Key Points

• Gynecomastia (occurring in 40%– 65% of male teenagers) is a frequent concern of boys who may find their breast development embarrassing or worry that there is something wrong with them. Unilateral or bilateral gynecomastia is common in middle puberty, affecting up to 70% of boys.
• Other health conditions related to male growth and development are not uncommon, can be quite distressing, and might not be identified until adolescence.

Early and delayed pubertal timing, including short stature, can result in negative consequences for the developing male. Consequences can include higher mean levels of aggression and delinquency. Earlier-maturing boys might have more frequent involvement in risk-taking behaviors, and later-maturing boys might have lower levels of confidence and self-efficacy and increased experiences of teasing, bullying, mental health issues, and substance abuse.^{1,2 ,3} Even a common issue such as acne, which affects 95% of male adolescents,⁴ can be related to self-reported embarrassment, lower self-esteem, depression and anxiety.^{5 (a cited in6)}

Gynecomastia (occurring in 40%– 65% of male teenagers⁷ is a frequent concern of boys who may find their breast development embarrassing or worry that there is something wrong with them. Unilateral or bilateral gynecomastia is common in middle puberty, affecting up to 70% of boys. It is usually mild, less than 3 cm to 4 cm. It is rarely related to underlying conditions such as testicular neoplasms, Klinefelter’s syndrome, medications or drug use (anabolic steroids or heavy marijuana use). Boys can be reassured that most of their friends also have or will have the same condition, and that it will resolve in one to two years without intervention. In obese boys, the condition may be worsened by pseudogynecomastia.^{8 (as cited in 9)}

Health conditions related to male growth and development are not uncommon, can be quite distressing, and might not be identified until adolescence. The frequencies of more common disorders are 1 in 500 to 700 for Klinefelter syndrome; 1 in 1000 to 4000 for fragile X syndrome; 1 in 5000 to 10 000 for Marfan syndrome; and 1 in 8000 to 10 000 for Kallman syndrome.^{10,11 ,12} Other non–STI-related male genital issues that occur during adolescence include, testicular torsion (8.6 per 100 000 males 10 –19 years of age), varicocele (10% of males), and testicular cancer (3.1 in 100 000 males 15–19 years of age).¹³

Voiding dysfunction is a broad term use to describe a voiding (urination) pattern that is abnormal for the child's age. The voiding dysfunction nocturnal enuresis (also known as bedwetting) can occur when an adolescent male cannot control his urination at night. This problem begins to be considered abnormal after the age of five.  Diurnal enuresis, or daytime wetting, can consist of either small urine leaks that spot or dampen underwear to the complete soaking of undergarments. Wetting occurs more commonly in the afternoon, as most children are anxious about wetting in school and work hard to stay dry. Giggle incontinence is the complete emptying of the bladder that occurs with vigorous laughter or giggling. Urge syndrome is frequent attacks of the need to void (at least seven times a day) countered by hold maneuvers, such as squatting. Urine loss is mild, represented by a dampening of undergarments. There are many treatment options. Referral to a urologist should be considered.¹⁴

Lower Urinary Tract Symptoms (LUTS) can also occur in males over 19 years of age, although it is uncommon in younger males.  LUTS) are storage, voiding and postmicturition symptoms affecting the lower urinary tract. LUTS can significantly reduce men's quality of life and may point to serious pathology of the urogenital tract.¹⁵ Prevailing guidelines suggest that the pathogenesis of LUTS is multifactorial and can include one or several diagnoses, commonly benign prostatic obstruction, nocturnal polynocturia and detrusor muscle instability.¹⁶