The Role of Cannabis in Recurrent Adolescent Gynecomastia

Gynecomastia is a common condition affecting adolescent males, and recurrence following surgical excision is not uncommon. Cannabis has been proposed as a potential endocrine system disruptor, though its role in gynecomastia or its recurrence remains unclear. We present a case series of 3 adolescent males who underwent initial excision for gynecomastia, reported postoperative cannabis use, and developed recurrence requiring secondary surgery. All patients had normal baseline endocrine evaluations and varied in body mass index, disease severity, and laterality. Recurrence occurred despite stable or decreased body weight. Secondary surgical management was successful, with no further recurrence at 1-year follow-up, and patients discontinued cannabis use. While causality cannot be established, these cases highlight a potential association between cannabis use and recurrent male breast glandular proliferation. Clinicians should consider counseling patients on modifiable risk factors, including substance use. Further prospective studies are needed to better define this relationship and its underlying mechanisms.