Gynecomastia in Adolescent Boys: Causes, Course, and Treatment

Gynecomastia (male breast tissue enlargement) affects up to 60% of boys during puberty.

Cause

Transient estrogen-testosterone imbalance: rising testosterone drives masculinization, but a relative estrogen increase stimulates breast tissue.

Natural Course

• Usually resolves spontaneously within 1–3 years as androgens dominate.
• Reassurance and monitoring are often sufficient.

When Treatment Is Needed

• Persistent >2–3 years, severe enlargement, pain, psychological distress.
• Medical: SERMs (tamoxifen, raloxifene) or aromatase inhibitors (off-label).
• Surgical: Subcutaneous mastectomy for refractory cases.

Consult a pediatric endocrinologist if concerned. Most cases are temporary and benign.