The social context for psychological distress from iatrogenic gynecomastia with suggestions for its management

Wassersug, Richard J. and Oliffe, John L. (2009) The social context for psychological distress from iatrogenic gynecomastia with suggestions for its management. Journal of Sexual Medicine, 6 4: 989-1000. doi:10.1111/j.1743-6109.2008.01053.x

Author Wassersug, Richard J.
Oliffe, John L.
Title The social context for psychological distress from iatrogenic gynecomastia with suggestions for its management
Journal name Journal of Sexual Medicine   Check publisher's open access policy
ISSN 1743-6109
Publication date 2009-04
Sub-type Article (original research)
DOI 10.1111/j.1743-6109.2008.01053.x
Open Access Status
Volume 6
Issue 4
Start page 989
End page 1000
Total pages 12
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell
Language eng
Formatted abstract
Introduction: 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.

Aims: 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.

Main Outcome Measures: 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.

Conclusion: 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.
Keyword Gynecomastia
Prostate cancer
Psychosocial oncology
Sexuality and cancer
Support groups
Treatment alternatives
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Link to Journal Article:

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
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Citation counts: TR Web of Science Citation Count  Cited 23 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 28 times in Scopus Article | Citations
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Created: Tue, 05 Aug 2014, 13:38:01 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work