son's concern

My 16 year old son asked me to take him to a doctor for Tamoxifen. He had been researching the internet as he had a concern about gynecomastia (sp)?  He is very unhappy with what her perceives as enlarged male breasts and nipples.  They have always looked puffy however my husband and his father also look this way.  he is not overweight and he lifts weights and participates in other sports.  He says other kids have commented on his "man boobs".  His health is fine otherwise except for food allergies (epi-pen ordered), mild asthma etc.  He has a hand tremor which was found to be an essential tremor.  He did have partial complex seizures when he was younger but has outgrown them.  Should I seek evaluation/treatment for this?

[Deanna L Aftab Guy, MD]

I would suggest firstly that he sees an endocrinologist. I agree he is probably very unhappy, my male patients are very affected and we try hard to help them.
Let talk about gynecomastia.
Gynecomastia-this is more than likely benign proliferation of the breast tissue, in a young peripubertal male the basic mechanisms of gynecomastia include a decrease in androgen (male hormone)production, an increase in estrogen (female hormone)production
We look for evidence of  hyperprolactinemia (elevated prolactin from the brain) from possible microadenoma or central precocious puberty, excessive estrogen production from estrogen producing tumor such as germ cell tumors of the testes which would lead to excessive estrogen production, aromatase (the enzyme that helps convert estrogen and testosterone back and forth) abnormality, exposure to externally related hormones, influence from alcohol or other drugs
Also there may be genetic reasons like rare but important Klinefelter's.
The most common though and reassuring but annoying reason is peripubertal (meaning that related to the time around puberty) gynecomastia.
I have had little success with estrogen blockers like tamoxifen especially with most of my boys who do not have measureably elevated estrogen. Honestly if it does not resolve after 2-3 years I often refer the boys to a plastic surgeon who I trust. He is very comfortable with this and tries to talk about surgical options and even arranges for the surgery to be around summer months so no one at school realizes that they are out for anything.
The surgical approaches are getting very minimal, either via the axillary area, around the nipple or even from under the chest area.
Removal of the tissue is curative unless the patient is not through puberty yet and some tissue is remaining that can still grow but this is very unlikely. Workup should start with a pediatric endocrinologist, labs and a discussion about his options based on his exam and workup.