Hormonal, anthropometric and lipid factors associated with idiopathic pubertal gynecomastia

BACKGROUND AND OBJECTIVES: To determine factors associated with pubertal gynecomastia. DESIGN AND SETTINGS: A cross-sectional study among healthy male school children and adolescents in Riyadh, Saudi Arabia. METHODS: Subjects were selected from diverse socioeconomic backgrounds. Tanner stage, height, weight, blood hormonal levels (leutilizing hormone [LH], follicle-stimulating hormone [FSH], total testosterone, and estradiol), and anthropometric and lipid parameters (body mass index [BMI], triglycerides, high-density lipoprotein [HDL], and low-density lipoprotein [LDL]), were collected and compared in children with and without gynecomastia. RESULTS: The study included 542 children and adolescents. Median (interquartile range) age in the whole group was 11(8–13) years. The prevalence of gynecomastia was 185/542 (34%), with a peak at age 14. The 2 groups compared had nonsignificant difference in cholesterol (P=.331), LH (P=.215) and FSH (P=.571) levels. Those with gynecomastia were significantly older, had lower gonad stage, had higher anthropometric (height, weight, and BMI), and lipid (triglycerides, HDL, and LDL) values. In multivariate regression analysis, factors significantly associated with gynecomastia were BMI (odds ratio [OR]=1.05; 95%CI 1.00–1.10; P=.013), HDL (OR=0.42; 95%CI 0.19–0.92; P=.03), and gonad (Stage II OR=2.23; 95%CI 1.27–3.92; P=.005, Stage III OR=6.40; 95%CI 2.70–15.0; P<.0001, Stage IV OR=3.24; 95%CI 1.32–7.95; P=.01, Stage V OR=1.37; 95%CI 0.52–3.56; P=.53, compared with stage I). CONCLUSION: Pubertal gynecomastia tends to increase in mid-puberty. In our setting, BMI, HDL, and gonad stage were the major factors associated with the development of pubertal gynecomastia.