What is Prepubertal Gynecomastia?

What is Prepubertal Gynecomastia?

/ Post by Josh Harwell

You likely already know what gynecomastia is—the enlargement of breast tissue in males throughout various stages in their life. That said, when dealing with enlarged breast tissue or this particular condition in children or pubescent boys, there are definitely some questions that need to be answered. Thus, to help you understand what prepubertal gynecomastia is, here is a quick overview of this condition and what it really means to be coping with gynecomastia in childhood. 

Gynecomastia in Children 

Pre pubertal gynecomastia or gynecomastia in children occurs for a variety of reasons. Typically, with this condition, you see enlarged breast tissue or a tender 5 cm to 15 cm mass located just underneath the nipple area or areola during the onset of puberty. If the mass is moveable, there is no need for further tests. However, if the breast tissue mass is large, fixed, or causes a discharge, then pediatricians will do a comprehensive physical examination. Overall symptoms and signs of gynecomastia include swollen breast tissue, possible fatty development around the nipples, breast tenderness, pain, and possible nipple discharge. Usually, gynecomastia in boys resolves itself in 6 months to two years. One breast might be more affected than the other as well (prepubertal unilateral gynecomastia). 

How Common is Gynecomastia in Prepubertal Boys? 

For young boys who are going through puberty, gynecomastia is very common. In fact, more than half of all adolescent males will develop this condition. That said, gynecomastia is more prevalent in male infants than it is in boys who have yet to go through puberty. Of course, that is not to say that this condition does not affect younger children or those who have yet to go through puberty. Rather, this condition tends to present itself at particular stages in a male’s life. Furthermore, some breast enlargement is fairly normal while boys are going through puberty, though it can be embarrassing and upsetting for most children. Moreover, boys who are overweight are more likely to develop gynecomastia. 

Cause of Prepubertal Gynecomastia 

As briefly mentioned, this condition is likely to occur during puberty due to the fluctuation in a child’s hormones. While in puberty, the balance between a boy’s testosterone and small quantities of estrogen can be upset. To make matters worse, boys that are overweight tend to have estrogen containing fat cells, adding to the likelihood of bilateral gynecomastia.  

Types and Grades 

Generally, when speaking about types and grades of gynecomastia, it is in reference to older men and teens. That said, there are two types—true gynecomastia and pseudogynecomastia. The first is due to the enlargement of the glands below the nipple or areola, and the second is due to fat accumulation. In terms of various grades of gynecomastia, you will find four different categories. Grade One refers to mild enlargement with a concentration behind the areola, and Grade Two means that breast growth is spreading beyond the areola with edges that blend with the chest wall. With Grade Three and Grade Four, there is breast growth extending beyond the areola, with clear boundaries and redundant skin (Grade 3) and marked bilateral breast enlargement with redundant skin and feminization (Grade 4). 

Differential Diagnoses  

A differential diagnosis looks at the possible disorders that could be causing your symptoms. Thus, in addition to being diagnosed with prepubertal gynecomastia, your child’s doctor should be looking for possible underlying causes, including Klinefelter syndrome, testicular feminization, hormone-secreting tumors, hyperthyroidism, and hypothyroidism. Other disorders that may be causing your child’s condition are Cirrhosis, drug use, family history, and obesity. 

How Boys With Prepubertal Cope  

Prepubertal gynecomastia often goes away as puberty progresses within six months to two years. In addition to letting nature take its course, if the breast development is due to an increase in fatty tissue, then losing some weight may help. There are available medications, which affect the hormones. However, none have been approved as being both effective and safe. Usually, reassurance that their condition is a normal part of puberty and it is only temporary is enough for most boys. There are also available compression garments your child can wear to feel more comfortable with their appearance until the condition resolves. 

Are there long-term complications with prepubertal gynecomastia?

Are There Long-term Complications?

There are no real long-term complications to one’s health with this condition, especially if it is not due to any differential diagnoses but rather just puberty. Often, your child will experience some discomfort, and his condition will likely be a source of distress. Moreover, though there can be psychological issues from embarrassment or bullying from other kids, it is important to understand that this condition occurs in nearly half of pubescent boys or adolescents. Thus, it is less likely that your child will be bullied because of his situation when other boys are dealing with the same issues. Consequently, other than some embarrassment and short-lived discomfort, your child should be able to deal with prepubertal gynecomastia and go on with his life without giving it too much of a second thought in adulthood. 


Unfortunately, there is a small percentage of adolescents whose gynecomastia does not go away on its own, which in that case, the only effective treatment is likely surgery. However, your pediatrician and any cosmetic surgeon will likely urge that the procedure wait until growth and puberty have been completed. If you and your child are considering medications that block estrogen and increase testosterone levels, you should speak with your child’s doctor before taking any hormone blockers, especially during puberty. 

Take Away 

As you can see, gynecomastia in a prepubertal boy is not too different than gynecomastia in men. Nonetheless, this condition is more likely to go away on its own or with time. That said, you should still push for your child to see a doctor to ensure that there are no other underlying disorders causing this condition. Finally, if your child is struggling with their condition, then you should consult with his pediatrician and consider having your child speak with a professional therapist/counselor.

You have successfully subscribed!