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Q: My son is 14 years old and has developed "breast buds" -- hard knots under his nipples. The first one arrived in February, and the second one developed in April. Our pediatrician has told us that they are normal for boys developing. How long will he have these? They bother him so much he can't lay flat on his stomach at times. He has heard horror stories from other boys about having them cut out. Is there anything that we can do to make them go away or ease the discomfort?
A: Breast development during puberty occurs in about 70 percent of boys to some degree. The medical term for this is gynecomastia. It can be very minimal or quite marked, and it usually occurs on both sides but can sometimes occur just on one side. It is most apparent in boys whose puberty is progressing rapidly.
It occurs because of a transient imbalance between how much estrogen and testosterone the body produces. It generally doesn't require any type of hormonal treatment, however, and will gradually go away on its own. Only very rarely does anyone need surgery to remove the breasts. It can take a while to go away though. For most boys it lasts less than a year, but occasionally lasts for 2 to 3 years.
As you described, the breast buds can be rather sensitive and tender to touch. It is helpful to wear loose fitting undershirts, and avoid anything tight, or that puts any pressure on the nipples. He will likely need to avoid lying flat on his stomach for a while There really isn't much you can do to make them go away sooner. Boys do tend to tease each other about it, and this can be embarassing for some children. It's important to reassure boys about this, and give them some emotional support.
If a child seems to have significant emotional disturbances because of the gynecomastia, if he has other medical or endocrine problems, or if it lasts longer than 2 years, then further medical evaluation may be indicated, and you should have him revaluated by his pediatrician.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.