Psychosocial Adjustment of Two Boys With Gynecomastia

Gynecomastia is a benign condition in males, characterized by proliferation of glandular elements resulting in concentric enlargement of one or both breasts. Although this condition typically resolves by age 18 years when adult androgen/estrogen ratios are achieved, it has been documented that boys experience significant psychosocial distress related to their perceptions about their appearance and internalization of others’ negative reactions1,2. Indeed, the extant literature examining the psychosocial adjustment of boys with gynecomastia is quite sparse, consisting of single case reports that do not incorporate psychometrically sound measures of adjustment3,4. As such, we report quantitative data on the psychosocial adjustment of two boys seen consecutively in our Pediatric Endocrinology service. Patient A was 15-years-old, of Caucasian ethnicity, and resided with both parents. Patient B was 17-years-old, of Caucasian ethnicity, and resided with both parents and a younger brother. During their regularly scheduled clinic appointment, both boys completed the following well-validated self-report questionnaires in their clinic room: Children's Depression Inventory5, Social Anxiety Scale for Children − Revised6, and Asher Loneliness Scale. Their mothers completed the Child Behavior Checklist8, a parent-rated index that provides ratings of child externalizing and internalizing symptoms. As compared to same age peers, both boys reported significantly elevated levels of depressive symptomatology (T scores = 88 and 85). Patient B reported elevated feelings of loneliness (T score = 67), whereas patient A reported moderately elevated social anxiety (T score = 64). Although parent ratings of patient A did not indicate any clinical problems, patient B's mother reported evidence of significantly elevated externalizing and internalizing problems (T scores = 69 and 67). Regarding the discordance of the ratings of patient A and his mother, it is relevant to note that it is not uncommon for parents to be unaware of internalizing symptoms in their children9. Our data are noteworthy in that they suggest that some boys with gynecomastia may experience elevated levels of psychopathology. As such, it is imperative that clinicians working with these children should be trained regarding identifying psychological distress. On this end, conducting a rapid assessment of adjustment in clinical settings seems warranted. One brief and cost-effective manner of accomplishing this would be to include measures of psychological functioning as a standard component of the clinical visit. Child and parent report questionnaires, such as those used in this report are sound examples of possible assessment measures. In addition, although some recommend supportive reassurance to assist the youth in coping with their condition1, these cases provide preliminary evidence that more focused clinical intervention may be necessary for some. However, further study in larger samples is needed to document if rates of psychosocial maladjustment in this population differ from normative samples. Author Note: This study was supported by grants awarded to Dr Storch from the Human Growth Foundation and University of Florida Center for Pediatric and Family Psychology.