Special treatment for teens at SFGH: 'Man boobs'

File photo: The San Fernando General Hospital.
File photo: The San Fernando General Hospital.

SAN FERNANDO General Hospital (SFGH) is making strides in treating excessive sex hormones, testosterone and oestrogen among boys and girls, which has caused them embarrassing growth.

Over the past weeks there has been a lot of focus on the high levels of testosterone in female athletes, specifically double Olympic gold medallist Caster Semenya. An excess of this male sex hormone has enhanced her masculine features to the extent that she has a competitive advantage over other female athletes. She has been compelled by the court to take suppressants to lower the testosterone levels if she wants to continue competing.

While the hormonal imbalance causes women to look more manly, right here in TT, doctors have been treating boys with lower testosterone levels or low T, which has caused them to grow “man boobs.”

Chief Medical Officer Dr Roshan Parasram said this condition, known as gynaecomastia, can be caused by a number of factors, including an imbalance between the sex hormones testosterone and oestrogen. He explained that while all men produce some oestrogen, they usually have higher levels of testosterone. In some cases, where the oestrogen level is higher, it can cause a male’s breasts to grow. It is more common among older men and boys during puberty.

Although the incidence of boys with enlarged breasts is not prevalent, at the SFGH doctors saw the need to deal with this medical problem through an adolescent clinic started last August.

At the South West Regional Health Authority (SWRHA) public board meeting last month, director of health Dr Albert Persaud lauded the strides the clinic –the only one in TT, he said – has made since its inception. He said the clinic has been treating boys with breasts and girls who are starting to menstruate earlier or later than the norm.

Asked about a link to the consumption of fast foods and obesity, Persaud said this is a theory that has always existed.

“We do know that within the food industry there is talk, for example, of chicken being injected with steroids to make them grow faster. If that is true, then eating a lot of food injected with steroids could possibly be responsible. But that would be a small percentage.”

On obesity, he said there is a distinction between fat and excess breast tissue.

Gynaecomastia "is a worldwide illness, if you want to call it that. It isn’t specific or peculiar to San Fernando or Trinidad. It is a hormonal problem.”

He said what happens with boys is that when the hormones are competing in the puberty years, the female hormones become a little more dominant, causing the enlargement of the breasts. Persaud said usually the boy child would grow out of it as the male hormones reach the required concentration level.

“Most of the time the breast recedes. We have a small percentage we operate on and remove the excess breast tissues.

"In the females, when young ladies have an excess of hormones it can result in an early period or late, when the hormones sort of matures late.”

He said the hospital sees "about one or two boys, per month where the growth of the breast is so excessive that we do a simple operation to remove excess breast tissue. Because you know, a boy who has breasts is not going to go down to Maracas beach and take off his jersey. It is embarrassing.”

He said the tissue does not grow back once removed, because , “as the boys grow older, the hormones would have settled down and the proportion of the female to the male hormones would have corrected itself and the boys would be normal after that.”

Talking about the evolution of the adolescent clinic at SFGH, Persaud said the idea came about while treating patients at the paediatric clinic for diabetes, when teens came in with hormonal problems

“We realised diabetes in the teenagers needed special attention. What started with diabetes – which is primarily a hormonal problem – escalated when they came for diabetes treatment, but were discussing other problems at the same time. These young people with hormonal problems were being dealt with in the usual way at the children’s paediatric clinic. We started separating the teenagers because their treatment was slightly different from children under ten and adults.

“Our region (SWRHA) is the only one in the country at the moment that deals specifically with adolescents, although adolescent clinics have become a speciality because of problems peculiar to teenagers.”

Thought the clinic started off with just a few adolescents, he said, "and I thought it would have grown slowly, it is heavily subscribed, because young people now have an outlet where they can speak out about a range of subjects with people who are trained to deal specifically with their issues.”

The adolescent clinic now covers a wide range of topics such as the physical and emotional changes teens go through, relationships, sexuality and mental health, among other areas of development.

He recalled one of the doctors attached to the clinic recently went to a high school in the district to give a 35-40 minutes lecture.

“After that lecture was finished, he was assailed by all of these young ladies who have problems. He spent about two hours taking questions and explaining the changes and emotions they are experiencing.

“Whereas before we would have dismissed some behaviours as normal and accepted it as being consistent with that age group – even mental-health issues we would have chalked up as expressions of their teenage years – we now know that many of them have concerns that need to be addressed. We now know that the pressures teenager experience are more than what they were a couple decades ago.”

Persaud said the clinic has a dedicated staff, consisting of mainly house officers.

“It many countries adolescent medicine is becoming a speciality of its own, and since we started this clinic at SFGH, many of the young graduates have expressed an interest in it, so I would not be surprised within the next five to ten years you are going to see a lot of them specialising in that field.”

Dr Persad said there is a special staff dedicated to that clinic, consisting of mainly house officers.

“It many countries adolescent medicine is becoming a speciality of its own, and since we started this clinic at SFGH many of the young graduates have expressed an interest in it, so I would not be surprised within the next five to 10 years you are going to see a lot of them (young doctors) specialising in that field.”

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