Although population studies have shown that the prevalence of pubertal gynecomastia varies widely, most have indicated that 30% to 60% of pubertal boys exhibit gynecomastia, which usually begins 10 to 12 years of age. The highest prevalence age group is usually 13-14 years of age (Harris, 2004 p. 76). Other causes of gynecomastia include the use of some medications such as prescription hormones, and the use of anabolic steroids or marijuana. The condition is Gynecomastia is not physically harmful to man’s death, but it can produce self-consciousness and self-doubt.
Gynecomastia is not always the result of obesity or lack of fitness (Gerber & Kuechel, 2005 p. 129). Usually, this condition is associated in Klinefelter syndrome, tumors of the adrenal gland, nonseminomatous germ cell tumors of the testis or Ectopic HCG-producing tumors. Gynecomastia is usually the first sign of these pathologic conditions most especially if this manifest in outside the range of normal occurrence (Dronkers, 2002 p. 252). Physical Changes – Pathophysiology Several mechanisms have been proposed to account for this disorder.
All involve a relative imbalance between estrogen and androgen concentrations or action at the mammary gland level. Decrease in free testosterone may be due to primary gonadal disease or an increase in SHBG as is found in hyperthyroidism and some forms of liver disease. Decreased androgen action in patients with the androgen insensitivity syndromes result in unopposed estrogen action on the breast glandular tissue. Acute or chronic excessive stimulation of the Leydig cells by pituitary gonadotropins alter the steroidogenic pathways, and favors excessive estrogen and estrogen precursor secretion relative to testosterone production.
This mechanism is one of the possible physiologies that lead to gynecomastia (Greenspan & Gardner, 2004 p. 505). Gynecomastia must be differentiated from pseudogynecomastia, which is breast enlargement as result of fat accumulation rather than an increase in the glandular component. Pubertal gynecomastia complains of pain in the breasts and exhibit tenderness during examination; those with pseudogynecomastia generally do not conjure such signs (Eugster et. al, 2004 p. 355).
The condition of gynecomastia mainly modifies the breast features of males, which creates emotional, mental, social, and psychological impact. Such conditions are sometimes the cause of depression, mental and emotional instability, and identity role confusion. Given that, more than half of adolescent boys experience this condition, and at a developmental stage when concerns about their bodies and relationship with their peers are at a lifetime peak, it is remarkable that so little data are available regarding psychological impact and treatment.