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Overdeveloped Son
Boys Who Grow Breasts: What They Can Do
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Enlarged breasts plague many boys and some older men. An endocrinologist discusses solutions.
Boys Who Grow Breasts: What They Can Do
When Merle Yost was 10, his breasts grew noticeably enlarged. From then on, school could be nightmare. Girls would taunt him by offering their bras, and boys would slap at his chest. Yost eventually underwent breast reduction surgery when he was 33. His condition, called gynecomastia, affects males who have a hormonal imbalance. His situation is hardly unique, but his solution isn't the only one available. This week, the New England Journal of Medicine published an article about treatments for gynecomastia, focusing attention on this common yet rarely discussed condition. U.S. News spoke to the author, Glenn Braunstein, an endocrinologist at Cedars-Sinai Medical Center in Los Angeles.
All males produce some "female" hormone. Sometimes there is an imbalance, and when the imbalance occurs, it produces gynecomastia. Probably about two thirds of boys will develop this. It usually comes toward mid-to-late puberty or at about age 13 or 14. Gynecomastia may cause pain and tenderness when boys put their shirt on and the cloth rubs against the nipple. Another big peak is in older individuals after the age of 50.
In boys, it usually lasts for three to six months or less, and then goes away in the vast majority of cases. About 5 percent will have persistent gynecomastia. If it is particularly distressing or painful, the medication tamoxifen can help. Up to 80 percent of individuals will have some improvement using tamoxifen. If that doesn't help, then a plastic surgeon can remove the extra tissue.
What role does obesity play in gynecomastia?
One of the more common causes of breast enlargement is fat accumulation behind the breast. One study showed a direct correlation between [body mass index] and gynecomastia.
Yes. There are two good reasons to lose weight. First, it may reduce the fat [in the breast]. Second, it can improve cosmetic results if you end up having a plastic surgical procedure.
I have heard that some men intentionally gain weight to avoid the embarrassment of their breasts.
That would be a very silly thing to do. Gynecomastia really is not a disease. It doesn't make sense to take something that is a benign process and risk developing type 2 diabetes, heart problems, eye problems, joint problems, etc.
I imagine the condition can be rather distressing for boys.
If all of a sudden a boy starts getting breast enlargement, they are afraid to take their shirts off in the locker room and may have fears that they're turning into a girl. I give [the patient] a lot of reassurance that he is not turning into a female.
Can gynecomastia be confused with male breast cancer?
One should be able to differentiate gynecomastia from male breast cancer, which accounts for about 1 percent of all breast cancers. Gynecomastia starts out in the nipple and spreads out. Breast cancer is oftentimes not symmetrical. Gynecomastia, in about half the cases, is on both sides, whereas breast cancer is usually on one side. If there is still a concern, one can get a mammogram.
Gynecomastia can be a symptom of certain cancers and problems involving the testis, thyroid gland, liver, or kidneys. Should parents worry that a teen with gynecomastia has an underlying disease?
Parents should be reassured that two thirds of teenagers will develop gynecomastia without any underlying problem. If the child develops it early—at age 5, 6, or 7—there is more of a concern that there is an underlying disease. When it occurs early, then by all means, the parents need to have the child see a pediatrician.
When is breast reduction surgery a good option?
For somebody who is really emotionally distraught and whom medication has not helped, I think surgery is a good solution. A number of different techniques can be used, and the cosmetic results are pretty good. There are risks to the surgery, of course, but of the people who undergo surgery, the majority is pleased with the results.
How long should boys wait before considering surgery?
After a year and a half, if [the gynecomastia] is still there, it's likely to contain scar tissue and is unlikely to go away spontaneously or to respond to medication. So then you can think about surgery. You want to make sure boys are pretty much through puberty. If you remove breast tissue too early, it may grow back.
Should the surgery be covered by insurance?
No. It's usually not covered by insurance because it is considered cosmetic. The costs of healthcare are so high I would rather see those same dollars go towards better immunization of children, better prenatal care of women rather than going to cosmetic surgery.
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The baby boy has now been treated with hormone therapy and his symptoms have decreased
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'Precocious puberty is traumatic for a child of his age and it makes them violent'
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'Precocious puberty is traumatic for a child of his age and it makes them violent'
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A one-year-old boy who developed sexual organs and sexual urges has been diagnosed with a rare hormonal condition.
The infant from Delhi, in India , was found to have a rare hormonal dysfunction known as "precocious puberty" after his family noticed that he was developing pubic and facial hair, as well as the penis the size of an older boy.
He also showed the brain development of a 12-year-old teenager .
Many of his symptoms have since been treated through hormone therapy.
The boy's mother, Shabnam Praveen, said the family had at first noticed he was much taller than other babies his age before becoming increasingly concerned.
"We thought he was just a big baby but later everyone started to point out that this growth couldn't be normal," she told the Deccan Chronicle.
"His penis had grown to that of a man's size and we knew something was wrong."
Precocious puberty in one-year-old infants is thought to affect one in 100,000 toddlers, and one in 10,000 aged between eight and 10. The condition usually causes infants to stop growing after several years and remain about 1 metre tall.
Girls can also develop the condition between the ages of eight to 10.
The child, who also became more muscular as a result of his condition, was brought to Dr Vaishakhi Rustagi, a consulting paediatric endocrinologist at the Max Super Speciality Hospital in Shalimar Bagh.
Whereas at 18 months old he would usually have a testosterone level of 20 nanograms per deciliter (ng/dl), he had one of 500 to 600 ng/dl - the same as a 25-year-old man.
"Since the baby was so young, he could hardly understand the changes taking place in his body. He would experience sexual urges," said Dr Rustagi.
"Precocious puberty is traumatic for a child of his age and it makes them violent. His muscle strength increased to a level that even his parents couldn't control him."
Other age-related developmental conditions include the extremely rare genetic disorder, progeria, which causes the body's cells to age prematurely and often causes the death of its sufferer by 13 years old.
The boy's genital size and other changes have decreased over the past five months since being placed on hormone therapy which requires his family to pay for a hormone dose every month.
The cost is reportedly not being covered by the family's medical insurance.
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Recently, there have been several stories in the news about violence in children and what can—and should—be done about it. A five-year-old boy was taken out of his Kindergarten class in handcuffs in Indiana, and the same thing happened to a six-year-old girl in Louisiana.
Talk shows and the news media have been hosting shows on whether or not a parent should ever call the police on their own child. Everyone seems to have an opinion—usually a strong one—about the “right” way to handle a child or adolescent who is violent toward others, particularly family members. There’s no behavior—with the exception of substance abuse or self-harm—that frightens parents as much as a child’s physical aggression.
Why does anyone become violent? Violence has existed since the beginning of time and is sadly found in so many types of relationships: child abuse, sibling abuse, elder abuse, domestic violence, gang violence, and in crimes of passion or hatred.
The motto of people who are violent to get what they want is, “I’m going to get my way by using force.” Our media constantly reflects violence in our movies, television and video games.
The point is, we live in a violent culture and then wonder why our children sometimes resort to violence. So which came first—the chicken or the egg? Does media promote violence or simply reflect what’s occurring in our world today? And does it really matter which came first?
The fact is, our children are faced with violence—no matter how much we try to protect them—and there are times when they also resort to aggression. Why? For the same reasons that have existed for thousands of years: frustration, anger, power and control.
For some reason, it’s much easier for society to think rationally about how to handle violence between people who aren’t related.
If someone you don’t know assaults you, the police are going to be involved and there are going to be some legal charges. If you punch your boss, you’re going to be charged with assault—count on it! Even if a child is violent toward a peer, if he’s twelve years old or older, it’s possible there will be some legal consequences.
But when it comes to violence in the family—especially if the aggressor is the child or teen—things get emotional and suddenly no one’s sure how to handle it. What do we do?
We go to extremes as a society in our response, arresting five-year-olds on one hand yet blaming parents when a teen is violent on the other hand. Common sense just seems to fly right out the window.
The fact is that many parents of aggressive kids have very likely tried everything they can think of to handle their child’s behavior and just don’t know what else to do. Parents whose children have assaulted them feel hurt, angry, afraid, betrayed and ashamed. They may be afraid to tell anyone—even close friends or family, let alone the police—about what’s going on in the home.
If a parent finally does break down and call the police, they often face a legal system that is itself confused about how to respond to youth violence in the home. One mom we know called the police when her 15-year-old son had shoved her into the wall (after he had punched a few holes in it). The officer stood in her yard, in front of her son, and said, “If you want to beat him, I’ll turn my back. Otherwise there’s nothing I can really do.”
She never called the police for help again.
It took many years for legislation to be passed regarding domestic violence between spouses/partners. For a very long time, police didn’t want to get involved in “domestic fights.”
The same is true about child abuse. But education, advocacy and many, many tragedies led to a change in the way society looked at things: It’s not okay to abuse someone just because you’re married or they’re your child.
But until recently, not much attention has been given to what can be done when a child abuses a parent or sibling. Society tends to discount the behavior: “Well, he’s only twelve. He’s upset. You just need to discipline him.” People often blame the parent as well, holding that parent accountable for the teen’s behavior.
The fact is, your child does not have the right to violate the rights of others, just because he’s upset, angry or frustrated. As James Lehman states, “There’s no excuse for abuse—period.”
The nature of childhood is to be frustrated. From the moment a baby is born, he is frustrated. He will cry and kick to get his needs met. Feed me. Change me. Hold and comfort me. He doesn’t know any other way to communicate so he uses what he’s got – his cry! We expect that.
As children grow, they learn other, more effective ways of getting their needs met—by asking nicely, for example. But some kids have a really difficult time learning those skills, so when they’re frustrated or feeling any negative emotion, they fall back on the instinct to push—literally.
Kids who are Oppositional-Defiant get very upset if they feel a loss of control or are frustrated in any way. Because they don’t have the ability to cope within themselves, they may resort to hitting, pushing or other negative behaviors.
Children with other conditions (such as ADHD, anxiety or a history of trauma), may also fall back on the quickest and easiest way to release pent up energy that’s coursing through them as adrenaline: their instinct is to whack something.
Physical aggression accomplishes several things: it releases that adrenaline and sometimes has other payoffs, such as a temporary feeling of being in control or power. The problem is, this payoff doesn’t last long and the consequences of aggression cause more negative emotions.
It can be difficult for kids—and some adults, for that matter—to understand this, and so a cycle can develop where a child becomes frustrated, lashes out and feels temporary relief until the frustration comes back.
Some adolescents who’ve moved into Conduct Disorder (a pervasive pattern of violating the rights of others) engage in physical aggression to prove they are the “Top Dog” in the home. I control things around here — not you. Don’t even try to put rules on me or this is what’ll happen.
Most kids throw things, yell, scream or hit siblings at some point when they’re angry or frustrated. That’s typical. As a parent, you give a consequence, the child learns this behavior isn’t going to work for her, and you feel that you are in control in your own home. But sometimes, children don’t respond to a parent’s discipline or consequences . If you’ve tried everything you can think of to address your child’s aggressive behavior and you’re considering calling the police, take some time to evaluate the situation:
It can be terrifying when your child is violent toward others, but you do not have to live like a prisoner in your own home. Many parents are experiencing youth violence in the home and you need to know that if things reach the point where you must seek law enforcement support there’s nothing to be ashamed of. It doesn’t mean you have failed as a parent—it means you are trying to help your child become a productive, law-abiding citizen who respects the rights of others.
Kimberly Abraham and Marney Studaker-Cordner are the co-creators of The ODD Lifeline® for parents of Oppositional, Defiant kids, and Life Over the Influence™ , a program that helps families struggling with substance abuse issues (both programs are included in The Total Transformation® Online Package ). Kimberly Abraham, LMSW, has worked with children and families for more than 25 years. She specializes in working with teens with behavioral disorders, and has also raised a child with Oppositional Defiant Disorder. Marney Studaker-Cordner, LMSW, is the mother of four and has been a therapist for 15 years. She works with children and families and has in-depth training in the area of substance abuse. Kim and Marney are also the co-creators of their first children's book, Daisy: The True Story of an Amazing 3-Legged Chinchilla, which teaches the value of embracing differences and was the winner of the 2014 National Indie Excellence Children's Storybook Cover Design Award.
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My 10 year old granddaughter was diagnosed with ODD at 18 months, she now is diagnosed with autism, ODD, ADD, ADHD, General anxiety, major depressive disorder with psychosis and suicidial ideation. She has also tests as extremely gifted.
She can be charming and she can be extremely violent. She is almost 5’ tall and weighs close to 100 lbs.
She has been treated by psychiatrists and therapists (in home and in clinical settings) since she was 4, has been prescribed numerous medications and hospitalized in an in patient psychiatric fa
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