title: The social context for psychological distress from iatrogenic gynecomastia with suggestions for its management.
abstract: BACKGROUND
  Gynecomastia (breast development in males) is a side effect of androgen deprivation therapy (ADT) for prostate cancer (PCa). Medical interventions to prevent or treat gynecomastia carry risk of additional detrimental side effects. However, untreated gynecomastia can be physically uncomfortable and psychologically distressing. Shame from gynecomastia can lead patients to stop otherwise beneficial exercise.
  
  
  OBJECTIVE
  Our first aim is to explore the social context for gynecomastia and how it is interpreted by men with the condition, as well as by others, both male and female. Subsequently, we use our understanding of why gynecomastia is psychologically distressing to propose psychosocial interventions that could help men accept this side effect of ADT.
  
  
  METHODS
  We draw on academic literature, media accounts, and web-based testimonials from men with gynecomastia, to understand how gynecomastia is perceived by both patients and the medical community. We examine these resources in light of gynecomastia's impact on sex roles, sexuality, and gender identity issues.
  
  
  METHODS
  By exploring what breasts in a male mean to the individual, we produce an understanding of the social context for distress from gynecomastia. From this understanding, we derive hypotheses about who might be most distressed from gynecomastia and strategies for alleviating this distress.
  
  
  RESULTS
  The shame and stigma of gynecomastia is linked to the objectification of women. We suggest that men fear that their breasts will marginalize and subordinate them within gender hierarchies. There is little evidence that breasts on a male erotically attract either men or women. Novel options for living with gynecomastia are contrasted with medicalized strategies including mastectomy.
  
  
  CONCLUSIONS
  Assessment instruments need to be developed to identify patients most likely to experience distress from gynecomastia and seek out medical interventions. Surgical, radiological, or pharmacological interventions may not be universally necessary if greater acceptance of gynecomastia is made available through psychosocial support programs. For example, PCa patients may learn to accept gynecomastia through reconceptualizing their breasts as autoerotic. Support programs modeled on those of the breast cancer community, including Encore and dragon boat racing, may also help to build communities to serve patients with gynecomastia while defending individuals against shame, isolation, and loss of self-esteem.
authors.affiliation: Dalhousie University-Anatomy & Neurobiology, Halifax, Nova Scotia, Canada;. Electronic address: tadpole@dal.ca.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wassersug
authors.affiliation: University of British Columbia-School of Nursing, Vancouver, Canada.
authors.forename: John L
authors.initials: JL
authors.lastname: Oliffe
mesh_terms: D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005783:Gender Identity; D006177:Gynecomastia / Q000453:epidemiology / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008408:Mastectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D011584:Psychology; D012649:Self Concept; D012725:Sexual Behavior / Q000523:psychology; D012752:Shame; D012931:Social Environment; D012934:Social Isolation; D012944:Social Support; D013240:Stereotyping
chemical_list: D000726:Androgen Antagonists