginning treatment. And frequently, gynecomastia may appear again in men between the ages of fifty and eighty.

What health conditions are associated with gynecomastia?

- Aging

- Kidney failure

- Liver failure (cirrhosis)

- Malnutrition and starvation

- Tumors (Involving the testes, adrenal glands, pituitary gland)

- Hypogonadism

- Hyperthyroidism

What medications and drugs may lead to it?

- Anti-anxiety medications such as diazepam (Valium)

- Anti-androgens used to treat prostrate enlargement or cancer (Such as cyproterone, flutamide, finasteride, spironolactone)

- Tricyclic antidepressants

- AIDS medications (Especially for patients on the highly active antiretroviral therapy and Efavirenz)

- Heart medications (Such as digitalis and calcium channel blockers)

- Antibiotics

- Ulcer medications (cimetidine)

- Cancer treatment (Chemotherapy)

Substances that have been linked with gynecomastia include:

- Marijuana

- Alcohol

- Heroin

- Anabolic steroids and androgens

- Amphetamines

How is it treated?

Sometimes, gynecomastia fades away on its own. For example, when the majority of affected boys finish puberty, often the excess tissue will shrink or even disappear. But some patients, like Seth, do not show improvement after several years and need further treatment. First, doctors will most likely review the patients' medications to rule out as the primary cause of the hormone imbalance. Then, other medications may be offered as relief. Tamoxifen and raloxifene, usually prescribed to treat breast cancer, have been helpful to some patients (Note: Though approved by the FDA for the treatment of breast cancer, they are not officially approved for the use of treating gynecomastia).

Other solutions include surgery. Doctors may advise liposuction to remove the breast fat, but not the breast gland tissue itself. Note, there is a difference between glandular tissue and fatty tissue. The fatty tissue surrounds the breast glands, extending throughout the breast; the glandular tissue is organized in lobes that are connected to the nipple by ducts. The other surgical option may be a mastectomy in which doctors do remove the breast gland tissue endoscopically.

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