Case Report: Gynecomastia in a transgender male

Abstract: Objectives To describe a 17 year old transgender male who experienced breast development while on testosterone, having been suppressed with an GnRH agonist prior to testosterone therapy. Case report A 17 year old transgender male presented with breast development after having been on GnRH agonist and then testosterone since the age of 11, having never experienced breast development before, consistent with pubertal gynecomastia. A small decrease in testosterone dose resulted in significant reduction of gynecomastia. Despite the improvement, he still went on to have chest surgery with removal of breast tissue. Discussion Pubertal gynecomastia is a common phenomenon in the cisgender male population. However, it has not been described in transgender males previously. Potential mechanisms for its occurrence are discussed. Conclusion Transgender males who undergo GnRH agonist treatment for puberty suppression, and subsequently go on to testosterone for puberty induction may develop gynecomastia. Judicious adjustment of testosterone therapy may lead to improvement.