BACKGROUND: For a population of adolescents, gynecomastia is a persistent problem. Occurring during a critical period in the formation of self-image and gender identity, this gender-incongruent process may disrupt normal psychological development. This study was designed to identify the prevalence of psychological disturbances in young male patients presenting with symptomatic gynecomastia to determine whether psychological examination should be included as a routine portion of this patient population's treatment. METHODS: From 2002 to 2009, patients aged between 10 and 18 presenting to our institution for idiopathic adolescent gynecomastia were recruited to participate in a retrospective cohort study. All patients underwent psychological interviews conducted by the same clinical psychologist (C.W.) and were examined using the following metrics: the Children's Depression Inventory, the Multidimensional Anxiety Scale for Children, and the Child Behavior Checklist. All patient scores were compared against population norms. RESULTS: Twenty-four patients between the ages of 12 and 18 were observed. Compared with the general population, measures of anxiety, depression, and social phobia were significantly elevated in patients with gynecomastia; 100 percent of patients with gynecomastia received a Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis. CONCLUSIONS: Idiopathic adolescent gynecomastia is a psychological threat to normal self-esteem and sexual identity. Patients presenting with this condition likely suffer an adjustment disorder subsequent to this anatomic stressor. Surgeons should strongly consider referring their patients with gynecomastia for psychological evaluation and treatment as an adjunct to successful surgical management of this condition. Future studies examining the postoperative effects on psychological health both with and without psychological treatment will be of great interest to treating physicians.
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