help /advice

[worriedmum]

hi ,
    im looking for some ,help and  or advice.....
i have a sixteen year old son ho has had gynecomastia since the age of 12-13 ,this was only confirmed two weeks ago when we went to see a pedatrician at our local hospital,we had seen ourg.p numerous times befoe this and we were told it was part of puperty and may sort its self out which it hasnt .
We seen the ped who was quite happy to refer my son to a plastic surgeon,he also did some bloods.
He called last week saying there his levels were off and that he needed further tests which were started last week ,he had a canula had base bloods done then was injected with a hormmone and had bloods taken at 10,20  and 60 mins after and then had an injection intio his thigh before we left  and had to go back three days later for one other blood test.....can anyone help me with what our ped is looking for and what questions I should be asking
thanks in advance P

[phantom]

Hello worriedmum

First of all, it's fantastic to see a mother that is taking this problem seriously.  As you may have read on this forum, very often gynaecomastia is a hidden condition that many men live  with and never tell anyone in fear of rejection or dismissal from family and friends.  Your son is a lucky young man.

Conversely, gynaecomastia is not the end of the world, far from it.  Breast tissue in men is very, very common.  Around 60% of all adult men have some degree of breast tissue.  For most, it's not a problem visibly.  For others it can be visible but is still not a problem.  For others, even the slightest breast shape or protruding nipple can have a devastating impact.  It's all relative.  From my own experience, the more educated everyone is about it and more 'normalised' the issues surround it are, the less psychological impact it will have on not only the man that has it, but those around him!

So what questions should you be asking?  Your son is currently going through some blood tests.  What they will be looking for is a number of hormones and check there levels to see if they are in the normal range.  The main hormone they will be looking at is testosterone to see if it is within the normal range.  As you will know, hormones can be very erratic during puberty which is why you have been told that things may normalise as your son comes through into full adulthood, which may not be until he is around the age of 21

You say that the paediatrician said his hormones were 'off'.  What does this mean?  Ask him or her which of his hormones are affected, if they are likely to normalise or if it is a chronic condition (hypogonadism - or low testosterone).

Personally I am surprised that the paediatrician would be happy to refer to a plastic surgeon.  It is unusual for males to be surgically treated at such a young age.  Most of the time, doctors prefer to wait until the end of puberty.  But each patient is very different from the next.  I don't know your son's personal circumstances or the extent of his gynaecomastia.  It would be worth asking your pediatrician what the likelihood of your son's gynaecomastia going on its own accord is rather than go through the trauma of the surgical route.

If your son is indicated for surgery, do you intend to go via the NHS?  If so, find out who that surgeon is.  Will it be a general surgeon, a breast surgeon or a plastic surgeon?  Does this surgeon have significant experience in sculpting male chests?  Male breast surgery is very different from female breast surgery.

Once you have progressed to the next stage - ie. surgery is definitely indicated and you are due to meet with the surgeon, it might be an idea to come back to this forum and ask "What should I be asking the surgeon?"

You probably still have a load of questions or feel you have a knowledge gap.  Feel free to post on here as much as you need.  Comb  through the Gynaecomastia Talk and Diaries sections of this forum and you will come across posts by other concerned parents (though those topics tend to be far and few between).

Hope that helps.

[worriedmum]

Hi Phantom,
      I wouldnt have it any other way ,Im here for my kids no matter what ,I like to think they can come to me what ever the problem .
My son has ben depressed about this problem for a long time tears and all.He wont take his top off in front of any one,wont go swimming and has recently we have noticed started rounding his sholders to kep his t-shirts off his chest so as not to emphasize.
His gyne is quite noticeable,he is hypersensative about baggy clothes.
To be honest I havent seen the ped since the first visit when he said he would reffer my son to a plastic surgeon and took some bloods,two weeks later I got a phone call saying there were levels that were to low that he had set up these other tests and would see us once the results were in which should be next Friday-ish,as untill he had these  he couldnt quite say what  was up..
Before the first blood results came back the ped did tell us that he thought  the gyne wouldnt go on its own whether that will change now Im not sure.
He will be treated on the NHS we are in Scotland.I have had experiance of surgeons with another of my children,so have a rough idea what i will be asking him /her.
Once i get these test results back I will have a better idea of what we are dealing with and which questions to be asking...
I have to add that my son is 16 his voice has broken,he has hair ect where it should be bits and pieces to me have grown as they should...mind you thats only as a mum seing the naked body fly into the shower.
many thanks for your reply
       P

[orrible]

"has recently we have noticed started rounding his sholders to kep his t-shirts off his chest so as not to emphasize.
His gyne is quite noticeable,he is hypersensative about baggy clothes."

Whilst your son is waiting  for answers before he can proceed with surgery, you could try and make his life easier with clothing. The Nike Compression vests they sell in Soccerworld are good at compressing the chest, and in a small work excellent as an undershirt. If he wore these under his baggies he might not be so self concious. Not ideal but in the short term might help him a little.

[worriedmum]

thanks for the advice Stonecold,off on holiday for a week so we shall look ovt for one of these vests.
Hope to come home to results from blood work .
take care all thanks for support
         P

[orrible]

No problem, just seen this new thread with similar issues, http://www.gynecomastia.org/cgi-bin/gyne_yabb/YaBB.cgi?board=1;action=display;num=1151369515

it shows what can be achived via compression. Anyway good luck and i hope you have a nice holiday.

[PupBitch]

Hi Worried Mum
I have been promted by your message to post a message myself for the first time as I have found myself at a similar postiton to you.  
My son is approaching 16 but I first noticed the problem when he was about 12/13.   I asked my GP to refer him for tests, which he did without even seeing him.      He went through a battery of blood tests, had endocrine levels tested, pubertal monitoring, even testicle size measured for growth over a number of months.  He has even had  a chromosome count to rule out Klienfelters syndrome.  All tests were carried out at our local childrens hospital.  Every test returned a normal result.
At this point I asked that he be refered to a surgeon to see what could be done.
The Surgeon was seen in Nov 2003, he was wonderful and treated my son with great sensitivity.  He would have booked him in for surgery there and then but asked my son to  go away and lose a little weight for a better result.  
So to the present,  My son is  a little lighter and taller by 5 inches and YES........he is booked in for surgery on tues 18/07/06 and I cant wait.  I never thought that I would look forward so much to him "going under the knife".  If he has to go thru this for his life to start then bring it on.  I cannot stand seeing him with a jacket on (even in this hot weather) with his shoulders hunched over, walking with a stoop (he is 5'11) no swimming and I know he is desperate for a girlfriend but he will not even contemplate it.  I will not need to mention the teasing he gets and the persecution that is Tuesday (school changing room for sport).
I shall keep you posted on his progress.  This site has been fantastic source of info for me and even my son realises that he is not a freak and not alone.
Good luck    

[parminder]

how comes your son is having the surgery so soon? don't you normally have to wait until 18 to see if it goes naturally?

[worriedmum]

Hi  all ,
       back from holiday  to a letter to see a surgeon on the 15th August  ,and still no blood results.I have called a few times for them as we will not be making a decision about surgery untill we have these and know more about my sons condition.
I hope all goes well for your son next week ,keep in touch and let us know how things go.
parminder,im not so sure how doc's,surgeons ect decide who and when they get this surgery .Personaly our g.p did not reffer my son to a ped until he was over sixteen,the ped decided that in my sons case surgery would benifit him now as it was having such a negative impact on his life....mabe they all have there own criteria.
take care all
P

[worriedmum]

hI ..........well we got all but one blood result back and everything is showing as normal levels of hormmones.....My son is a bit relieved to say the least .
He will be going ahead with his surgery after we see this surgeon depending on his past history which I will question...any Ideas on what I/we should be asking
              thanks P

[phantom]

Things to ask your surgeon - and this list is NOT exhaustive.

Which procedure will he be doing?  Via the areola or remotely via an incision near the armpit?  What is his reason for his chosen method?

How many cases of correction of gynaecomastia does he do a year?  How many has he done in total?

What emphasis will the surgeon put on liposuction of fat and excision of glandular (breast) tissue?  Reading this forum, some surgeons do not focus on breast tissue.  This often leads to a poor result.  It seems that those that aim to be aggressive with glandular tissue have more pleasing results.

Does the surgeon have any before and after photos of HIS (or her) past patients to help manage your expectation of an end result?

What is the recovery procedure, such as use of compression garments.

At which point in time should you return for final assessment to decide if revision is indicated or not?

Hope that helps.

[worriedmum]

many thanks phantom..I have written these questions down so we dont forget what we are asking about on the day of the appointment .........
     thanks for help and advice
                 P